The size of the follicle is 33 mm, is ovulation possible? How the follicle grows and develops: phases of the process, sizes by day of the cycle until ovulation. Internal processes of follicle evolution

For every woman of childbearing age, it is very important to know the state of health of her internal organs, especially, such as the ovaries. This is not accidental, because it is on them that a woman's ability to have children depends. Consider the main parameters and indicators that the ovaries of a healthy woman should have.

Only women are endowed with ovaries by nature, which is associated with the function of childbearing. The ovaries are a special type of female, where the complete formation, development and maturation of the eggs takes place. Every woman has in her body two paired ovaries located in. By location, the paired ovaries occupy a position on the sides of the uterus, due to which they become quite distinguishable during an ultrasound examination of the body. If, due to some circumstances, the detection of one of the two ovaries becomes inaccessible, the doctor focuses on the region of the iliac vein. Thus, under any circumstances related to the state of health of a woman, the ovaries are clearly distinguishable in her body.

In a healthy woman, the shape of the ovary is somewhat flattened, but it is quite mobile and visible during examination. The flattened shape indicates their healthy condition. The size of the right and left ovaries varies and this is the norm. This is especially noticeable in the fair sex, who are in reproductive age. At the same time, they fully perform the functions assigned to them.

The size of the female ovary is affected by its age characteristics, the number of pregnancies with childbirth, the stages of menstruation and methods of preventing unwanted pregnancy by using oral contraceptives.

The size of one ovary relative to the other can vary and fluctuate significantly.

Features of the ovaries:

• In the internal structure of the ovary, two layers are distinguished: cortical and cerebral. Both layers are clearly distinguishable upon detailed examination through special magnifying devices.
• Outside, each ovary is covered with a special layer of the albumen.
• The outer or cortical layer of the ovary is characterized by the presence of follicles of different maturity.These follicles are represented by two main varieties: primary immature, they are also called primordial and mature, also referred to as preovulatory. All types of follicles perform certain functions in the female body.

With the help of ultrasound examination, specialists can detect changes occurring in their structural structure, including those of a negative nature. Usually such procedures are carried out during the first week of menstruation. Conducting this type of study, experts pay great attention to the volumetric indicators of each ovary. After all, the state of health of each ovary depends on their numbers, and the type of a particular pathology in the body is determined.

Dimensions of the ovaries of a healthy woman

In a healthy woman, the size of the ovaries is in the following ranges:

• The volume is from 4 to 10 cubic centimeters
• Width varies from 18 to 30 mm
• The thickness is in the range from 16 to 22 millimeters
• Length occupies the limit from 20 to 37 millimeters

For a more detailed examination of the internal structure, the anatomy of the ovaries is examined taking into account the phases of menstruation. In a woman in the early follicular phase, which falls out from the fifth to the seventh day of the menstrual cycle, an ultrasound examination shows a protein capsule with ten follicles located on the periphery, measuring up to six millimeters. Already in the middle follicular stage, which falls on the tenth menstrual day, we can clearly distinguish the dominant follicle, reaching a size of fifteen millimeters. This follicle does not end its development on this, but continues to develop further. Smaller follicular cells nearby finish developing in the female body. This happens even if they have scored in the order of ten millimeters.

At the late follicular stage, which falls on the fourteenth menstrual day, there is a period of active growth of the dominant follicle.

Sometimes the growth process of this follicle becomes so active that the increase occurs by several millimeters daily. When an actively growing follicle becomes equal in size to eighteen millimeters, doctors ascertain the speedy process of ovulation in the body. This usually happens when the follicle reaches eighteen millimeters in size. At the same time, the ongoing changes in the structure of its internal and external structure become noticeable.

In addition to the follicular stage, the luteal phases play a special role:

• So in the early luteal phase, which falls on the fifteenth day, a corpus luteum is formed in the female body. Its dimensions range from fifteen to twenty millimeters. All this happens in the position of ovulation.
• With the onset of the middle luteal stage in the female body, an active and rapid growth of the corpus luteum begins. Usually, this process falls into phase on the twentieth day of the menstrual cycle. The corpus luteum grows, acquiring dimensional indicators ranging from 25 to 27 millimeters.
• Then the late luteal phase begins, ending on the twenty-seventh day. During its period, the process of reducing the corpus luteum and its slow extinction is clearly manifested. It becomes similar to a ten-millimeter object. As soon as a woman begins menstruation, the fading corpus luteum completely disappears.

If a period begins in the female body, a period of activity begins for the corpus luteum, lasting up to almost two weeks. At the same time, progesterone is actively synthesized in the female body. At this stage, the release of a new egg is completed.

Useful information from the video about inflammation of the ovaries.

With pregnancy, there is a marked increase in the size of the ovaries.This is observed in all women in this position. The reason for this increase is the active blood flow that carries blood to these organs. Pregnancy is also associated with a change in their position, compared with the original. The change in the position of the ovaries goes towards the upper part of the small pelvis. This is facilitated by the uterus increasing in this position.

