Reasons for the development of two dominant follicles in the ovary

 For the proper development of the egg, which directly affects the health of the unborn fetus and the course of pregnancy in general, nature has created a unique mechanism for its protection. Few people know that this task is performed by the follicles located in the ovaries in women.

A follicle in gynecology is a shell consisting of a group of cells formed by the body to protect and fully develop the egg.

In a healthy woman, a large number of follicles mature in the ovaries throughout life, according to the degree of development they are divided into:

• primordial;
• antral;
• dominant;
• preovulatory;
• persistent.

The main function of the follicle is to create a favorable environment until the full maturation of the egg and ensure its safety.

In the case of a well-functioning reproductive system, the follicle accompanies the egg during the growth period, after which, under the influence of estrogen and luteinizing hormone, its walls become thinner, the membrane ruptures and ovulation occurs.

The most common cause of female infertility is the depletion of the ovarian follicular apparatus. Thanks to the symbiosis of technology and medicine, specialists can now detect such a deviation as the formation of a follicle without an egg, which can only be detected by puncturing the follicular fluid.

The development of follicles without an egg, or even its absence in the ovary, can be a serious problem for a couple and threaten infertility.

What are ovarian follicles in women?

What are ovarian follicles in women? The female monthly cycle is divided into two phases - follicular and luteal. The formation of follicles occurs in the first phase. The follicle, consisting of an epithelial cover and a two-layer connective tissue, is the receptacle of the egg, ensuring its development and preservation.
The structure ripens within a month. Inside the germ cell is protected from the effects of negative factors. It matures to a predetermined stage, but maturation is completed after fertilization. Also, the ovarian follicle is a structure that provides the synthesis of estrogens. Follicular synthesis occurs continuously throughout a woman's life.

Every month, one follicle remains in the ovary, called dominant (less often two or three). An egg is released from it. The dominant formation is larger than the rest, before ovulation, its diameter can reach 2 cm. Under the influence of hormones, the walls are torn, the cell ready for fertilization enters the fallopian tube, moves to the uterus.

If the dominant structure does not appear in the ovary, then the cycle is anovulatory, the corpus luteum is not formed, conception is impossible. It happens that two or more dominant formations appear in the ovary in one month. This is a normal phenomenon, meaning that fertilization of two eggs is possible, bearing twins.

Follicles on the ovaries - the norm

Both appendages contain a huge number of primordial vesicles. At birth, a girl has about 1-2 million of them. In the process of sexual development, many of them die under the influence of the following factors:

• environmental impact - poor environmental conditions;
• the course of infectious, viral and other diseases of the body or genital area;
• decreased immunity;
• transferred surgical interventions;
• taking medications;
• unbalanced diet;
• natural hormonal failure in the process of sexual development.

As a result, a normal healthy woman at the beginning of the reproductive period has about 250-500 thousand bubbles. Their small number indicates past severe illnesses or the presence of other pathologies of the body.

The norm of the number of follicles in the ovaries, depending on the day from the beginning of the cycle:

• 2-5 day - up to 10-14 pieces;
• 6-10 days - 5-7 pieces;
• 11-14 days - 1-3 pieces.

Immediately after the end of bleeding, only primary vesicles are detected. Some of them decrease, the rest become secondary. By the beginning of ovulation, only one bag remains, less often - several pieces, ready to burst. Bubbles of smaller diameter undergo regression. The Graafian vesicle differs from the others in its large size already from the 9-11th day of the cycle.

During pregnancy, follicles in the ovaries are normally absent. This condition can continue until the end of lactation. This is due to the natural suspension of the work of the appendages - the body prevents the onset of conception, which can harm the current pregnancy and feeding the child. Therefore, during lactation, contraceptives may not be needed. But menstruation is able to resume 6-8 months after childbirth, even with continued milk production.

Most often, violations in the process of folliculogenesis occur when the endocrine organs fail and during the course of gynecological diseases. This is manifested by the absence of ovulation, the deviation of the number of bubbles from the norm, etc.

persistence

Persistence - the absence of rupture of the sac at the time set for ovulation. This condition can occur in healthy women, but not more than 1-2 times a year. Persistence is caused by hormonal failure, frequent stress, diseases of the appendages.

A monthly repetition of the disease requires a diagnosis of the functionality of the genital area. The absence of a gap entails the impossibility of conception. If untreated, persistence is fraught with the development of infertility.

Exceeding the norm

This condition is called ovarian multifollicularity. It is not considered a disease. Many follicles in the ovary, the development of which ends with ovulation, do not require treatment in the absence of symptoms of impaired reproductive function of the woman.

In some cases, multifollicularity can lead to the development of polycystic appendages. This occurs when there is no ovulation or when only a few sacs have ruptured. In the latter case, persistent follicles remain in the ovary, degenerating into cysts. Ovarian folliculosis in women needs hormonal treatment.

