A dominant follicle is formed in the female body at the stage of ovulation. Based on the results of its development, doctors assess the woman’s general health and make predictions regarding the likelihood of conception. Minor pathologies or deviations in the development of the dominant follicle can cause the formation of a cyst or infertility.
The dominant follicle develops in several stages. Each stage of follicle formation has its own name:
- primordial;
- preantral;
- antral;
- dominant.
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The primordial follicle is an immature egg. Such a follicle is surrounded by a connective membrane. The follicle is located in the subcapsular zone. At this stage of development, the follicle has a flat shape. During the menstrual cycle, approximately 3 to 30 follicles can be formed. And only a few of them are able to move to the next stage.
When follicles enter the process of maturation, they are called preantral. They increase in size and are surrounded by a membrane. In this case, the production of estrogen increases. The follicles acquire a cubic shape with a shiny shell, which consists of complex proteins. They are located in two layers near the reproductive cell.
At the next stage of development, secondary, or antral, follicles are formed. The cells of the granulosa layer enlarge and produce follicular fluid. The epithelium becomes multilayered. The follicle may have several cavities with a fluid base that contain estrogen. The secondary follicle differs from the primary one in that it has an additional membrane around it. As a rule, this stage is observed on days 7-9 of the menstrual cycle.
The next stage of folliculogenesis is considered final. At this stage, the dominant, largest follicle is formed, which contains many cells of the granulosa layer. It is he who helps determine the onset of ovulation in a woman. Due to the increase in the amount of follicular fluid during ovulation, the follicle reaches about 20 mm in diameter. It rises above the surface of the ovary with one wall. Its other side is located in the center of the ovarian stroma. In the center of the tubercle is the egg. The outer layer of the follicle consists of connective tissue.
Multiple follicles
If the number of follicles in the ovaries exceeds 10, then this is a deviation from the norm. This pathology can be detected using intravaginal ultrasound. Multiple follicles can appear at any time during the menstrual cycle. This phenomenon does not always indicate the presence of any disease. The reason for the formation of multiple follicles can be stress, severe emotional stress or overwork. In most cases, the number of follicles returns to normal after ovulation.
The causative factor may be sudden weight loss or, conversely, obesity. Endocrine disorders in the body can provoke pathology. In some cases, the cause of the pathology is the use of hormonal contraceptives or excessive production of prolactin. In medical practice, this disorder is called polycystic disease.
To determine the root cause, it is necessary to undergo a series of tests and be examined by a gynecologist. Once the diagnosis is confirmed, doctors prescribe a treatment regimen. The main goal of therapy is aimed at reducing the level of male hormones and normalizing the menstrual cycle if it is disrupted.
In addition, doctors prescribe a low-calorie diet. Antiandrogens, ovulation-stimulating drugs, metformin and hormones are prescribed. If drug treatment is ineffective, then doctors use a radical method. In this case, they perform a puncture. This procedure evaluates follicular fluid and determines the underlying cause.
The puncture is performed using a special thin needle under ultrasound control. The removed follicular fluid is sent for further laboratory examination.
Self-medication can lead to an increase in male hormone levels. Doctors do not recommend treatment with folk remedies or drinking various herbal infusions or decoctions.
Lack of dominant follicle
During an ultrasound of the pelvic organs, the dominant follicle may not be identified. Its absence indicates that ovulation has not occurred. This phenomenon can occur for several reasons. Firstly, the follicle may develop slowly and not have time to reach the desired size. In this case, ovulation does not occur, but hormone tests remain normal. Secondly, the follicle develops to the desired size, but does not burst, that is, it remains without the onset of ovulation. Thirdly, the follicle may at some point stop developing and stop at one of the phases. And fourthly, the reason for the absence of a dominant follicle can be dormant ovaries.
The absence of follicles may be due to early menopause. Over the course of a lifetime, the ovaries produce a certain number of follicles. Therefore, in case of any deviation from the norm, be it their absence or excess, you must consult a doctor. Without appropriate treatment, a woman can become infertile.