With the onset of the postmenopausal stage in the fair sex, there is a noticeable reduction in the size of both ovaries.

They even become equal in volume. In this case, the dimensions of the ovaries will be as follows: the volume is from 1.5 to 4 cubic centimeters, the width varies from 12 to 15 millimeters, they occupy a limit of 20 to 25 millimeters in length, and thickness - from 9 to 12 millimeters. Such dimensional indicators are considered the norm for a healthy woman.

If the doctor found a difference in the volumetric parameters of the ovaries of the female body, exceeding the figure of one and a half cubic centimeters, or one of the ovaries is almost twice as large as the other, then the woman develops a pathology. In such cases, appropriate tests are immediately prescribed for an accurate diagnosis, and treatment begins.

One of the most common types of pathological changes in the structural structure of the ovaries is the appearance of formations in them, referred to as a cyst. A cyst on the ovary is the formation of a small vesicle that is filled with fluid. This vesicle can form both on the surface of the body of the ovary, and in its thickness. The resulting cyst can have different sizes. They vary in the range from millimeter to centimeter indicators.

If the ovarian cyst is of considerable size, then it is easy to detect it during an ultrasound examination of the woman's ovaries.

The cause of the occurrence of cysts on the ovaries is the functional activity of the data. Often this pathology does not pose a big threat to the health and life of a woman, but there are cases when a cyst that has appeared is a symptom of the development of a serious disease in the body. To dispel all doubts about the cyst that is forming, the woman is sent to the hospital for a complete examination and delivery of the necessary ones. If the cyst carries signs of a pathological nature, then the woman is prescribed special treatment.

Every month in the body of a healthy woman occursthe formation of one cyst that differs in size from other vesicles:

• The cyst occurs in the ovary and becomes clearly distinguishable among the rest of the follicles. It is called the dominant or Graf's follicle.
• This type of follicle contains in its structure an egg cell immersed in a special liquid and at the stage of its maturation.
• The follicle containing it has a significant size - from 25 to 28 millimeters. Therefore, it stands out more than others.
• As soon as the menstrual cycle approaches its middle, the dominant vesicle ruptures, and the female sex cell present in its composition is released. This cell goes directly into the cavity of the fallopian tube.
• At this time, this egg can be fertilized. Conception is associated with the development of a new life in the female body.

In the place where the dominant follicle has burst, the “yellow body” referred to in medical language is formed. The corpus luteum is considered to be a small compaction of a part of the ovary in the center of which lies a small vesicle. During this period, there is an active production of hormones, due to which the maintenance of a developing pregnancy is promoted.

Sometimes the dominant vesicle filled with liquid in the structural structure of the ovary does not burst, but rather continues to grow actively.

The volume of liquid inside it also increases. Such a bubble is considered a follicular cyst. In medical practice, even such cases are known and described when the corpus luteum also becomes a formation that is very reminiscent of a cyst. In other words, the formation of cysts on the ovaries occurs during their normal functioning in the body of a healthy woman.

Another fairly common type of ovarian pathology is the formation of a cancerous tumor on them. In the first stages of the appearance of this pathology, it does not betray itself at all and is almost invisible. This helps the disease to spread without much resistance of the body. Of all women with cancer, only a third were diagnosed with its development in the early stages. In other cases, the disease did not manifest itself practically in any way. Typically, ovarian cancers become noticeable when the disease progresses to advanced stages. In order not to start this disease in the body, women should periodically check their internal organs, especially the ovaries, because their ability to become mothers depends on them.

The growth of the follicle and the subsequent ovulation of the mature egg in it are key processes that ensure the readiness of the female reproductive system for conception. Violation of this natural mechanism is one of the most common causes of infertility. And all IVF programs include a stage of stimulation of follicle growth to induce hyperovulation.

Depending on the protocol used, it is performed on the biological mother or on the egg donor. At the same time, folliculometry is required to track the number of maturing follicles, their size and readiness for ovulation.

A bit of theory

Follicles are called special formations in the ovaries, consisting of an oocyte of the 1st order (an immature egg) and several layers of special cells surrounding it. They are the main structural formations of the female gonads, performing endocrine and reproductive functions.

Follicles are laid in utero. They are based on oogonia - primary germinal germ cells that migrate to the germinal ovary at about 6 weeks of gestation. After meiotic division and proliferation, these precursors form first-order oocytes. These immature germ cells are covered with cuboidal epithelium and form the so-called primordial follicles. They will remain in a dormant state until the onset of the sexual development of the girl.

Subsequently, primordial follicles are successively transformed into preantral, antral, and preovulatory follicles. This process is called folliculogenesis. Normally, it ends with ovulation - the release of a mature and ready for fertilization egg. In place of the follicle, an endocrine-active corpus luteum is formed.

At the onset of conception, it is stored under the action of chorionic gonadotropin. The progesterone produced by them contributes to the prolongation of pregnancy. In all other cases, the corpus luteum is reduced, which occurs before menstruation. The accompanying sharp drop in progesterone levels provokes the onset of menstruation with rejection of the overgrown glandular (functional) layer of the endometrium.