Absence

In the complete absence of bubbles in any of the appendages, conception is impossible. In this case, menstruation may continue with normal regularity or not occur for several months. The main reason why there are no follicles in the ovaries is hormonal failure. In severe cases, adnexal dysfunction is diagnosed. The most dangerous complication of such a pathology is the early onset of menopause, and, as a result, complete infertility.

With a small number of follicles in the ovaries, it is possible to become pregnant, but less likely. If they are insufficient for ovulation, fertilization will not take place. Pathology can be corrected by taking medications that accelerate the growth of bubbles. Such treatment, even with a small number of follicles in the ovaries, increases the likelihood of the appearance of a Graafian vesicle in the same cycle, but at a later date.

The number of all dormant oocytes is laid down by nature at the stage of embryonic development. It is characteristic that before the onset of puberty, it decreases significantly. One egg is released every month.

The number of capsules with oocytes is determined by the day of the cycle. There may be several of them already a few days after menstruation. On the fifth day there can be up to 10 of them, and this is also the norm. After all, only one follicle will be dominant.

Deviations

In the absence of a dominant follicle, the release of the egg does not occur. This happens as a result of hormonal imbalance and some pathologies:

• decreased production of follicle-stimulating hormone and increased excretion of luteinizing hormone;
• regression due to hormonal disorders (including due to an increase in insulin content);
• the presence of a persistent process;
• the presence of an overripe sac;
• the formation of a follicular cyst that grows in place of the dominant follicle (sizes exceed 2.5 cm during ultrasound examination);
• polycystic ovaries;
• pathological luteinization, when, without ovulation, the corpus luteum grows at the site of dominance.

All disorders of ovarian development require a thorough instrumental examination. Doctors prescribe hormonal tests for women, as the cause of deviations may be pituitary dysfunction, endocrine diseases.

If there are more than 10 follicles in the ovaries, they are called multifollicular. Polyfollicularity is also distinguished, that is, when a significant number of vesicles are detected on ultrasound. With an increase in their number several times, the diagnosis of "polycystic" is determined.

If the follicular elements are scattered around the entire periphery of the ovary, they become crowded. This interferes with dominance and all processes that promote conception.

This pathology develops due to stress and passes after a short time. The problem is treated if:

• multifollicularity is caused by problems with the functioning of the endocrine glands;
• there is a sharp weight loss or weight gain;
• there were failures in the choice of oral contraceptives.

The lack of follicles is provoked by hormonal problems. You can find out the problem on an ultrasound scan on the seventh day. If there are less than 6, then the probability of conception is negligible. Finally, if there are less than 4, then pregnancy practically does not occur.

In some cases, women do not have follicles at all. The complete absence of menstruation signals the occurrence of problems with the female body. If they are absent for more than 3 weeks, you need to urgently visit a gynecologist.

It may not ripen due to the presence of such reasons:

• dysfunction of the female gonads;
• disorders of the functionality of the endocrine system;
• tumors of the pituitary gland, hypothalamus;
• inflammatory pathologies of the small pelvis;
• stress, nervous instability or depression;
• early onset of menopause.

In these situations, there may be no follicles in the ovaries at all. It often happens that it does not reach a sufficient size so that an egg can come out of it.

The scheme of its growth can be visualized in the form of a table.

cycle day	Quantity and characteristics
1 to 4	Several follicles develop, each having a size of no more than 4 mm.
five	Uniform development with atresia of several follicles.
7	The dominant follicle is determined. All others are completely reduced.
8	12 mm
nine	14 mm
10	16 mm
eleven	18 mm
12	20 mm
13	22 mm
fourteen	24 mm. At this stage, ovulation occurs.

The cyclic development of the dominant cell is determined by estrogenic influence. Estrogen prepares the uterus for the likely attachment of a fertilized egg, stimulates the thickening of the endometrium. The body reacts to this by increasing the synthesis of luteinizing hormone in the pituitary gland. Under the influence of this hormone, the follicular membrane gradually becomes thinner, then bursts. The ovarian follicle changes by day as follows:

1. On the 5th - 7th day from the beginning of menstruation, the cell is 4 - 5 mm in diameter.
2. On the 8th - 10th day, a cover of connective tissue appears. The dominant stands out among other formations.
3. On days 11–13, the diameter of the dominant reaches 16–18 mm. The remaining follicles regress, gradually resolve.
4. On the 14th - 16th day, the next ovulatory cycle begins. The diameter of the remaining follicular cell, referred to at this stage as a Graaffian vesicle, is 20–22 mm.

In place of the burst bubble, a corpus luteum is formed, synthesizing progesterone, a hormone that prepares the body for a possible pregnancy, regulates the change in the uterine endometrium for better attachment of the embryo, weakens the contractile activity of the uterus, and maintains the tone of the uterine cervix in the last months of gestation.

