The size of the dominant follicle from the first day of the cycle to ovulation. Infertility and its treatment Follicle size 33 mm is ovulation possible

Every month, an egg matures in a woman's ovary. It comes out of a special “bubble”, which is formed before birth, gradually matures, and then bursts. This “bubble” is the dominant follicle. Sometimes it is called dominant, but doctors prefer the first option.

The size of the follicle by day of the cycle is very important. A woman’s ability to conceive depends on this factor.

What is a dominant follicle? This is a “leader” who has surpassed his “colleagues” in growth and development. Only it has a chance to burst and produce a mature egg, which will then be fertilized by a sperm. Doctors distinguish four stages of its development:

What should a follicle look like on different days of the cycle: medical norms

If you were told on an ultrasound that there is a dominant follicle in the left ovary (or in the right, it doesn’t really matter), you need to ask about its size. Unfortunately, it happens that the size does not correspond to the day of the cycle, that is, a full-fledged egg does not mature.

The size of the follicle by day of the cycle depends on the length of the menstrual cycle (namely, its first phase). The longer it is, the slower the egg matures, and the smaller it is on a certain day. For example, on the 10th day of the cycle, a follicle of 10 mm can be considered a relative norm if the monthly cycle is 35 days. But with a cycle of 28 days, this is no longer the norm.

If the cycle, on the contrary, is short, then the follicle will mature faster and reach its maximum size already on day 11-12.

Therefore, the standards that we present below should not be taken as absolute. Much depends on your individual characteristics. But they will be useful for reference. So, here are the norms for a healthy woman with a 28-day menstrual cycle.

• From days 1 to 4 of the cycle, several antral follicles measuring 2-4 mm in size can be seen on ultrasound.
• Day 5 – 5-6 mm.
• Day 6 – 7-8 mm.
• Day 7 – 9-10 mm. The dominant follicle is determined, the rest “lag behind” it and no longer grow. In the future, they will decrease in size and die (this process is called atresia).
• Day 8 – 11-13 mm.
• Day 9 – 13-14 mm.
• Day 10 – 15-17 mm.
• Day 11 – 17-19 mm.
• Day 12 – 19-21 mm.
• Day 13 – 22-23 mm.
• Day 14 – 23-24 mm.

So, from this table it can be seen that normal growth is approximately 2 mm per day, starting from the 5th day of the MC.

If the size does not correspond to the standards

If the follicle is 11 mm on the 11th day of the cycle or 13 mm on the 13th day of the cycle, then this size is not normal. This means that the egg matures too slowly and ovulation is unlikely. The reason for this condition is most often hormonal abnormalities: improper functioning of the thyroid gland, pituitary gland, ovaries, or this entire “ligament”.

This condition requires additional examination (in particular, you need to find out the level of hormones) and medical correction. Gynecologists often use hormonal drugs, but this does not always happen. In some cases, vitamins, drugs that improve blood circulation, herbal medicine, and physiotherapy are sufficient.

Experienced doctors know: many women do not ovulate every cycle. And they are in no hurry to prescribe hormonal drugs based on folliculometry for only one month. Perhaps in the next cycle the egg will mature at the “correct” speed.

Sometimes anovulation (lack of ovulation) is associated with natural causes:

• Stress, overwork, lack of sleep;
• Poor nutrition (strict diets, in particular low-fat diets);
• Obesity or extreme thinness;
• Heavy physical work or exhausting sports training.

If these factors are excluded, there is a chance that ovulation will return on its own.

Ovulation size

When a follicle bursts, at what size does ovulation occur? This usually happens on days 12-16 of the menstrual cycle. With a 28-day cycle, ovulation occurs around day 14 (plus or minus two days). With a 30-day cycle – on the 15th day.

At ovulation, the follicle size is 24 mm. The minimum figure is 22 mm.

In order for a follicle to burst, the coordinated action of various hormones in a woman’s body is necessary. Namely - estradiol, LH, FSH. After ovulation, progesterone also enters the process.