A situation is possible when a mature follicle does not ovulate. At the same time, it can continue to increase in size, transforming into a reduced egg. Such formations can be single and gradually absorbable. But sometimes cysts persist for a long time, deforming the surface of the organ. In this case, one speaks of . Such a diagnosis is prognostically unfavorable for conception, it is usually accompanied by persistent dyshormonal disorders and infertility.

How many follicles are in the ovaries?

Not all ovarian follicles initially laid in utero are preserved by the time of puberty and subsequently develop. About 2/3 of them die and resolve. This natural process is called apoptosis or atresia. It begins immediately after the laying of the gonads and continues throughout life. A girl is born with approximately 1-2 million primordial follicles. By the beginning of puberty, their average number is 270-500 thousand. And during the entire reproductive period, only about 300-500 follicles ovulate in a woman.

The sum of all follicles capable of further development is called the ovarian reserve. It determines the duration of the woman's reproductive period and the onset, the number of productive (flowing with ovulation) menstrual cycles and, in general, the ability to re-conceive.

The process of progressive depletion of the ovarian reserve in the ovaries is noted on average after 37-38 years. This means not only a decrease in a woman's ability to naturally conceive, but also the beginning of a natural decrease in the level of basic sex hormones. The cessation of the development of follicles in the ovaries means the onset of menopause. It can be natural, early and iatrogenic.

Graafian bubble formation phase

The amount of follicular fluid progressively increases, it pushes the entire epithelium and the egg to the periphery. The follicle grows rapidly and begins to protrude through the outer shell of the ovary. The egg in it is located on the periphery on the so-called egg-bearing mound. Approximately 2 days before ovulation, the amount of secreted estrogen increases significantly. This feedback triggers the release of luteinizing hormone from the pituitary gland, which triggers the ovulation process. A local protrusion (stigma) appears on the surface of the Graafian vesicle. This is where the follicle ovulates (ruptures).

As a result of ovulation, the egg, ready for fertilization, leaves the ovary and enters the abdominal cavity. Here she is captured by the villi of the fallopian tubes and continues her natural migration towards the spermatozoa.

How is the “correctness” of folliculogenesis assessed?

The stages of folliculogenesis have a clear relationship with the days of the ovarian-menstrual cycle. Moreover, they do not depend on the age and race of the woman, but on her endocrine status.

The growth and development of the follicle is primarily regulated by the follicle-stimulating hormone of the pituitary gland. It begins to be produced only with the onset of puberty. At a certain stage, folliculogenesis is additionally controlled by sex hormones, which are produced by the cells of the wall of the developing follicle itself.

Any hormonal imbalance can disrupt the process of maturation and ovulation of the egg. At the same time, determining the level of hormones does not always provide the doctor with all the necessary information, although it allows you to identify key endocrine disorders. Therefore, the diagnosis of violations of the folliculogenesis process is the most important stage in the examination of a woman at the stage of pregnancy planning and in identifying the cause of infertility.

At the same time, the doctor is interested in how large the follicle grows and whether it reaches the stage of the Graafian vesicle. Be sure to monitor whether ovulation occurs and whether a corpus luteum of sufficient size is formed. In anovulatory cycles, the maximum size of developing follicles is determined.

An accessible, informative and at the same time technically simple method is. This is called monitoring the maturation of follicles using ultrasound. It is performed on an outpatient basis and does not require any special preparation of the woman. Folliculometry is a dynamic study. Several repeated ultrasound sessions are required to reliably monitor changes occurring in the ovaries.

In the process of folliculometry, the specialist determines the number, location and diameter of maturing follicles, monitors the formation of a dominant vesicle, and determines the size of the follicle before ovulation. Based on these data, you can predict the most favorable day of the cycle to get pregnant naturally.

With IVF protocols, such monitoring allows you to evaluate the response to ongoing hormonal therapy, set a date for the introduction of drugs to stimulate ovulation and subsequent puncture egg retrieval. The key parameter of folliculometry is the size of the follicle by day of the cycle.

Norms of folliculogenesis

Folliculometry is performed on certain days of the cycle, corresponding to the key stages of folliculogenesis. The data obtained during repeated studies are compared with the average statistical norms. What size of the follicle should be on different days of the ovarian-menstrual cycle? What fluctuations are considered acceptable?