The number of follicles in the ovaries somehow matters. During the formation of follicular cells, the following deviations may occur:

1. The absence of a dominant, when the body produces insufficient follicle-stimulating hormone, but an excess of luteinizing hormone.
2. Absence of follicles. It is observed in diabetes, hyperthyroidism and other endocrine pathologies, is a consequence of hormonal failure.
3. appearance of a persistent cell. During persistence, the follicular cell enlarges, but does not enter the rupture phase. There is no ovulation process. The pathological phenomenon is usually associated with an excess of male hormones in the female body. Without treatment, infertility develops.
4. Multifollicular ovaries. At the preovulatory stage, there is an excess number of oocytes in the gonads. The pathological phenomenon occurs due to stress, chronic overwork, mental and emotional disorders. With multiple follicles, therapy is not always required; after a couple of cycles, follicular synthesis may return to normal.
5. Luteinization - the appearance of a corpus luteum from an egg that has not left the shell. Pathology is observed with hormonal failure, endometriosis, an inflammatory reaction in the reproductive system.
6. The follicular cyst is formed from an unruptured dominant. The bubble continues to grow, on the ultrasound monitor it looks like a formation filled with liquid contents, with a diameter exceeding 25 mm. If there are several such bubbles, then polycystic is diagnosed.

The process that takes place every month in the female body, metamorphoses concerning the follicles, is called folliculogenesis. The process of maturation of these bubble sacs is very complex, regulated at the hormonal level by the body itself. It proceeds continuously and breaks are possible only during pregnancy. Folliculogenesis ends during menopause - with a depleted ovarian reserve, new follicles do not mature, there is no menstruation.

Multiple primary follicles are very small (no more than 50 microns), they cannot be seen without a microscope, they were laid before the birth of a girl and are called primordial. They originate in the ovaries at the 6th week of pregnancy. And the process of formation of new primordial follicles is completely completed by late pregnancy.

When a girl enters puberty, her anterior pituitary gland begins to produce a special substance - follicle-stimulating hormone (FSH). Under the influence of this active substance, every month immediately after the start of the next menstruation in the right and left ovaries, the formation and growth of 5-15 follicles from the reserve simultaneously begins. As soon as they begin to grow, their status changes - they become preantral, and their size is about 200 microns.

In the process of growth, many cellular processes take place, inside the vesicle-follicle a cavity with a liquid is formed, in which there is a first-order oocyte. Such follicles can already be assessed on ultrasound, they are called antral. Their dimensions are already equal to 3-4 millimeters.

But all antral follicles must survive until ovulation, only one remains - the dominant one. Its growth rate is more intense. The remaining antral counterparts undergo reverse development and are stored by the body for future menstrual cycles. The development of the next follicle is delayed at the hormonal level. The dominant follicle grows rapidly, an egg matures inside it - before ovulation, the size of the follicle reaches 20-22 mm (sometimes 24 mm). Active production of estrogen and luteinizing hormone begins.

The LH hormone acts on the follicular membrane, thinning it. A mature egg is located on a tubercle and protrudes above the surface of the ovary. The follicle is now tertiary or preovulatory. It is also called the Graaffian bubble. Under the action of LH, a stigma is formed - a protrusion in the wall of the follicle. At the site of the stigma, the membranes rupture and the mature egg is released.

First, the egg enters the abdominal cavity, from where it is captured by the fallopian tube. Once in the fallopian tube, the oocyte retains the ability to be fertilized for 24-36 hours. If conception does not occur, the egg dies.

But after an increase in growth, that is, after the follicle, in fact, has fulfilled its role and ensured the maturation and release of the egg, matured and burst, development does not end. From the remnants of the shells, a new formation is grouped - the corpus luteum. This is a temporary gland that produces shock doses of progesterone. This hormone prevents the rejection of the endometrium and the onset of menstruation, the layer of the inner lining in the uterus grows under its influence and prepares to accept the fetal egg.

Implantation, if a woman in the current cycle has conceived a baby, usually occurs 6-8 days after ovulation. And in this case, within a day, the production of another hormone well-known to women, hCG, starts (it is he who makes the pregnancy tests “strip”). This hormone maintains the corpus luteum in working condition until 12-14 weeks of pregnancy, until all endocrine functions are taken over by the young placenta.

If there was no conception or the embryo for some reason could not implant, the corpus luteum dies 10-12 days after ovulation, progesterone production stops, estrogen concentration rises, which leads to the onset of menstrual bleeding, in which endometrial rejection occurs. And already in the first days of the cycle, everything starts from the very beginning - the growth of primordial follicles.

The entire female cycle is divided into two phases - follicular and luteal. In the first, the follicle matures, and the luteal phase begins after ovulation. Typically, the luteal phase in women of different ages and health conditions lasts about 14 days. This helps determine the expected day of ovulation - subtract 14 from the duration of the menstrual cycle.

How does growth happen?