How to understand that ovulation has occurred? The following methods will help you:

• Folliculometry (a type of ultrasound). This is by far the most reliable method;
• Ovulation tests. They are quite truthful and easy to use, but are not 100% accurate;
• . In this case, it is necessary to build a BT schedule: the method is painstaking, not always reliable, but accessible.

Some girls (although not all) feel ovulation physically, here are the characteristic symptoms of follicle rupture:

• Pulls the lower abdomen and lower back;
• There may be slight bleeding in the middle of the cycle;

Some experience irritation and increased fatigue. Others, on the contrary, experience a surge of strength and sexual energy.

Now the egg has 12-24 hours to meet the sperm. If this does not happen, it will regress, and after 12-14 days your period will come.

If the follicle does not burst

It happens that a follicle that has reached 22-24 mm in diameter does not burst, but turns into a follicular cyst. This occurs due to a deficiency of certain hormones in the body. This condition can be determined by ultrasound.

Sometimes the cyst is single, and it “resolves” on its own. If this does not happen, then first they try to eliminate it with medication. And only if it is large and does not decrease in size, then they resort to surgical intervention.

Sometimes there are many such cysts. They deform the ovaries and interfere with their proper functioning. This condition is called polycystic ovary syndrome and requires treatment.

If it turns out that the dominant follicle in the ovary matures but does not burst, then doctors can use hormonal drugs. For example, .

Where do twins come from?

The “main” follicle is determined approximately on days 7-10 of the cycle. All others shrink and die naturally. 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. This means that fraternal twins will be born.

Unlike twins (when one egg is fertilized by two sperm), twins are not identical, not identical. 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 frighten them. Indeed, in most cases such deviations are successfully treated.

The female body is periodically rebuilt (natural cyclical changes) due to the influence of hormones that control complex mechanisms relating to its reproductive system (the set of organs that ensure the process of fertilization). For pregnancy to occur, a mandatory condition must be met - the growth and normal development of ovarian follicles, which act as a kind of “containers” for already

Interpretation of the concept of “follicle”

This is a small anatomical formation that looks like a gland or sac filled with intracavitary secretion. Ovarian follicles are located in their cortex. They are the main reservoirs for the gradually maturing egg.

Initially, the follicles in quantitative terms reach significant values ​​in both ovaries (200 - 500 million), each of which, in turn, contains one germ cell. However, during the entire period of puberty, women (30-35 years old) reach full maturity only 400-500 specimens.

Internal processes of follicle evolution

They occur in their sacs and are characterized by the proliferation of granulosa or granular cells that fill the entire cavity.

Then the granular cells produce a fluid that pushes and pushes them apart, directing them towards the peripheral parts of the follicle (the process of filling the internal cavity with follicular fluid).

As for the follicle itself, it increases significantly both in size and volume (up to a diameter of 15-50 mm). And in terms of content, it is already a liquid with salts, proteins and other substances.

On the outside, it is covered with a connective tissue membrane. And it is precisely this state of the follicle that is considered mature, and is called the Graaffian vesicle (in honor of the Dutch anatomist and physiologist Rainier de Graaff, who discovered this structural component of the ovary in 1672). A mature “bubble” interferes with the maturation of its colleagues.

What size should a follicle be?

With the onset of puberty (14-15 years), he completely completes his development. It is considered normal if during the follicular phase, when the menstrual cycle begins, several follicles mature in both ovaries, of which only one reaches a significant size, which is why it is recognized as dominant. The remaining specimens undergo atresia (reverse development). The product of their vital activity is estrogen - a female sex hormone that affects fertilization, childbirth, as well as calcium content and metabolism.

The dominant follicle, whose size increases on average by 2-3 mm every day, reaches its normal diameter (18-24 mm) at the time of ovulation.