It is possible to grow a dominant follicle only after determining the cause of its violation. If the cause has not been eliminated, then the treatment will not bring the desired result. In this case, a comprehensive diagnosis is carried out. Doctors order intravaginal ultrasound over a number of cycles. The woman also undergoes an examination by a gynecologist and undergoes a series of tests. When ovulation is restored, doctors prescribe hormonal therapy, including Clostilbegit. In addition, doctors provide a course of vitamin therapy and folic acid. Positive dynamics can be achieved only with the right drug and dosage.
In some cases, a dominant follicle can be found in 2 ovaries at the same time. The menstrual cycle is not disrupted, and ovulation occurs in 2 ovaries at the same time. This phenomenon is considered normal. In a woman, the maturation of dominant follicles on both ovaries indicates that there is a high probability of conceiving twins. However, this phenomenon occurs infrequently. According to medical statistics, the dominant follicle of the right ovary is more common than the left one.
Causes of developmental pathologies
One of the reasons for pathological development is that the dominant follicle does not rupture. This phenomenon is called a follicular ovarian cyst. The follicle may not rupture due to a hormonal disorder. The development of cysts can also be triggered by excess estrogen or lack of progesterone in the second phase of the menstrual cycle. In this case, ovulation does not occur, and the follicle develops into a cyst. The formation can reach a diameter from 20-30 to 60-100 mm.
A strict diet, chronic diseases, mental disorders, overwork, numerous abortions, irregular sex life, genital surgery and diseases of the pelvic organs can lead to the appearance of a follicular cyst.
A follicular cyst can cause menstrual irregularities. Often, during an ultrasound, such a formation is discovered instead of pregnancy. If during the examination a cyst was discovered on the ovary, the doctor will prescribe a test for tumor markers in order to make sure that it is indeed follicular. If the test results are negative, the doctor prescribes treatment. Radical treatment methods are not carried out, since ovarian rupture may occur if the follicle ruptures.
Therefore, the doctor prescribes more gentle methods. Treatment is mainly carried out with progesterone drugs. The cyst resolves and the menstrual cycle is restored. In addition, doctors prescribe vitamins and antibiotics. Physiotherapy shows good results for follicular cysts.
If drug treatment does not bring results and the follicular cyst continues to grow, then doctors perform surgery.
Today, the safest and most reliable surgical method for treating follicular cysts is laparoscopic intervention. The operation is performed under local anesthesia and takes no more than half an hour.
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To perform the operation, the doctor makes a small incision in the abdominal cavity. The surgeon then inserts a special tube into this incision, at the end of which there is a surgical instrument and a camera. The video camera transmits an enlarged image to the monitor. For a clearer picture, the doctor administers a small amount of gas, which straightens the internal organs. After obtaining a clear image, the surgeon excises the follicular cyst.
When removing a tumor, traditional surgery methods can be used, which are performed through an incision in the abdominal cavity. When performing a cystectomy, doctors excise only the follicular cyst. The functions of the ovary are fully preserved. If during the operation damaged ovarian tissues were discovered, doctors remove them along with the formation. In this case, reproductive function is preserved. If the follicle bursts and the ovary ruptures, doctors completely remove the damaged ovary.
Conception occurs due to ovulation. It is provided by one leading follicle, in the depths of which the egg matures. If there is no dominant follicle for several cycles, this indicates infertility.
How the “dominant” develops, why in some cases it does not exist, read our article.
Follicle maturation: how it should be
A certain number of eggs are laid in the ovaries of each girl during the period of intrauterine development. Before puberty, they are in a “dormant” state, and with the onset of the menstrual cycle they begin to function.
The growth and death of the follicles in which the egg develops occurs monthly. In this case, follicular development goes through several stages.
At the beginning of the cycle, the growth of several follicles begins, which are of the same size. However, around the 9th day of the cycle, a leader begins to clearly stand out among them: a follicle that is significantly larger than the others in size (it is also called the Graafian vesicle). Its diameter can reach 15 mm. From the moment the dominant is isolated, the remaining follicles begin to regress, that is, decrease in size and gradually die.
Approximately on the 14th day of the cycle, the dominant reaches its maximum size (from 18 to 24 mm) and ruptures, “releasing” a mature egg. Ovulation occurs.
In place of the bursting dominant follicle, a corpus luteum begins to form. Its task is, in case of successful conception, to supply the woman’s body with the hormone progesterone necessary for pregnancy.