Deviated from the normal cells in the ovary, this is when there are more than 10 of them. In medicine, several terms are used when diagnosing abnormalities, these are “multifollicular” and “follicular ovaries”. Before making this diagnosis, a woman must undergo an examination and do an ultrasound.
Having heard such a diagnosis, you should not be upset and think that this is an indicator of infertility. Multifollicular ovaries can be after nervous breakdowns, constant stress or overwork. In such a situation, there is no need to panic and you should not take any medications. Having eliminated the cause that caused such a diagnosis, by the next period of ovulation, normalization of cells in the ovaries can be expected.

Factors that provoke deviations from the norm:

• improperly selected contraceptives;
• problems with the thyroid gland;
• after the period of feeding the baby (excess of prolactin in the body);
• the endocrine system is not working properly.

Attention! How to act in such a situation? After examination by a specialist and confirmation of the diagnosis, a treatment method is prescribed, which is followed relentlessly. With improper treatment, infertility develops, so you can not start it.

There are two types of menstrual cycle and they pass depending on the number of dominant follicles.

Types of the menstrual cycle:

• normal;
• a cycle with deviations, in the absence of a mature dominant follicle.

With a large accumulation of hormones and multifolliculosis, infertility develops.

Follicles are given to a woman by birthright. Newborn girls have from 500 thousand to a million primordial follicles in their ovaries, the sizes of which are negligible. With the onset of puberty, the girl starts a monthly continuous process of folliculogenesis, which will last throughout her reproductive life and end only with the onset of menopause.

For life, a woman is assigned about 500 germ cells, it is they who will mature one at a time in each menstrual cycle, and on the day of ovulation they will leave the refuge bubble, which has reached its maximum size. After ovulation, fertilization is possible within 24-36 hours. It only takes one follicle and one egg to conceive.

With the onset of puberty, the girl begins to produce a hormone responsible for follicular growth. It is called FSH - follicle stimulating hormone. It is produced by the anterior pituitary gland. Under its influence, the primordial vesicles begin to increase, and already during the next ovulation, some of them first become preantral, and then antral, inside which there is a cavity filled with liquid.

Antral follicles at the very beginning of the female cycle can be from 5 to 25. Their number allows doctors to predict how a woman is capable of self-conception, whether pregnancy is possible without stimulation and the help of doctors. The norm is from 9 to 25 bubbles. If a woman has less than 5 antral-type follicles, then the diagnosis of "infertility" is established, in which IVF with donor eggs is indicated.

Antral follicles grow at about the same pace, at the same speed, but soon a leader begins to form, growing faster than others - such a bubble is called dominant. The rest slow down growth and undergo reverse development. And the dominant one continues to grow, a cavity with a liquid expands in it, in which the egg matures.

By the middle of the cycle, the follicle reaches a large size (from 20 to 24 mm), during which it usually bursts under the action of the LH hormone. The egg becomes available for fertilization in the next 24-36 hours.

The former follicle, or rather the remains of its membranes, are grouped into a new formation - the corpus luteum, which produces progesterone. If conception does not occur, the corpus luteum dies after 10-12 days, and progesterone production decreases sharply before menstruation. During pregnancy, the corpus luteum continues to function until the end of the first trimester.

In the absence of pregnancy, a new stage of folliculogenesis follows the same pattern from the first day of the cycle, that is, from the very beginning of the next menstruation. If a woman's body is working normally, there are no problems with the hormonal background, then ovulation occurs monthly. 1-2 anovulatory cycles per year are considered acceptable.

The maturation of the follicle in the ovary. Follicle development

During its development, the follicle goes through several stages (phases).

Early phase

Several follicles grow. After reaching one of them (dominant) up to 24 mm in diameter, ovulation occurs.

luteal phase

The interval between ovulation and the start of a new cycle is called the luteal phase (or corpus luteum phase). After the graafian bubble bursts, it begins to accumulate fats and pigments. This is how the corpus luteum develops. It produces progesterone, androgens, esradiol.

These substances activate the maturation of the endometrium. The uterus is preparing for the implantation of a fertilized oocyte. If pregnancy occurs, the corpus luteum continues to secrete progesterone until the placenta reaches a certain size and begins to produce it itself.

If pregnancy does not occur, then the corpus luteum is destroyed. The level of estrogen and progesterone gradually decreases, which contributes to the beginning of a new monthly cycle.

Follicles are born in the ovaries of the girl in utero - even when she grows in her mother's stomach. Active development occurs during the puberty of the girl, and ends with the onset of menopause. The closer a woman approaches the turn of menopause, the faster the natural process of depletion of elements occurs.

Let us consider the main stages of the evolution of Graaffian bubbles in order to better understand the specifics of their “work”.