Normal follicle size on different days of the cycle for a woman aged 30 years with a 28-day cycle, not taking oral contraceptives and not receiving treatment with hormonal stimulation of ovulation:

• On days 1-4 of the cycle, several antral follicles are found, each of which does not exceed 4 mm in diameter. They can be located in one or both ovaries. Their number depends on the age of the woman and her ovarian reserve. The norm is if in both ovaries a total of no more than 9 antral follicles mature simultaneously.
• On the 5th day of the cycle, antral follicles reach a size of 5-6 mm. Their development is quite uniform, but already at this stage atresia of some vesicles is possible.
• On the 7th day, the dominant follicle is determined, its size is on average 9-10 mm. It is he who begins to actively develop. The remaining bubbles will gradually decrease, while they can be determined in the ovaries and during ovulation.
• On the 8th day of the cycle, the size of the dominant follicle reaches 12 mm.
• On day 9, the bubble grows to 14 mm. It clearly defines the follicular cavity.
• Day 10 - the size reaches 16 mm. The remaining bubbles continue to decrease.
• On day 11, the follicle increases to 18 mm.
• Day 12 - the size continues to grow due to the follicular cavity and reaches 20 mm.
• Day 13 - Graafian vesicle with a diameter of 22 mm (this is the minimum size of the follicle for ovulation in the natural cycle). On one of its poles, a stigma is visible.
• Day 14 - ovulation. Usually the follicle bursts when it reaches 24 mm in diameter.

Deviations from these normative indicators in the direction of decrease are prognostically unfavorable. But when evaluating the results of folliculometry, the duration of the woman's natural cycle should be taken into account. Sometimes early ovulation occurs. In this case, the follicle reaches the required size for 8-12 days of the cycle.

IVF follicle size

With IVF protocols, ovulation is drug-induced and pre-planned.

On different days of the menstrual cycle, the follicles have a certain size, as they mature, they increase, and before menstruation they break, releasing the sex cell. Knowing about the change in the diameter of the follicular tissue is important, as it helps to calculate the period of ovulation, as well as determine the parameters of the health of the woman's reproductive system. What is the size of the follicle on the days of the cycle and why can it stop growing?

The "rudimentary" sex cells are laid in the body of every girl even before her birth, there are about 8-10 thousand of them inside the ovaries. But initially, such rudiments are not yet ready for fertilization, because they must go through several successive divisions for maturation. To protect the egg during its growth and transformation, several layers of epidermal tissue grow around it - this is the follicle, which resembles an epithelial cocoon.

Follicular tissue is under the influence of the endocrine system, its increase and development is regulated by the hormones of the ovaries themselves, as well as the pituitary gland, an indirect effect is observed from the adrenal glands. For example, FSH (follicle-stimulating hormone) stimulates the maturation of primordial (rudimentary) follicles during adolescence and on different days of the menstrual cycle, and LH (luteinizing) helps to accelerate their growth for further release of the germ cell before ovulation.

Size by day of cycle

The size of the follicle changes on different days of the menstrual cycle. After the end of menstruation, under the influence of the active substances of the ovaries and pituitary gland, the development of several epithelial cocoons (up to 6-7 pieces) begins, but by the eighth day after the onset of development, a dominant follicle appears, in which the gene activity was the highest, so it reached the mark of 8 the fastest. -10 mm. The remaining epithelial cocoons may stop growing or undergo apoptosis, that is, planned cell death.

Dominant follicle development

After that, the body "concentrates" on this dominant follicle, and the growth of the rest stops to save nutritional resources and energy. Every day before ovulation, there is an increase in this epithelial cocoon for the egg by 1.5-2 mm in diameter. During this period, the egg begins to mature, undergoes several successive divisions, during which nutrients are concentrated inside it, the necessary membranes appear (there are 3 of them in the egg).

On the 11th day of the cycle, the size of the follicle is about 15-16 mm, after which its growth slows down a bit. During this period, the egg is already at the final stage of its development, preparation for ovulation begins. On which day it happens depends on the activity of the endocrine system and the state of health of the woman, usually this happens on the 15-16th day.

On the 15th day of the cycle (sometimes there are shifts of 2-3 days), the follicle reaches 22-24 mm in diameter and a critical point occurs, since it can no longer grow, so the epithelial cocoon breaks and the sex cell comes out - into the abdominal cavity, and then into the fallopian tubes.

It is during this period, which will last only 36-50 hours, that fertilization can occur. But it is important to understand that under the influence of hormones, ovulation, that is, the release of an egg, can occur sooner or later. If you observe the follicular tissue during the ovulatory phase, you can see how the epithelial cocoon increases dramatically, the egg is released, and after that it decreases, only its remnants (yellow body) are visible.

Follicle Growth Chart

After reading a short information about, the algorithm itself becomes clear, but it is difficult to understand the exact data, so below is a simple table that shows the size of the epithelial coating of the egg on different days of the menstrual cycle.

The indicators presented in the table are the established norm for the development of follicles on the days of the cycle, but it is not in vain that the gynecologist, in order to prescribe contraceptives or determine “safe” days of the cycle, checks the size data for the girl individually, because the rate of maturation and growth of the egg in the follicular cocoon depends on her heredity , the work of the endocrine system, the level of stress and even weight.