A dominant can develop on any ovary. Although most often it is observed on the right. There are frequent cases of the development of a dominant follicle on both ovaries. This mainly occurs after stimulation of ovulation or during artificial insemination. In this case, the chances of conceiving twins or triplets are high. If an ultrasound reveals that there is no dominant follicle in a woman’s ovaries, ovulation, and therefore conception, cannot occur.
Additional examinations
Anovulatory cycles, when the dominant does not develop, occur several times a year in every healthy woman. This phenomenon is not pathological. During these periods, the ovaries “rest”.
In addition, after 30 years there is a slow but steady increase in anovulatory cycles. Early menopause, which occurs before the age of 45, also guarantees frequent anovulatory cycles. Despite the fact that women at this age rarely plan pregnancy, gynecologists believe that these deviations cannot be ignored and prescribe appropriate hormonal therapy.
If such disorders are recorded in young women of childbearing age every month, this indicates pathological changes that require mandatory treatment.
Why the follicle does not grow or is not able to “release” a mature egg at the time of ovulation, only the attending physician can answer after a series of studies:
- Examination on a gynecological chair;
- Blood tests to detect levels of important hormones at different stages of the menstrual cycle;
- Folliculometry is an ultrasound diagnostic procedure during which the entire process of ovarian function during the menstrual cycle is monitored monthly.
The gynecologist also pays attention to the length of the menstrual cycle. A cycle that is too long or short is often evidence of ovulation disorders.
Most often, the absence of a dominant is associated with hormonal imbalance. The process of proper development of follicles is influenced by several hormones: luteotropic, follicle-stimulating, estrogen and progesterone. Each of these hormones is important at a certain stage of egg maturation. Their insufficient quantity or incorrect distribution leads to problems with the maturation of the dominant.
How does the follicle behave?
There are several reasons why there is no dominant follicle or its development is pathologically altered. But in any case, with these disorders, ovulation does not occur. Let's consider exactly how the “wrong” follicle can behave.
Persistence
If a woman has a lack of LH or progesterone, it develops instead of the dominant one.
The development of the follicle reaches the size required for ovulation, but it cannot rupture, releasing the egg. Therefore, she remains in his body.
A characteristic feature of persistence is the ability of the dominant to remain on the ovary throughout the entire period of the menstrual cycle. Moreover, it is often recorded even after the end of menstruation.
Signs of the development of a persistent follicle:
- The corpus luteum is absent;
- The amount of estrogen is increased;
- The amount of progesterone is reduced;
- Lack of fluid behind the uterine cavity.
"Sleeping" ovaries
The follicles do not mature, they do not grow at all, so ovulation cannot occur.
Follicular growth disorder
In this case, they mature poorly, and stopping at a certain phase of development, they begin to regress. Or the dominant develops successfully, but does not reach the required size by the ovulation phase. A blood test for hormones will be normal.
Ovarian cyst
If the dominant follicle continues to grow without releasing an egg, it will give rise to a follicular cyst. This benign formation appears if there is no ovulation. The cause of this pathological change is hormonal imbalance, which most often occurs due to dysfunction of the cerebral cortex. The appearance of a follicular cyst is also influenced by the following factors:
- Poor nutrition;
- Chronic diseases;
- Irregular intimate relationships;
- Mental disorders;
- Frequent abortions;
- Surgical intervention for diseases of the genitourinary area.
A follicular cyst can affect the regularity and duration of the menstrual cycle.
A cyst-like change may also appear at the site of formation of the corpus luteum. After a follicle bursts, liquid always remains. If its amount exceeds the norm or contains blood, a cyst appears on the corpus luteum.
In most cases, such cystic changes do not require special treatment. They disappear on their own after 2-3 cycles, and if conception occurs, by the beginning of the second trimester.
What treatment is prescribed if there is no dominant
Problems of missing dominant follicles most often affect women who have been diagnosed with inflammatory diseases of the genitourinary area. Prolonged stress and depression, abortions also lead to impaired maturation of the dominant follicle.
A gynecologist will tell you what to do to restore proper functioning of the ovaries after a comprehensive diagnosis, which we discussed above. Hormone therapy is most often prescribed.
Gynecologists often prescribe. This drug is popular in Russia, but it must be used with great caution and only under the supervision of the attending physician: the drug has many contraindications. In addition, some patients are strictly prohibited from using it.