1. primordial stage. Follicles of this type begin to form in girls as early as the 6th week of pregnancy. And by the time of her birth, the ovaries contain about 1-2 million follicular elements. At the same time, they do not receive further development, waiting for puberty. By this time, their number is significantly reduced. This reserve is called ovarian reserve. During this period, the egg is just beginning its maturation in the epithelium of the follicle. Additional protection is provided by two shells consisting of connective tissue. With each cycle (after puberty) the development of numerous primordial follicles begins, which gradually increase in size.
2. preantral stage. The maturation of the follicles is accelerated, as the pituitary gland begins to produce follicle-stimulating hormone. Immature eggs are covered with a membrane. At the same time, estrogen synthesis begins in epithelial cells.
3. Antral stage. The "injection" into the cell space of a special fluid, which is called follicular, begins. It already contains the necessary estrogen for the body.
4. preovulatory stage. A “leader” begins to stand out from the follicular mass: the follicle, which is called dominant. It is he who contains the most follicular fluid, which by the end of its maturation increases a hundred times. At the same time, the level of estrogen reaches its maximum values.

Inside the dominant, the maturing egg moves to the oviduct. And the rest of the follicular elements die.

The dominant develops in the ovary for an average of 2 weeks, the remaining follicles are inhibited at the initial stage of formation. The dominant formation under the influence of estrogen and luteinizing hormone bursts in the middle of the month. At the same time, the ultrasound shows that the bubble in the gonad has disappeared, instead of it a small amount of liquid remains. Further, a corpus luteum will form in this place. In its formation, the ovarian follicle goes through 4 stages described below.

At the primordial stage of the connective tissue. She is small, flattened. In one cycle, 5-20 such structures are formed in the gonad.

secondary follicle

On the 8th - 10th day of the cycle, secondary structures are formed. The thickened follicular epithelium produces a fluid that is a source of estrogen, gradually filling the formed bubble, the diameter of which is 10-12 mm. Education can be single-cavity or consisting of several chambers. At this stage, about 10 formations remain.

Visual stage of follicle development

At the final stage, the development of one oocyte continues, for the rest of the formations, the process of oppression - atresia begins. The remaining dominant reaches 2 cm, protrudes into the abdominal cavity from one side, and attaches to the connecting layer of the ovary on the other. Inside is an egg ready for fertilization.

Kinds

There are such types of follicles:

• primordial;
• primary;
• secondary;
• tertiary.

Primordials are otherwise called resting. They are localized in the subcapsular zone. They are the smallest. Cells have a flat structure.

Primary otherwise are awakened. They are somewhat larger than primordial ones. Around the egg is a shell formed by protein substances.

Secondary follicles are slightly larger. They have a stratified epithelium and several small fluid-filled chambers. Around it grows a shell inside the ovary - theca. It appears in the ovary earlier than the theca and it is by it that the secondary capsule is identified.

Common Deviations

• violation of menstrual periodicity (their duration increases to 50 days);
• anovulation;
• inability to get pregnant.

If, with a plurality of follicles in the epididymis, cysts begin to form, then this condition is commonly called polycystic ovary syndrome. At the same time, the capsule of the appendages thickens, which is an additional obstacle to the release of mature eggs. It also increases the production of male sex hormones, which leads to hyperandrogenism.

How to check?

Of course, it is impossible to measure the follicles on your own. The only way to do this is to visit a doctor and do a folliculometry. This is a type of ultrasound examination (ultrasound), in which the state of a woman's ovaries is observed in dynamics. The first ultrasound is usually done immediately after the end of menstruation, usually on the 7th-8th day of the cycle there is every opportunity to estimate the number of antral vesicles. Then ultrasound is done several times with regularity in 2-3 days in order to be able not to miss the day of ovulation.

The ultrasound doctor, based on the average size of the follicle, will tell you when it is better to stimulate ovulation, when it is better to prescribe the procedure for the removal of eggs by ovarian puncture in the IVF protocol, and will also be able to say with certainty whether there was ovulation in the current cycle at all.

At the very first procedure, a woman may be surprised to hear that quite a lot of follicles are maturing in her ovaries. For antrals, this is completely normal. Anxiety is caused by situations when there are either too many or too few such bubbles. If there are 26 or more, the doctor will suspect polycystic ovary syndrome, in which conception is impossible without prior treatment.

If there are less than 5 antral vesicles (a single follicle, 2, 3, 4 follicles), this means that the woman is infertile, so the follicles do not grow even with stimulation - IVF and stimulation of ovarian function are not carried out in this case. IVF with a donor oocyte is acceptable.

Dominant follicle in the left ovary

In practice, often the right ovarian follicle is dominant. This is possible due to better blood supply to the organ and a larger number of vessels than in the left appendage.

In rare cases, there may be 2 dominant follicles in the right ovary at once. This will lead to the conception of identical twins.

If the female reproductive system is in order and healthy, then both organs of the reproductive system can alternately produce eggs ready for fertilization. If in most cases a dominant follicle appears in the left ovary on ultrasound, then this may indicate pathological abnormalities in the right, such as:

• Inflammatory processes;
• cystic formations;
• anomalous structure;
• Change in the shape of the body as a result of surgery, trauma.