Generative function as a priority

On the inside, the mature follicle is lined with multilayered epithelium; it is in it (in the thickened area - the oviductal tubercle) that a mature egg capable of fertilization is located. As mentioned above, the normal follicle size is 18-24 mm. At the very beginning of the menstrual cycle, a protrusion (resembling a tubercle) on the surface of the ovary is observed.

Due to a number of hormonal disorders, this gap may be absent, and therefore the egg does not leave the ovary and the process of ovulation does not occur. It is this moment that can become the main cause of infertility and dysfunctional uterine bleeding.

Folliculometry: definition, possibilities

This is an ultrasound diagnostic test, through which the process of development and growth of follicles can be monitored. Most often, women suffering from infertility or menstrual irregularities resort to it. The manipulation in question allows us to track the dynamics of ovulation using ultrasound.

At the beginning of the menstrual cycle, it becomes possible to observe the process of endometrial growth, and in a later period - the evolution of the follicle. So, you can determine the exact size of the follicles by the days of the cycle.

When is folliculometry required?

This diagnostic study allows:

The significance of indicators of norm and pathology of follicle development

At the very beginning of its evolution, the indicator in the “norm” status is the size of the follicle with a diameter of 15 mm. Further, as mentioned earlier, it increases by 2-3 mm per day.

Many women are interested in the question: “What is the size of the follicle at ovulation?” Normally it is considered to be about 18-24 mm. Then the yellow body appears. At the same time, the level of progesterone in the blood is necessarily increased.

A single ultrasound is not able to build a complete picture of the development (maturation) of the follicle, since it is especially important to monitor each individual stage.

The main pathologies that impair the maturation of follicles are:

1. Atresia - involution of a non-ovulated follicle. To be precise, after formation it develops up to a certain point, and then freezes and regresses, thereby ovulation never occurs.

2. Persistence - the preservation of the virus, when it is still functionally active, in tissue culture cells or an organism beyond the period characteristic of an acute infection. In this case, the follicle forms and develops, but it never ruptures, as a result of which it does not increase. This form of anatomical formation is maintained until the very end of the cycle.

3. Follicular cyst is a type of functional formation localized in the ovarian tissue. In this situation, the unovulated follicle does not rupture, it continues to exist, and fluid most often accumulates in it, and subsequently a cyst larger than 25 mm in size is formed.

4. Luteinization - the formation of the corpus luteum, which sometimes forms without rupture of the follicle, which subsequently also develops. This situation is possible if there was a previous increase in LH levels or damage to the ovarian structure.

Follicle sizes by cycle day

From the very first days of the next cycle, using ultrasound, you can notice that in the ovaries there are several antral anatomical formations in question, which will subsequently grow. Their increase is due to the influence of special hormones, the main ones being FGS and estradiol. Provided that their level corresponds to the established norm for the content of these substances in the blood, a woman most often experiences stable ovulation, and anovulatory cycles are observed no more than twice a year.

After the size of the follicles during stimulation according to the first scheme reaches a diameter of 18 mm (at 8 mm), triggers (drugs that simulate the release of LH) are administered. Then, after the administration of hCG, ovulation occurs approximately two days later.

The second manipulation scheme is applicable mainly to women who have a low and low probability of effect from small doses of FSH.

Mandatory indications for this manipulation:

• female age over 35 years;
• FSH value over 12IU/l (on days 2-3 of the cycle);
• ovarian volume up to 8 cubic meters. cm;
• secondary amenorrhea and oligomenorrhea;
• the presence of ovarian surgery, chemotherapy or radiotherapy.

A visible result should appear by the sixth day. A significant side effect affecting the ovaries during this ovulation is the risk of their hyperstimulation syndrome. If the next ultrasound reveals follicles in the ovaries whose diameter exceeds 10 mm, the doctor regards this as a signal to carry out preventive procedures for this syndrome.