It should be remembered that any potent hormonal drugs, if taken uncontrolled, can harm health rather than help. Therefore, self-medication in this case is unacceptable.
To maintain the reproductive system, folic acid and multivitamins are also prescribed. In this case, the selection of drugs and dosage are selected individually, depending on the age and general health of the woman.
At a consultation with a gynecologist
Obstetrician-gynecologist Elena Artemyeva answers patients’ questions.
—I am 24 years old. I have never been pregnant. Menstruation is scanty, cycle is 20 days. I took Cyclodinone for four months (prescribed by a doctor), my cycle became longer. But now at the end of the cycle I feel very unwell. An ultrasound scan of the ovaries did not show dominant follicles. How to cure it? Is it necessary to take hormones? I'm afraid of gaining weight due to hormonal treatment.
- You need to undergo an in-depth examination. You will have to donate blood for hormones twice: on the fifth-seventh and twentieth-twenty-third days of the cycle. Your gynecologist will tell you which specific hormones to test for. Be sure to visit an endocrinologist and undergo an examination to rule out pathologies of the thyroid gland and pituitary gland. You may need to do an MRI of the brain.
Depending on the results, treatment will be prescribed. You may need stimulation with hormonal drugs for the growth of dominant follicles and ovulation. In most cases, they do not cause sudden weight gain, don't worry.
— I took Regulon for four years, I stopped it six months ago. Pregnancy does not occur. The cycle is 34-36 days. The ultrasound did not show a dominant follicle or corpus luteum. Can I get pregnant?
— Normally, after oral contraceptives, ovulation is restored within 2-4 months. Your case is not the norm. You need to contact an endocrinologist or, better yet, a gynecologist-endocrinologist and examine your hormonal profile, in particular, you need tests for insulin, prolactin, TSH, as well as “female” hormones. After the examination, you will be prescribed treatment. Will you be able to get pregnant? Why not, if ovulation and normal cycle are restored? In most cases, hormonal imbalances can be corrected.
“I haven’t been able to get pregnant for two years.” Could it be that the follicle first grew to 8 mm (on the 7th day of the cycle), and then, on the 11th day of the cycle, became smaller - 6 mm. This is the result of my folliculometry...
- This is a sign of ovarian dysfunction. Get tested for hormones (sex, thyroid, insulin, prolactin). Depending on the results, you will be prescribed treatment. It is also important for the husband to be examined (in general, examination of a couple always begins with confirmation of the man’s fertility). Let him do a spermogram.
What it is?
The latter is surrounded by epithelium and two-layer connective tissue. The key role of this vesicle is to protect the egg from the negative influence of external factors.
It is inside it that the egg matures. And the maturation of the egg, and, consequently, depends on how good such protection is.
It's no secret that girls' reproductive system is formed even before birth, in the womb. Actually, at the same time the development of the follicular apparatus occurs. Already at this time, a certain number of follicles was determined, which will be constant throughout life. Between 50,000 and 200,000 is considered adequate.
Reference! After the birth of a girl, a new stage in the development of her reproductive system begins - the so-called postnatal period.
As is known, in the body of each representative of the fairer sex, one egg matures once per cycle. If fertilization occurs, then conception occurs. If this does not happen, then the shell is released from the undeveloped egg, and a new menstrual cycle begins.
Stages of development
Experts divide follicles into dominant and dominant. The latter are the largest and most developed in the ovary. By the very middle of the cycle, several follicles mature in the female ovaries. One of them subsequently becomes the most important. All others dissolve over time.
Before a follicle becomes dominant, it must go through several stages:
- the appearance of antral follicles;
- development and growth of small;
- maturation of dominants;
- ovulation.
If all these stages have passed without any disturbances or difficulties, then an egg is released from the mature follicle, which allows you to conceive a child.
Peculiarities
As noted above, the development of the leader occurs, as a rule, in the right ovary. This is due to the fact that in women of reproductive age the right gonad is characterized by greater activity.
However, egg formation and maturation can also occur in the left ovary. The most important thing in this case is that from the mass of antrals, the formation of one dominant one occurs. If it ruptures and releases the egg, then we can assume that the ovulation process was successful.