The functionality of the Graafian vesicle determines the likelihood of ovulation. In order for its shell to burst, it must produce the maximum amount of estrogen. The latter stimulate the pituitary gland, which produces luteinizing hormone, which triggers the process of ovulation. Under its influence, a stigma is formed on the vesicle - a protruding area in which the egg is located. It is at this point that the shell breaks.

The dominant follicle is formed in the left or right ovary. In most women, the right appendage is considered more active - it is he who is also responsible for the production of sex hormones, the implementation of the reproductive function. The ovaries are able to work alternately - in this case, in one menstrual cycle, ovulation occurs in the left organ, and in the next - in the right.

In some women, two or more dominant follicles are formed at once in one ovary. This condition is not a pathology if they rupture at the right time. Several sacs ovulating at the same time increase the chance of multiple pregnancy. This condition is likely with the individual characteristics of the woman, stimulation of ovulation with medications, or after the abolition of oral contraceptives. Sometimes two or more dominant follicles develop in different ovaries.

Causes of violation of folliculogenesis

The processes of folliculogenesis proceed under the guidance of the hormonal background and depend on the concentration and ratio of the hormones FSH, estradiol, luteinizing hormone, progesterone, testosterone, prolactin. Therefore, any deviation in the endocrine accompaniment can cause a disruption in the maturation of the follicles, which will lead to the fact that maturation will proceed either too slowly or rapidly. In the first case, late ovulation is possible, in the second - early. Any of them is not too favorable for normal conception.

Folliculogenesis disorders are varied. For example, during persistence, there is no rupture of the follicular membrane. This phenomenon is usually associated with insufficient levels of the hormone LH. In this case, the egg overripes, dies, and the follicle continues to be present on the surface of the gonad for several more weeks. This causes a failure of the menstrual cycle, conception during this period is impossible.

With luteinization of the follicle, the corpus luteum begins to develop before the rupture occurs, so ovulation also does not occur. And if the follicle does not mature to the desired size, stopping its development suddenly, then they talk about follicle atresia. In all cases, the process of ovulation is disturbed - a woman cannot conceive a baby.

The reasons why the development of follicles is disturbed are numerous. There are temporary factors, after the elimination of which the cycle is restored, and a woman can become a mother without the help of doctors.

Temporary disruptions can cause:

• excessive physical activity, professional sports;
• passion for mono-diets, sudden weight loss or weight gain in a short time period;
• chronic stress, emotional instability, worries;
• work at an enterprise with a high level of occupational hazard (with paints, varnishes, nitrates, on a night shift, in conditions of strong vibration and enhanced electromagnetic radiation);
• trips and air travel, if they are associated with a change in climate and time zones;
• cancellation of oral contraceptives;
• diseases transferred in the current months with an increase in body temperature.

Among the pathological causes of impaired follicular maturation, various diseases and conditions can be noted in which the endocrine background is disturbed:

• pathology of the pituitary gland, hypothalamus;
• dysfunction of the ovaries;
• inflammatory and infectious diseases of the genital tract and pelvic organs;
• trauma to the ovarian tissue, the consequences of surgery;
• violation of the thyroid gland, adrenal cortex.

Hormonal failures are often preceded by childbirth and abortion, bad habits, long-term use of antibiotics, antidepressants, anticoagulants.

Antral follicles in the ovaries

Antral follicles are vesicles about 8 mm in size in which the maturation of eggs occurs. The possibility of getting pregnant is directly related to functional activity and the number of formations. They play an important role in determining a woman's fertility. In infertility, the number of antral follicles is usually counted. Their number determines the likelihood of a successful conception of a child.

Quantity	Result
Up to 5	Worst indicator. Infertility, in which stimulation will not bring any result.
6 - 10	Indicates violations in the reproductive system of women
10 - 15	Low chance of conception
15 - 26	High chance of pregnancy
Over 26	There is a possibility of developing polycystic

These are glands that are highly likely to develop into a primordial follicle. In the future, he has a chance to evolve into a dominant one, from which the egg will then come out.

Potentially all antral glands have a chance to mature into a full-fledged oocyte. But there can be no more than 500 of them in a woman’s entire life. By the age of 50, a woman’s monthly cycle gradually fades away and reproductive function stops.

The reserve of eggs in a woman in medicine is called the ovarian reserve. It is laid even during the period of being in the mother's womb.

• the formation of FSH (follicle-stimulating hormone) in the pituitary gland begins;
• under the influence of this hormone, the growth of the egg begins;
• layers of protection begin to form;
• the onset of menstruation, marked by the monthly formation of follicles that protect the egg and ensure its release from the ovary.

Primordial follicles represent the primary stage of oocyte defense. This means that they are protected by several layers of granulosa cells and are located in the thickness of the appendages. These follicles are not visible on ultrasound.

Secondary follicles are up to 8 mm in size. Their calculation is carried out on the 7th day from the beginning of menstruation. This information is necessary for the doctor to determine the reserve of eggs capable of fertilization.