Control ultrasound examination

It is necessary to confirm ovulation using transvaginal ultrasound. This is as important as the monitoring itself. It was previously mentioned what the size of the follicle is before ovulation (18-24 mm in diameter), however, even when the required size is reached, the capsule may not break through, and the mature egg will not be released into the abdominal cavity. A control ultrasound is performed 2-3 days after the estimated moment of ovulation.

At this session, the doctor will check the condition of the ovaries for signs of ovulation:

• the dominant follicle is absent;
• corpus luteum present;
• there is some fluid in the space behind the uterus.

It is important to note that if a specialist conducts a control ultrasound at a later period, he will no longer detect either fluid or the corpus luteum.

Finally, it would be useful to once again answer the question: “What is the size of the follicle at ovulation?” This dominant anatomical formation at the time of ovulation matures to a size of approximately 18 - 24 mm in diameter. It is worth remembering that the size of the endometrium and follicles change depending on the day of the menstrual cycle.

05/20/2003, CAROLINA
There are no infections. fsg 4.61(norm 1.8-11.3), lg 6.58(1.1-8.7), prol 261.8(67-720), estradiol 113.3(110-440), testost 1.83(0.5-4.3), progest. on day 22 - 7.20 (10-89). There were no abortions or births. According to HSG, there are peritubal commissures on the left, the patency of both tubes is preserved, but they are very long and helical. BT is almost never up. above 36.8., jump to ovulation. practical not expressed. The doctor says it's possible that I'm ovulating. doesn't happen at all. The cycle is irregular, now due to vitamins it’s generally 21 days. Before this I took OK for 5 years, for 10 months already. I can't take it. Spermogr. normal From the above: 1) how do you recommend stimulating and maintaining ovulation and what medications are best? 2) with a 21-day cycle, on what days should you take Utrozhestan? 3) And how can I reduce leukocytosis (I have chronic left-sided inflammation of the appendages and Candida)?

The LH/FSH ratio is disturbed, which is normally 1\1.5. Because of this, anovulation and the absence of phase 2. It is necessary to check prolactin again on the eve of menstruation and take blood at 6.30 am. Regarding increased leukocytosis of the smear and persistent thrush, it is necessary to take DNA (PCR) tests for chlamydia, gardnerella, mycoplasma and ureaplasma.

05/21/2003 Janet
I have never had an infection, abortion, or childbirth. Two years ago I had a bilateral ovarian resection. I'm afraid I might have a blocked tube. I have been trying to get pregnant for 7 months without success. My gynecologist does not order a tube check for me, he says that I don’t need to worry now, I just need to make a baby. Tell me, what is my chance of getting pregnant? Is it possible for pipes to become obstructed? I ovulate regularly, the dominant follicle is maturing. My husband has a very good spermogram. He also never got sick. Both of their hormones are normal. During laparoscopy, when resection of the ovaries was performed, the tubes were then passable.

Unfortunately, after laparoscopy, an adhesive process developed in the small pelvis, precisely where the surgeons’ hands worked, i.e. in the area of ​​the appendages. This apparently disrupted the patency of the fallopian tubes. It is necessary to take a gynecological smear and DNA (PCR) tests for chlamydia, gardnerella, human mycoplasma, urogenital and ureaplasma. If the tests are negative, then do an HSG (just ask for pain relief before the test).

05/21/2003, Elena
After an HSG, the diagnosis was made that the tubes were passable but tortuous, bilateral valve sactosalpinx, peritubar adhesions, and adhesions in the pelvis. The doctor prescribed nystatin and vilprafen for 15 days, followed by lidazan, and hydrotubation after the injections. It is imperative to do it, what does it do if my pipes are passable. Can I get pregnant with such tubes if I do not undergo hydrotubation?

Hydrotubation cannot be done with valve hydrosalpinx! After all, hydrosalpinx is an accumulation of fluid in a pipe, and you still need to inject fluid there?! You can contact me, I propose to conduct a course of anti-inflammatory and absorbable physiotherapy with the RIKTA apparatus.