At the moment when potential mothers are ovulating, the size of the dominant follicle reaches 18-22 mm in diameter. At the moment when luteinizing hormone is released into the blood under the influence of estrogen, it ruptures and ovulation occurs.
In a situation where large follicles develop in parallel in the ovaries on both sides, two mature eggs are released simultaneously, as a result of which there is a possibility of a multiple pregnancy. Thus, a woman has a chance to become pregnant with twins.
Ultrasound tracking
According to experts, in normal condition the largest follicle can be identified by ultrasound starting from day 5-8. By this point, it is larger than the others. This is due to the influence of follicle-stimulating hormone.
A reduction in the amount of this hormone risks the fact that the largest follicle does not grow to the appropriate size and the process of its development begins in the opposite direction.
It may happen that ovulation does not occur if sclerosis of the ovarian membrane has developed. In this situation, it can continue to develop further, leading to the appearance of a cyst.
After ovulation, such a follicle disappears, and it can be observed in this area. In some cases, overripening may occur when the size reaches 21-23 mm. This indicates, .
As practice shows, the development of a dominant follicle most often occurs in the right ovary.
Evidence of this is the very frequent detection during ultrasound of the corpus luteum in the ovary on the right side and ectopic pregnancy, accompanied by rupture of the tubes on the right side.
How to explain this is still unknown. However, there is a theory that the formation of a dominant follicle on the right side occurs more often in those who write with their right hand.
Reference! This happens due to the high nervous stimulation carried out by the nervous system.
It is ultrasound that makes it possible to understand who is to blame for developing infertility. This research technique in medicine is called folliculometry. The patient undergoes an ultrasound scan over several days during the expected period. It is at this time that it is possible to identify the absence of a dominant follicle or pathology in its development.
Common deviations
As you know, the release of an egg will not happen under any circumstances if the dominant follicle is absent.
This can occur due to hormonal imbalance and the presence of a number of pathologies:
- Low levels of follicle-stimulating hormone or elevated levels of luteinizing hormone can lead to the absence of a leading follicle.
- Hormonal disturbances, for example, high levels of insulin in the blood, can lead to regression or atresia.
- If ovulation does not occur, then it is possible to observe a persistent follicle on ultrasound.
- The leading follicle can also form a follicular cyst, which will continue to grow. If there are many such cysts, then polycystic ovary syndrome develops.
- The process of luteinization, when instead of the so-called leading follicle without the process of ovulation, the formation of the corpus luteum occurs.
If it so happens that a woman, after repeated unsuccessful attempts to conceive a child, was unable to do so, and this was caused by one of the listed pathological processes, then she needs highly qualified help from a medical specialist. It is he who will prescribe the medications that will stimulate the ovulation process. The effectiveness of the course of therapy can be monitored using ultrasound results.
Dominant follicle - what is it, we can say that it is the largest, most developed follicle. In accordance with physiology, in a woman’s body, in the initial phases of the cycle, several follicles develop and mature, but it is the one that is larger in size than 15 mm or more that is dominant.
Number of follicles.
If we talk about how many follicles there should be in the ovary, then at the very beginning it is worth saying that the number of primordial follicles at the time of a girl’s birth varies between 1-2 million, at the time of her puberty - there are about 250-300,000.
The normal number of follicles in the ovaries in a woman’s reproductive age depends on the current day of the cycle - on days 6-7, their number varies from 6 to 10, and from day 8 to the tenth, one, the largest, the so-called dominant follicle is formed. As doctors themselves note, it is rare that a woman’s body can develop 2 or more dominant follicles, which increases the chances of a multiple pregnancy.
Stages of follicle development.
In its development, the follicle goes through the following stages and each of them has its own medical name:
- A primordial follicle is an unripe egg. It is a follicle surrounded by a connective type of membrane - so throughout the entire cycle, a woman produces from 3 to three dozen of them in the body, they gradually grow and transform into the primary type.
- Preantral type of follicle - in this case, the oocyte is increased in size and surrounded by a membrane. At this stage, the level of production of female hormones estrogen in a woman’s body is increased.
- Antral follicle - what is it? This is the so-called secondary follicle - at this stage, the cells of the granulosa layer are enlarged, which provoke an increase in follicular fluid. This period of follicle development occurs on days 8-9 of the cycle.