• on day 8, they begin to produce estrogens;
• the formation of androgens (androstenedione, testosterone) also begins in the theca cells of the outer layer of the follicle;
• differentiation of the epithelium occurs, it becomes two-layered;
• the amount of fluid increases, due to this, the cavity of the follicle expands.

Measurement of the number and size of antral follicles is of great importance in the process of assisted reproductive technologies. With their size up to 5 mm, ovarian stimulation will be required, with a larger size, fertilization can occur on its own.

Monastic collection helps with such diseases and conditions

1. Diseases of the uterus (myoma, erosion, endometritis, bends and prolapse of the uterus);
2. ovarian cysts, inflammation of the appendages;
3. thrush and bad smell;
4. pain during sex;
5. infertility;
6. discomfort when urinating.

Every year, doctors record more and more cases of women being unable to have children. The development of medicine and technology, unfortunately, does not yet completely cure all disorders of the human genitourinary system.

More and more couples are faced with the need for artificial insemination or surrogacy, and more and more doctors are talking about the importance and necessity of family planning

In this article we will talk about ovulation and the dominant follicle: what does “dominant follicle” mean, whether there are two dominant follicles (in both ovaries), as indicated by the size or absence of a dominant follicle.

The follicle is the container for the egg. In the middle of the development phase, the dominant follicle is quite noticeable - it is the largest and most well developed of all. Every month, the egg matures and prepares for fertilization - the follicle increases 15-20 times, fills with fluid and bursts (approximately on the 14th day of the menstrual cycle).

At the same time, only one of the many (10-15) follicles fully matures and bursts - the rest stop development at different stages and die. This is what is called ovulation. In the case when dominant follicles develop in both ovaries, the probability of conceiving twins increases many times over.

Ultrasound to determine the dominant follicle and monitor it allows doctors to assess the health of women (their ability to conceive a child) and predict the likelihood of pregnancy, indicating the days of maximum chance of conception.

The most common modern method of ovulation stimulation is hormonal therapy, in particular, the appointment of clostilbegit. But, despite the rampant popularity, its use is not always justified. Moreover, some women absolutely cannot use it.

That is why it is so important to be sure of the qualifications of the attending physician and that he has sufficient arguments for prescribing potent drugs. After all, it is known that the higher the effectiveness of the remedy, the higher the likelihood of unwanted side effects and the more diverse and serious they are.

Remember that the selection of drugs to stimulate ovulation and the dosage of the selected drugs are purely individual, in no case should hormone stimulation be used without medical supervision.

Many women note a positive trend after prescribing a course of vitamin therapy and taking folic acid.

The main condition for the successful restoration of ovulation is an adequate determination of the cause of its violation. If this cause has not been identified and eliminated, even repeated stimulation does not always bring results.

Diagnosis of the causes of ovulation disorders cannot be based only on the analysis of basal temperature charts (even if charts of several cycles are available). Diagnosis should be comprehensive - medical examination, analysis of hormonal levels, ultrasound diagnosis of follicle development over a number of cycles (and not as a result of a single visit to the doctor).

An ultrasound examination of women with infertility is done to determine whether the egg is maturing and whether ovulation occurs. The main feature is the dominant follicle before ovulation and its absence after it.

Even in the body of the fetus, when organs are laid in the ovaries, about 500 thousand follicles are formed, some of them regress and about 200 thousand remain in women by puberty. Of these, only a small proportion matures and can participate in fertilization. Therefore, the data obtained during ultrasound examination can help to find out the cause of infertility and start treatment on time.

What does ultrasound show

Capsules with eggs can be easily detected on the screen during ultrasound diagnostics from the fifth day of the cycle. In the future, their dimensions increase. On the 7th day of the cycle, you can see which one is dominant.

On examination, empty follicle syndrome can be detected. This means that the ovary is not able to provide the exit of the gonad. Such a woman needs to get rid of infertility.

Ultrasound is completely safe for the body.

FAQ

This process lasts only 9 days (plus or minus one). Provided that the hormonal background of a woman is stable, ovulation occurs on the 14th day of the cycle.

With a hormonal disorder, too many follicles may be found in the ovary, or vice versa, too few. Sometimes it does not have a sex gland at all.

All these phenomena adversely affect the reproductive function of women.

The reduction of the follicle on the day of ovulation leads to the fact that the egg cannot be released from it. The woman cannot get pregnant. An increase in the Graaffian vesicle indicates a high probability of a cystic process. It also has a negative effect on conception.

In this case, one speaks of its persistence. This phenomenon is considered pathological and requires correction.

Fraternal twins appear from the fact that not one, but two eggs came out of the ovary.

The follicle is the most important structural element of the ovary. The probability of an egg being released and a woman's chances of becoming pregnant depend on their number and development. The discrepancy between its size and number of indicators of the norm is a pathology. Such women should be treated for infertility.