Why does the follicle not grow

The lack of growth and development of follicles is one of the most common causes of infertility in women. Deviation from the norm of development of follicular tissue may appear due to:

• disturbances in the work of the pituitary and hypothalamus;
• dysfunction or underdevelopment of the ovaries;
• the appearance of cysts in the ovaries or the presence of multifolliculosis;
• inflammatory or infectious processes in the organs of the reproductive system;
• hormonal imbalance;
• the appearance of cancerous neoplasms in the mammary glands, pituitary gland or ovaries;
• frequent stressful effects on the body, severe depression;
• dramatic weight loss, BMI below 17.5;
• early menopause.

It’s worth starting with a hormonal imbalance, which becomes the main reason for stopping the growth of follicles in the ovary. With tumors or dysfunction of the pituitary gland in the body of a girl, there is a lack of the hormone FSH, and the regulation of the release of active substances by the ovaries and thyroid gland is also disrupted. The same effect of inhibiting the development of follicles is observed with underdevelopment or poor functioning of the ovaries.

If a girl has too low weight or there are infections of the reproductive system, the body “understands” that she will not be able to bear the child, so there is no need for ovulation and follicle growth. After STD treatment or weight gain, the follicular growth cycle usually returns to normal.

During stressful periods or prolonged depression, the girl's adrenal glands secrete more than the norm of the stress hormone - cortisol, which increases the risk of miscarriage of the fetus, so follicles will not develop in such an environment. Restoring their growth in such a situation is not so easy, it can take several months until the hormonal background stabilizes.

The growth of follicles continues from the beginning of the menstrual cycle until ovulation. First, several epithelial cocoons develop, but already on the 8-9th day, one dominant one is released, and the rest stop growing. The growth of follicular tissue lasts until ovulation, during which it ruptures and releases a mature egg. But with various disorders in the body, the follicular cycle can be suspended.

The follicle is the component of the ovary that is surrounded by connective tissues and is made up of an ovum. The follicle contains the nucleus of the oocyte - the "embryonic vesicle". The oocyte is located inside a glycoprotein layer surrounded by granulosa cells. The granulosa cells themselves are surrounded by a basement membrane, around which are theca cells.

The primordial follicle consists of an oocyte, a stroma cell, and a follicular cell. The follicle itself is almost invisible, its size averages 50 microns. This follicle is formed before birth. It is formed due to germ cells, they are also called oogonia. The development of primordial follicles is facilitated by puberty.

A single-layer ordinary follicle consists of a basal plasty, a follicular cell that forms a transparent membrane, and a multilayer primary follicle consists of a transparent membrane, an inner cell, and granulosa cells. During puberty, follicle-stimulating hormone (FSH) begins to be produced. The oocyte grows and is surrounded by several layers of granulosa cells.

The cavitary (antral) follicle consists of a cavity, the inner layer of Theca, the outer layer of Theca, granulosa cells, a cavity containing follicular fluid. Granulosa cells are already starting to produce progestins. The diameter of the antral follicle averages 500 µm. The gradual maturation of the follicle with the formation of its layers gives rise to the production of female sex hormones, including estrogen, estradiol, androgen. Thanks to these hormones, this follicle turns into a temporary organ of the endocrine system.

A mature follicle (Graaffian vesicle) consists of an outer layer of the theca, an inner layer of the theca, a cavity, granulosa cells, a radiant crown, and an oviparous tubercle. Now the egg is located above the egg tubercle. The volume of follicular fluid increases by 100 times. The diameter of a mature follicle varies from 15 to 22 mm.

How big should a follicle be?

It is impossible to answer this question unambiguously, since the size of the follicles change during the menstrual cycle. Follicles are fully formed by an average of fifteen years. Their sizes are determined only with the help of ultradiagnostics.

We will most accurately analyze the norm for the size of the follicle by the days of the menstrual cycle.

In the first phase of the menstrual cycle (1-7 days or the beginning of menstruation), the follicles should not exceed 2-7 mm in diameter.

The second phase of the menstrual cycle (8-10 days) is characterized by the growth of follicles, mainly their diameter reaches 7-11 mm, but one follicle can grow faster (it is commonly called dominant). Its diameter reaches 12 - 16 mm. On the 11-15th day of the menstrual cycle, the dominant follicle should normally increase by 2-3 mm every day, at the peak of ovulation it should reach a diameter of 20-25 mm, after which it bursts and releases the egg. Meanwhile, other follicles simply disappear.

This is what the follicle growth looks like. This is repeated monthly until the onset of pregnancy. For a more visual and understandable definition, we provide you with a table by which you can understand whether your follicles are maturing normally.

What is a dominant follicle

The dominant follicle is considered to be the follicle that is ready for successful ovulation. With natural ovulation, it stands out for its size. As we said earlier, although all follicles begin to grow, but only one of them (in rare cases, several) grows to a size of 22 - 25mm. It is he who is considered dominant.

Generative function as a priority. Let's figure out what it is.

There are two components of ovarian function.

The generative function is responsible for the growth of follicles and the maturation of an egg capable of fertilization. The hormonal function is responsible for steroidogenesis, which changes the lining of the uterus, helps not to reject the fetal egg, and regulates the hypothalamic-pituitary system. It is generally accepted that the generative function is in priority, so if it fails, the second one loses its abilities.