- The cycle ends with the formation of a dominant follicle, the most important of all just before ovulation. It is the dominant follicle that is the largest of all.
At each stage, as the main, dominant follicle grows and develops, the number of all others will gradually decrease.
If there are more follicles than normal?
Any deviation in the direction of decrease or even increase is a pathology, and if a woman has more than 10 follicles detected by ultrasound, we are talking about a phenomenon called multifolliculation. During the examination, you can see a large number of bubbles on the ultrasound monitor - follicular ovaries, but if their number increases significantly, then a diagnosis of polycystic disease is made.
This phenomenon interferes with the full formation and development of the dominant follicle, natural ovulation, and subsequent conception. The reason for this phenomenon can be very different, ranging from chronic fatigue and stress to incorrect and long-term use of contraceptives, a malfunction of the endocrine system, sudden weight gain or loss. To normalize the process of production and maturation of follicles, it is necessary to eliminate the root causes of the pathology - only then can we talk about the normal process of formation of the dominant follicle, subsequent ovulation and conception.
There are few follicles in the ovaries - what to expect?
Few follicles in the ovaries can also be caused by various factors and reasons - ranging from a malfunction in the hormonal system and a decrease in hormone levels to early menopause. In this case, it is worth undergoing an examination using an ultrasound, a vaginal sensor, diagnosing the causes and completing the course of treatment prescribed by the doctor. If an ultrasound scan shows from 7 to 16 follicles in a woman’s ovaries, the probability of conceiving is high; from 4 to 7, the chances of pregnancy are small; up to 4, there may be no conception.
One ovary contains several dominant follicles.
In the process of treating female infertility, doctors most often use a course of hormone therapy, and as a result, 2 or more dominant follicles can develop in one ovary. This phenomenon is rare, but it can cause the birth of twins, and if in a short period of time a woman has had contact with different partners, each egg may be fertilized by a different man and the children may have different fathers. Most often, two follicles are formed in the right ovary rather than in the left - it is impossible to understand the reason for this nature of this phenomenon, and doctors have not yet undertaken to put forward their theories.
If there is no dominant follicle.
If an ultrasound does not reveal a dominant follicle in time, doctors note that several reasons can provoke this condition. In particular, such root causes may be:
- the doctor does not detect the follicle on time by ultrasound due to the fact that the latter has not yet reached its size - this will indicate that ovulation as a physiological process has not yet passed, and the tests themselves for hormone levels remain normal;
- the follicle in the woman’s body has developed to the required size, but it does not burst - as a result, ovulation does not occur;
- the follicle itself at a certain stage of its development may stop developing and growing;
- diagnosing the patient's so-called dormant ovaries
The absence of a dominant follicle may be due to early menopause, as well as in the case of:
- failure of the ovaries and failure of the endocrine system, when there is an increase or decrease in the female hormone in the blood;
- with damage to the pituitary gland or hypothalamus;
- in the case of an inflammatory or infectious nature of the disease affecting the organs and systems of the pelvis;
- with frequent, chronic stress and constant fatigue, physical overload;
regression or aggression that develops due to hormonal imbalance in the body, including when the level of insulin in the blood increases;
What should you do?
First of all, it is worth undergoing a full and comprehensive examination - this will help to identify the root cause of pathological changes, if any, and then prescribe a course of treatment. Diagnosis is carried out not only on the basis of measuring basal temperature, but also by conducting an examination using ultrasound of the development of follicles on the 8-10th day of the menstrual cycle, taking laboratory tests for hormone levels at various stages of the menstrual cycle.
How to grow a dominant follicle?
How to increase the number of follicles in eggs - stimulate ovulation. In this case, doctors prescribe a course of hormonal therapy - most often a drug such as Clostilbegit or another drug is prescribed, selected taking into account the individual characteristics of the woman’s body and the root cause that provoked the pathology. Also, many patients note positive dynamics of treatment after a course of taking folic acid, as well as a course of vitamins. The main thing is not to self-medicate, but to strictly follow the doctor’s recommendations.
Folk remedies.
Many women also note the high effectiveness of using remedies from the arsenal of traditional medicine to stimulate - most often, medicinal herbs are used for this, individually or in combination, such as boron uterus, sage and red brush. It is these herbs, according to traditional healers, that stimulate the development, growth and maturation of the follicle, the release of the egg and the growth of the necessary endometrium. It is enough to steam 1 tbsp. l. per glass of boiling water of a medicinal plant or collection, leave for half an hour and take for a month.