Where do twins come from

The "main" follicle is determined approximately on the 7-10th day of the cycle. All others shrink and naturally die off. But sometimes it happens that there are two “leaders” at once. In a natural cycle (that is, without the use of hormones to stimulate ovulation), this happens quite rarely - in one woman out of ten, and not every monthly cycle.

It happens that two dominant follicles in different ovaries (or in one - this is also possible) ovulate, that is, burst. And then there is a chance that both eggs will be fertilized. So, fraternal twins will be born.

Unlike twins (when one egg is fertilized by two sperm), twins are not the same, not the same person. They can be of different sexes or the same sex, and look alike, like ordinary brothers and sisters.

So, the correct growth of the dominant follicle and subsequent ovulation are clear signs of women's health. And possible violations should alert you (and your doctor), but not scare. Indeed, in most cases, such deviations are successfully treated.

When to go to the doctor?

Both excessive and insufficient number of follicles in the ovaries is a pathology, often ending in infertility. You need to go to the gynecologist when there is a violation of the cyclical nature of menstruation: blood does not appear within the cycle, or appears more than once, or there are vaginal bleeding not associated with menstruation.

Therapy involves taking hormonal drugs. With a follicular cyst, surgical intervention is performed. With an inflammatory reaction in the reproductive system, anti-inflammatory drugs are prescribed. In some cases, stimulation of follicular synthesis with hormones is carried out. But this can lead to multiple pregnancies, since several dominant cells are formed under the influence of hormones. In the absence of a positive effect of therapy, the doctor recommends IVF to a patient who wants to become pregnant.

Is treatment required?

Very often a condition in which small follicles are diagnosed

. If recovery does not occur, treatment is prescribed. Treatment for this condition depends on the underlying cause.

If the woman was taking contraceptives, they should be discontinued. If it turns out that the cause of the pathology is systemic diseases, therapy of the underlying pathology is necessary.

The basis of drug treatment is the use of hormonal drugs. In some cases, the doctor may recommend surgery - ovarian cauterization (elimination of underdeveloped structures). With timely treatment of pathology, ovarian function is completely restored.

This disease can be cured.

: hormonal therapy and physiotherapy. In the first case, the patient takes drugs that normalize the concentration of sex hormones.

If the pathology is accompanied by amenorrhea, estrogen is prescribed first. The course of treatment is usually long, it can last about 2 weeks, if necessary, repeated after a month.

Physiotherapy methods include ultrasound and electrophoresis.

Like any condition that does not fit into the normal range and is detrimental to health,

Several specialists deal with the problem at once: a gynecologist, an endocrinologist, a nutritionist. The main task facing doctors is the elimination of all symptoms and the restoration of normal ovarian activity.

If the ovaries cannot fully perform their function, then the woman's body begins to age faster. Naturally, this negatively affects not only her physical, but also her psychological state. Therapy is selected depending on the cause of the disease. However, the most commonly required treatments are:

1. Replacement hormone therapy. A woman has to use drugs that artificially normalize the balance of sex hormones. If the patient has amenorrhea, then estrogens are prescribed to her in the first place.
2. Physiotherapeutic procedures: electrophoresis, ultrasound.

A good help in the fight against pathology are folk remedies. But they should be used only after consultation with the doctor. The following recipes are considered useful:

1. Infusion or decoction of the hog uterus. This herb is the leader among all the plants used to treat gynecological problems. It restores normal hormonal levels. However, during the use of prepared products, the dosage must be strictly observed. And between courses of therapy it is necessary to take breaks. The decoction is prepared very simply: 1 tbsp. l. raw materials are poured into 300 ml of liquid and boiled for 10 minutes. It is necessary to insist the remedy for the same amount of time. Drink 1 tbsp. l. up to 5 times a day. A decoction is taken for 3 weeks, after which it is necessary to take a break for 7 days. Treatment should be continued until the woman's condition improves.
2. Evening primrose oil. The presented remedy is considered a natural stimulant of the female reproductive system. The drug is recommended for those patients who are diagnosed with single follicles or ovarian failure syndrome. Additionally, vitamin E is used. Take the remedy as follows: in 1 tbsp. l. oil dissolves the capsule of the vitamin, after which the mixture is drunk. This is done three times a day, 60 minutes before meals.
3. Cabbage juice. Drink it should be half a cup a day. It is better to do this in the morning, before meals.
4. Beet juice. Positively affects the production of estrogen. Fresh juice should be diluted in half with cold water. It should be taken once a day for 1 tbsp.
5. A decoction of the red brush. It is required to fill a glass of water with 1 tbsp. l. dry herbs and boil for 20 minutes. Further, the product is cooled and consumed before meals, 1 tbsp. l.

Naturally, folk remedies are able to restore the normal function of follicle formation, but this method of treatment must be authorized by a doctor. Excessive stimulation of the ovaries can only hurt.

If conservative treatment fails, then surgery may be used. In the presence of only 3-4 follicles in the ovary, a woman is able to become pregnant only through IVF.