At what size follicle does ovulation occur?

Ovulation is the release of an egg from a burst mature follicle. In this case, the size of the follicle during ovulation becomes 15 - 22 mm (in diameter). To make sure that you have a full-fledged follicle by the time you ovulate, you need an ultrasound.

empty follicle syndrome

Currently, two types of this syndrome are described: true and false. Distinguishes their level of hCG. It can be said that thanks to IVF technology, scientists have examined under a microscope the phenomena when the follicle is “empty”.

According to statistics, in women under 40 years of age, this syndrome occurs in 5-8% of cases. The older a woman gets, the higher the number of empty follicles. And this is no longer a pathology, but the norm. Unfortunately, it is impossible to accurately and immediately diagnose this syndrome. To do this, you will need to completely exclude damage to the ovaries (structural anomaly), lack of ovarian response to stimulation, premature ovulation, hormonal failure, defects (pathologies) in the development of the follicles, and premature aging of the ovaries. That is why there is no such diagnosis as an “empty follicle”.

But scientists have found the reasons that accompany the development of the syndrome. Namely: Turner's syndrome, incorrect time of administration of the hCG hormone, incorrect dose of hCG, incorrectly selected IVF protocol, incorrect technique for sampling and washing the material. As a rule, a competent reproductologist, before making this diagnosis, carefully collects an anamnesis.

polycystic ovary syndrome

Otherwise, it is called the Stein-Leventhal syndrome. It is characterized by dysfunction of the ovaries, the absence (or altered frequency) of ovulation. As a result of this disease, follicles do not mature in the body of a woman. Women with this diagnosis suffer from infertility, lack of menstruation. A variant is possible when menstruation is rare - 1-3 times a year. Also, this disease affects the violation of the hypothalamic-pituitary functions. And this, as we wrote earlier, is one of the functions of the proper functioning of the ovaries.

Treatment here can proceed in two ways. It is operational and medical (conservative). The operative method often involves resection with the removal of the most damaged area of ​​ovarian tissue. This method in 70% of the case leads to the restoration of a regular menstrual cycle. For a conservative method of treatment, hormonal drugs are mainly used (Klostelbegit, Diana-35, Tamoxifen, etc.), which also help regulate the menstrual process, which leads to timely ovulation and the desired pregnancy.

Folliculometry: definitions, possibilities

Under the name folliculometry, it is customary to understand the observation of the reproductive system of a woman during the menstrual cycle. This diagnostic tool allows you to recognize ovulation (whether it was or not), determine the exact day, and monitor the dynamics of follicle maturation during the menstrual cycle.

Monitoring the dynamics of the endometrium. For this diagnosis, a sensor and a scanner are used (it is more common for us to call this ultrasound). This procedure is absolutely identical to the procedure for ultrasound of the pelvic organs.

Folliculometry is prescribed for women to determine ovulation, evaluate the follicles, determine the day of the cycle, for timely preparation for fertilization, to determine whether a woman needs to stimulate ovulation, to reduce (in some cases increase) the likelihood of multiple pregnancy, to determine the reasons for the absence of a regular menstrual cycle , detection of diseases of the pelvic organs (myomas, cysts), to control treatment.

This procedure does not require strict preparation. It is recommended only during these studies (usually ultrasound is done more than once) to exclude from the diet foods that increase bloating (soda, cabbage, brown bread). The study can be carried out in two ways: transabdominally and vaginally.

The values ​​of indicators of the norm and pathology of the development of follicles

The norms of indicators both by day and during ovulation, we described above (see above). Let's talk a little about pathology. The main pathology is the lack of follicle growth.

The reason may be:

• in hormonal imbalance
• polycystic ovaries,
• dysfunction of the pituitary gland,
• inflammatory processes of the pelvic organs,
• STD,
• neoplasms,
• severe stress (frequent stresses),
• breast cancer,
• anorexia,
• early menopause.

Based on practice, health workers distinguish such a group as hormonal disorders in a woman's body. Hormones inhibit the growth and maturation of follicles. If a woman has a very small body weight (plus there are still STD infections), then the body itself recognizes that it cannot bear a child, and the growth of the follicle stops.

After normalization of weight and treatment of STDs, the body begins the proper growth of follicles, and then the menstrual cycle is restored. During stress, the body releases hormones that contribute to either miscarriage or follicle growth.

After a complete emotional recovery, the body itself begins to stabilize.

Stimulation of ovulation

Under stimulation, it is customary to understand a complex of hormonal therapy, which helps to achieve fertilization. It is prescribed for women with a diagnosis of infertility for IVF. Infertility is usually diagnosed if pregnancy does not occur within a year with regular sexual activity (without contraception). But there are also contraindications for stimulation: impaired patency of the fallopian tubes, their absence (except for the IVF procedure), if it is not possible to conduct a full-fledged ultrasound, low follicular index, male infertility.