05/21/2003, Irina
I contacted you twice, thank you for not leaving my questions unattended, your answers helped me a lot. I decided to contact you again because I was already tired of being treated for secondary infertility. That month I had a delay of 7 days, then my period started with pieces of something incomprehensible (3 days), then brown water started pouring in, also with pieces (about 4 days), I went to the doctor, she said that I had residual sanguineous discharge after a miscarriage. Now again, waiting for my period, my husband and I have made every attempt to get pregnant, my period is 6 days away, my stomach doesn’t hurt, but my back is just breaking and I’m terribly depressed. I passed all sorts of tests and took a bucket of various pills over these 2 years, for three months my morning starts with a thermometer, ovulation is fine, there is constant stress at work, and it seems to me that I am fixated on trying to get pregnant, I really want to please my husband. We will be in Moscow in June-July, will we be able to get an appointment with you or will you be on vacation?

No, my vacation is in August. When you arrive in Moscow, call immediately and make an appointment. Bring all BT charts and test results. I will be glad to help you.

05/21/2003, Oksana
I had low progesterone. I took duphaston 1t for three cycles. from 15-25 days of the cycle. BT in phase 2 did not rise above 36.8. I read your answers on similar cases and for the first month I take Utrozhestan PO2T vaginally from days 16-27 of the cycle. Today, at 24 dmc, progesterone-109, estradiol-992, hCG-7. Should I take Utrozhestan at this dose after 26 days of pregnancy if I am pregnant? What time? My chest is very swollen and hurts. Maybe something can be changed (reduce the dose, switch to another drug)?

Utrozhestan can be continued if it is a pregnancy; it will not harm, it will only improve the condition of the embryo. If pregnancy is not confirmed, then on the eve of menstruation, without taking hormones, you will need to check prolactin, which may be the main cause of phase 2 deficiency.

05/21/2003, Julia
I haven't been able to get pregnant for 3.5 years. Endometriosis. There was a laparoscopy in February 2002 with removal of foci of endometriosis and endometrioid ovarian cysts (resection). At that time the pipes were passable. Treatment with duphaston from 5 to 25 days of m.c. 6 cycles. My husband has varicocele. The spermogram is not very good: only 1 ml of ejaculate, 50% motile, there is a pathology of the head. We have already decided on IVF (I am 29 years old, my husband is 36). But I was again diagnosed with an endometrioid cyst of the right ovary. Since March it has doubled. A nagging pain on the right began to bother me. Is it necessary to remove a cyst before IVF? Or is it possible to carry out drug treatment?

Unfortunately, the cyst can only be removed by surgery. This is such a terrible thing - endometriosis - if it is not treated, it grows and spreads. We need to put our husband in order: have a varicocele operated on, start taking Proviron (an androgenic hormone that improves the production and quality of sperm) + the food supplement Sperm-Active (from the Pharma-med company). It is necessary to take DNA (PCR) tests for chlamydia, gardnerella, mycoplasma and ureaplasma. When all this is normal, it is necessary to decide on a repeat laparoscopy, with the restoration of tubal patency. Immediately after the operation, you should try to get pregnant, and stimulate ovulation in the first 3-5 weeks after the operation. And leave IVF for last. This is also not a 100% method; it works in 1 out of 5 women. But after IVF there is nothing left to try.

05/22/2003, Irina
The day before yesterday I was 16DC, BT 36.6, an ultrasound revealed a follicle in the left ovary of 22 mm. The doctor prescribed 3 thousand hCG to stimulate ovulation. Yesterday my BT increased to 36.9, my left side hurt terribly. Today BT 36.9, I went for an ultrasound - the follicle is 33 mm, the doctor said that perhaps the follicle has grown into a follicular cyst and there is nothing to wait for. I made another 2 thousand HG. Please tell me, can there still be ovulation or is 33 mm already a cyst? For what reason does the follicle not burst? and one more thing - in the right ovary the follicles are 2-5 mm, one can hope that ovulation will occur in the right ovary.