Contraindications to stimulation.
First of all, doctors note that stimulation is not carried out in the case of diagnosing male type infertility, when both partners must undergo examination, as well as when:
- uterine pathologies;
- diagnosing acute inflammatory processes occurring in the organs and systems of the pelvis, affecting the woman’s reproductive system;
- with obstruction of the fallopian tubes;
As medical practitioners note, stimulating ovulation and the development of the dominant follicle after 35-36 years should become a regular procedure for all women before a planned pregnancy. Regarding the duration of the stimulation course, its duration should not exceed 6 menstrual cycles. If pregnancy has not occurred within a given period of time, then in addition to the failure of the dominant follicle to mature and the absence of ovulation, the causes of infertility are other, more serious diseases and pathologies.
Follicles in the ovaries are necessary for a woman’s reproductive function. Ovulation - the release of an egg for subsequent fertilization - is impossible without their participation. The regular course of menstruation in most cases indicates the absence of disturbances in their functioning. Failure of their function occurs due to pathologies of the reproductive or endocrine sphere.
Description
Follicles are found in every appendage of a woman. All of them cannot be functional at the same time. Their maturation occurs gradually, during each menstrual cycle.
Structure
The follicle is an oocyte - a spherical cell. Its initial size does not exceed 25 microns. It is protected by a double layer of connective tissue and surrounded by epithelial cells. In its center there is a nucleus and a germinal vesicle, from which the egg develops. The latter in its mature state is considered the largest cell in the body. Follicular fluid in the structure of the ovarian follicle is formed when it begins to grow. Such a vesicle is highly likely to rupture during the current menstrual cycle.
Purpose
The follicle is necessary to protect the egg from external influences. He provides her with favorable conditions for development. When the female cell is almost completely mature and the vesicle begins to grow in the first phase of the cycle, its fluid produces estrogen. When the latter reaches peak values, the level of luteinizing hormone increases sharply - it stimulates the rupture of the membrane for the release of the egg. This occurs in the middle of the cycle, when the follicle in the ovary has matured, and is called ovulation. This is where the functions of the bubble end.
Subsequently, the remains of the membrane are used to form the corpus luteum, which regulates the last phase of the menstrual cycle.
Kinds
The types of follicles differ in their degree of maturity. This determines its diameter and the likelihood of rupture in the current menstrual cycle.
Primordial
A vesicle that is at rest is considered primordial. This is the primary form of its development - it is in this state that it remains most of the time in the appendages of a woman. It contains an immature egg and does not increase in size. Its growth is possible in subsequent menstrual cycles.
Primary, or preantral
Develops from the primordial. The size of the primary sac increases slightly compared to the previous phase of its development. This occurs at the beginning of the menstrual cycle. Such vesicles contain a small volume of fluid, but are capable of producing sex hormones.
Secondary or antral
During this period of development, the fluid surrounding the egg is actively produced. More and more sex hormones are produced. Antral vesicles with a diameter of 7-11 mm are formed on days 8-9 of the monthly cycle. During menopause, the number of such follicles in the ovary is reduced to a minimum, sometimes they are completely absent.
Tertiary, or preovulatory, or mature
This type is most often called a dominant, or graafian vesicle, and is considered the peak of development. It reaches 18-22 mm in diameter, most often one or two such follicles are located in one ovary. The Graafian vesicle is formed by days 14-16 of the cycle. Its cavity contains a large volume of follicular fluid. The latter produces the maximum amount of estrogens, which contributes to the rupture of the membrane for the release of the egg.
The role of the dominant follicle
The functionality of Graaf's vesicle determines the likelihood of ovulation occurring. In order for its membrane to burst, it must produce the maximum amount of estrogen. The latter stimulate the pituitary gland, which produces luteinizing hormone, which triggers the ovulation process. 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 ruptures.
The moment of ovulation is the most favorable time for conception. It lasts only a few days, and the egg itself is considered viable only for one day.
The dominant follicle is formed in the left or right ovary. In most women, the right appendage is considered more active - it is also responsible for the production of sex hormones and 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.