The stimulation itself occurs using two schemes (they are usually called protocols).

First protocol: increase in minimum doses. The purpose of this protocol is the maturation of one follicle, which excludes multiple pregnancy. It is considered sparing, since when using it, ovarian hyperstimulation is practically excluded. When stimulated with drugs according to this scheme, the size of the follicle usually reaches 18-20 mm. When this size is reached, the hCG hormone is injected, which allows ovulation to occur within 2 days.

Second protocol: lowering high doses. This protocol is prescribed for women with a low follicular reserve. But there are also requirements for it that are considered mandatory indications: age over 35, previous ovarian surgery, secondary amenorrhea, FSH above 12 IU / l, ovarian volume up to 8 cubic meters. With the stimulation of this protocol, the result is already visible on the 6th - 7th day. With this protocol, the risk of ovarian hyperstimulation is high.

Control ultrasound examination. This study is usually carried out transvaginally. The purpose of the study is to confirm ovulation. This ultrasound should normally show that there is no dominant follicle, but there is a corpus luteum. There may be some free fluid behind the uterus. Ultrasound is performed strictly 2-3 days after the expected ovulation, since if you are late, you can not see the corpus luteum, and the same fluid.

Content

The female body is arranged in such a way that the birth of a new life depends on the quantity and quality of these small follicular elements in which the egg matures. Expectant mothers should know what processes are going on in their reproductive organs in order to contact a gynecologist in time for violations.

What are follicles

The process of the emergence of human life begins with the fertilization of the egg. What are follicles? These are the elements that protect her, the place where she matures until the moment of ovulation. The egg is securely surrounded by a layer of epithelium, a double layer of connective tissue. The possibility of pregnancy and bearing a child depends on high-quality protection. On ultrasound, it looks like a round formation. The second function of the elements is the production of the hormone estrogen.

Follicles on the ovaries go through their monthly cycle of evolution:

• start developing a few small pieces;
• one - antral - begins to increase in size;
• the rest decrease and die off - atresia occurs;
• the largest - dominant - continues to grow;
• under the influence of hormones, it breaks through, ovulation occurs;
• the egg enters the fallopian tubes;
• during sexual intercourse at the time of the meeting with the sperm, fertilization occurs;
• if this does not happen, during menstruation, the egg leaves the uterus along with the epithelium.

What is a dominant follicle

By the middle of the menstrual cycle, the follicular apparatus approaches the main stage of its activity. What is a dominant follicle? This is the largest and most mature element that protects the egg, which is already ready for fertilization. Before ovulation, it can grow up to two centimeters, more often located in the right ovary.

In a mature state, under the influence of hormones, it breaks - ovulation. The egg rushes to the fallopian tubes. If the maturation of the dominant element does not occur, ovulation does not occur. The causes of this condition are developmental disorders.

Persistent ovarian follicle - what is it

Due to hormonal changes that begin in adolescence, during menopause, there may be a violation of the activity of the follicular apparatus - persistence. This can cause delayed menstruation, bleeding. Persistent ovarian follicle - what is it? The situation means that the protective element:

• matured;
• reached a dominant state;
• there was no rupture;
• the egg did not come out;
• fertilization did not follow;
• pregnancy did not take place.

In this position, persistence occurs - the reverse development of the follicular formation, with further development of events from it, the formation of a cyst is possible. In order for the formation to burst, treatment with progesterone is prescribed in gynecology. What happens during persistence? The following process develops:

• hormones continue to be produced;
• thickening of the endometrial mucosa occurs;
• the uterus is compressed;
• the endometrium begins to shed;
• bleeding occurs.

Primordial follicle

The reserve of eggs for the whole life of a woman is laid in the womb, it is called the ovarian reserve. The primordial follicle is the primary stage in the development of the protective element. The rudiments of germ cells - oogonia - are located on the periphery of the inner surface of the ovary, have dimensions that are not visible to the eye. They are protected by a layer of granulosa cells and are at rest.

This continues until the girl's puberty - the beginning of the menstrual cycle. The course of this period is characterized by:

• the formation of follicle-stimulating hormone;
• under its influence, the growth of the nucleus of the egg - the oocyte;
• maturation of two layers of the outer protective shell;
• monthly development of several follicular elements that protect the egg.

Antral follicles

At the next, secondary stage, the follicles in the ovaries continue their development. Around the seventh day of the cycle, there is an increase in the number of cells that produce follicular fluid. Structural processes of the structure take place:

• antral follicles start producing estrogen on day 8;
• theca cells of the outer layer synthesize androgens - testosterone, androstenedione;
• the cavity containing the follicular fluid increases;
• The epithelium differentiates and becomes two-layered.

Preovulatory follicle - what is it

At the last, tertiary stage of maturation, the egg takes its place on a special hill, it is ready for fertilization. Preovulatory follicle - what is it? At this point, it is called the Graaffian bubble and is almost completely filled with liquid. Its number has increased tenfold compared to the previous period. The day before ovulation, major changes begin to occur.