Unfortunately, 33 mm is already a follicular cyst, which was formed as a result of ovarian hyperstimulation. Therefore, there was pain in the side. It releases a large amount of estrogen hormone into the blood, which suppresses the growth of other follicles; there will be no additional ovulation. Now you need to use large doses of progesterone. Administer 2 capsules of Utrozhestan vaginally in the morning and at night. This must be done for at least 10 days, until the 26-28th day of the cycle, under the control of BT. After menstruation, the cyst should go away.

05/22/2003, Alena
Please tell me. I am 25 years old, my husband is 31 years old. After two unsuccessful IVF attempts (embryo rejection). We did an HLA typing analysis: DRB1 07.10 (me) 07.01 (male) DQA1 0201.0101 (me) 0201.0101 (male) DQB1 0201.0501 (me) 0201.0501 (male). The doctor who did IVF said that next time I would need immunoglobulin drips (sorry if I wrote it wrong). Is it so? Is it possible to get pregnant with these test results? And what do these results mean? The doctor said that this is incompatibility - What with what?

Have you checked for the presence of mycoplasma, ureaplasma and chlamydia? herpes and cytomegaly viruses using DNA diagnostics? If not, then you definitely need to do it. These infections mainly cause embryo rejection. They disrupt its contact with the wall of the uterus. You can contact me, the test results will be ready the next day. When they are ready, I will be able to give you recommendations on how to continue your pregnancy.

05/23/2003, Tatyana
Now I can’t get to my doctor, and I don’t want to go to another one, because... Everyone treats in their own way and they often say that the treatment prescribed by the previous doctor is incorrect and everything should be done differently (personal experience), so I ask you to provide some clarification on a few more questions. I had an ultrasound, here is the result: Date of last menstruation: May 1-5, 2003. Body of the uterus, position in retroflexio - deviated to the right, left. The boundaries are clear. The contours are smooth. Irregular saddle shape. Dimensions: length - 56 mm, PZR - 38 mm, width - 59 mm. The structure of the myometrium is not changed. M-echo: thickness. 9 mm, clear boundaries, smooth contours. The echostructure is not changed. The endometrium corresponds to the secretion phase. The uterine cavity is not deformed or dilated. The contents of the cavity are homogeneous. The cervix is ​​of normal size. The echostructure is changed due to echo-negative inclusions D- up to 4 mm, single. The left ovary is identified. Dimensions: 42x26x40 mm. The echostructure is changed due to a large number of echo-negative inclusions d up to 9 mm. The right ovary is identified. Dimensions: 42x24x40 mm. The echostructure is changed due to. identical to the left one. Pathological formations in the pelvic cavity are not determined. Free fluid in the retrouterine space is not detected. Conclusion: 1) Retrodeviation of the uterus. 2) Saddle uterus. 3) Multifollicular ovaries. I would like to know what all this means (the ultrasound specialist refused to explain), could this be the result of taking medications, can it be cured and can I still get pregnant with such results? P.S. According to the results of the previous ultrasound, I only had multifollicular ovaries.

These are the ovaries a young woman should have. Read carefully the article on polycystic ovary syndrome on my portal. The saddle uterus is a defect of its formation in the embryonic period. This does not prevent pregnancy, but sometimes there is a risk of miscarriage associated with it. To determine your ability to become pregnant, you need to undergo not only and not so much an ultrasound. DNA analysis for sexually transmitted infections, 3-month BT schedule, tubal patency test, husband's spermogram, hormonal tests. Here is a sample list of examinations.

05/23/2003, Katerina
My husband and I want to have a child, but it hasn’t been possible for 1.5 years. I took hormone tests on different days of my cycle and it turned out that I had too many female hormones. I was prescribed to take Regulon for three months, and then come for an ultrasound and see if I am ovulating or not, since now I am not. The question is whether this problem is serious in order to get pregnant or not, how long it will take to treat it and how to treat it. I really want a baby, please tell me what to do.