At this time, the production of estrogen increases, then:

• it stimulates the release of luteinizing hormone, which triggers ovulation;
• the Graafian bubble forms a stigma on the wall - a protrusion;
• a breakthrough appears at this place - ovulation;
• after that, a corpus luteum is formed, which prevents the rejection of the endometrium due to the production of progesterone;
• after ovulation, it forms a pronounced network of blood vessels, helping the further formation of the placenta.

Solitary follicles in the ovary

How many tragedies happen because of the impossibility of conceiving a child. In some cases, ovarian impoverishment syndrome is observed. A woman is not able to become pregnant because their functioning stops. Single follicles in the ovary cannot develop to a normal size, there is a lack of ovulation, an early menopause occurs. The reasons for this situation may be:

• active sports;
• starvation diets;
• menopause;
• hormonal disorders;
• obesity.

The norm of follicles in the ovary

If there is an abnormal development of the follicular apparatus, the woman undergoes a regular examination for ultrasound. Compare the real picture and the number of follicles in the norm. With deviations - increases or decreases - a pathology arises - the impossibility of conception, the woman begins to be treated. How many follicles should an ovary have? At reproductive age, it depends on the days of the cycle:

• on the sixth, seventh - from 6 to 10 pieces;
• from the eighth to the tenth - one dominant appears - the rest die off.

How many follicles should be for conception

In order for a woman to become pregnant, the full maturation of the egg is necessary. How many follicles should be for conception? At the stage before fertilization, it is necessary to have one - high-quality dominant development. He must be ready to ovulate. If two such formations are found during an ultrasound examination, and they both undergo fertilization, twins will be born.

Follicle maturation

Folliculogenesis - the process of growth and maturation of the follicle under favorable conditions ends with ovulation and fertilization. Things don't always go well. In case of developmental disorders, observation and analysis is carried out using ultrasound. Starting from the 10th day of the cycle, the growth of the dominant element is monitored. If slow maturation is observed, ovulation does not occur, treatment is prescribed. During the next cycle, monitor the results. So you can increase the rate of maturation, achieve the onset of a long-awaited pregnancy.

Follicle size by day of cycle

Every month during menstruation, there is a gradual growth of follicles by day. The following process is observed:

• until the seventh day, the size of the bubble is in the range from 2 to 6 millimeters;
• starting from the eighth, there is an activation of the growth of the dominant formation up to 15 mm;
• the rest shrink and die;
• from 11 to 14 days of the cycle there is a daily increase;
• the mature element can be up to 25 mm in size.

Many follicles in the ovary - what does it mean

Deviation from the norm in the direction of increase is considered a pathology. A large number of follicles in the ovaries - more than 10 pieces are called multifollicular. With ultrasound, a huge number of small vesicles are observed, which is called follicular ovaries or polyfollicularity. When their number increases several times, a diagnosis of polycystic disease is made.

This situation does not mean the formation of a cyst, it is characterized by the presence of multiple follicular elements along the periphery. This can interfere with the development of dominant education, ovulation and conception. Such problems can be caused by stress or nervous disorders, and can quickly return to normal. Requires treatment for a situation caused by:

• improper selection of oral contraceptives;
• endocrine problems;
• weight gain;
• drastic weight loss.

Few follicles in the ovaries

A woman cannot become pregnant, to find out the reason, she is prescribed an ultrasound scan. Such a study takes place during the antral phase of the activity of the follicular apparatus - on the seventh day of the menstruation cycle. When at the same time they find that there are very few follicles in the ovaries, it is possible that the situation was provoked by a decrease in hormone levels. The analysis is carried out using a vaginal probe. If, during the examination, the follicles in the ovaries are in the amount of:

• from 7 to 16 - there is a chance of conception;
• from 4 to 6 - the possibility of getting pregnant is small;
• less than 4 - there is no chance of conception.

Two dominant follicles in one ovary

During the treatment of infertility with hormones, their concentration increases, instead of one, two dominant follicles mature in one ovary. It rarely happens on the left side. Those elements that should have stopped their development under the action of hormones begin to grow. Fertilization of two eggs can occur simultaneously or with a short time interval. This will lead to the birth of twins. If a woman has had sexual intercourse with different men in a short period, it is possible that the children will have different fathers.

Why the follicle does not mature - reasons

Developmental disorders have very serious problems - it leads to infertility. Why is the follicle not growing? There can be many reasons for this:

• early menopause - natural or surgical;
• disruption of the ovaries;
• having problems with ovulation;
• low estrogen production;
• endocrine disorders;
• inflammation in the pelvic organs;
• pituitary pathology.

Interruptions in maturation cause: stressful situations, the presence of depression, nervous strain. An important role is played by the state of the follicular component itself, it can:

• absent;
• have a stop in development;
• not reach the required dimensions;
• be late with maturation;
• not develop at all;
• linger with the moment of formation.

Video: how the follicle grows

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.