You have been prescribed the right treatment. Indeed, synthetic hormones are prescribed to suppress a large number of ovarian hormones, OK. You just need to undergo additional examination: DNA analysis for sexually transmitted infections, a 3-month basal temperature chart (after using Regulon), a test for patency of the fallopian tubes, a spermogram of your husband, hormonal tests when you finish drinking Regulon.

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

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

A little theory

Follicles are special formations in the ovaries, consisting of a 1st order oocyte (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 formed in utero. They are based on oogonia - primary germinal germ cells that migrate into the embryonic ovary at approximately 6 weeks of pregnancy. After meiotic division and proliferation, first-order oocytes are formed from these precursors. These immature germ cells are covered with cuboidal epithelium and form the so-called primordial follicles. They will remain dormant until the girl begins puberty.

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

When conception occurs, it is maintained under the influence of human chorionic gonadotropin. The progesterone it produces helps prolong 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 the rejection of the overgrown glandular (functional) layer of the endometrium.

It is possible that 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 resolve. But sometimes cysts persist for a long time, deforming the surface of the organ. In this case we talk about . This diagnosis is prognostically unfavorable for conception; it is usually accompanied by persistent dishormonal disorders and infertility.

How many follicles are there in the ovaries?

Not all follicles initially established in utero in the ovaries are preserved at the time of puberty and subsequently develop. About 2/3 of them die and dissolve. This natural process is called apoptosis or atresia. It begins immediately after the formation 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. The duration of a woman’s reproductive period and the onset of pregnancy, the number of productive (with ovulation) menstrual cycles and, in general, the ability to re-conceive depends on it.

The process of progressive depletion of the ovarian reserve in the ovaries is observed on average after 37-38 years. This means not only a decrease in a woman’s ability to conceive naturally, but also the beginning of a natural decrease in the level of major sex hormones. The cessation of follicle development 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 egg to the periphery. The follicle grows rapidly and begins to protrude through the outer lining of the ovary. The egg in it is located on the periphery on the so-called ovarian mound. Approximately 2 days before ovulation, the amount of secreted estrogens increases significantly. This feedback principle initiates the release of luteinizing hormone by the pituitary gland, which triggers the process of ovulation. A local protrusion (stigma) appears on the surface of the Graafian vesicle. It is at this point that the follicle ovulates (ruptures).

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

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 depend not on the age and race of the woman, but on her endocrine status.

The growth and development of the follicle is regulated primarily by follicle-stimulating hormone from 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 egg maturation and ovulation. At the same time, determining the level of hormones does not always provide the doctor with all the necessary information, although it allows one to identify key endocrine disorders. Therefore, diagnosing disorders of the folliculogenesis process is the most important stage in examining a woman at the stage of pregnancy planning and in identifying the cause of infertility.

In this case, the doctor is interested in how large the follicle grows and whether it reaches the stage of Graaf’s vesicle. Be sure to monitor whether ovulation occurs and whether a sufficiently sized corpus luteum is formed. During anovulatory cycles, the maximum size of developing follicles is determined.

An accessible, informative and at the same time technically uncomplicated method is. This is the name for monitoring follicle maturation using ultrasound. It is performed on an outpatient basis and does not require any special preparation for 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, a specialist determines the number, location and diameter of ripening 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.

In IVF protocols, such monitoring allows one to assess the response to hormonal therapy, set a date for the administration of drugs to stimulate ovulation and subsequent puncture collection of eggs. The key parameter of folliculometry is the size of the follicle by day of the cycle.

Norms of folliculogenesis

Folliculometry is carried out 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 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 undergoing treatment with hormonal stimulation of ovulation:

• On days 1-4 of the cycle, several antral follicles are detected, each of which does not exceed 4 mm in diameter. They can be located in one or both ovaries. Their number depends on the woman’s age and her available ovarian reserve. It is normal if no more than 9 antral follicles mature simultaneously in both ovaries.
• On the 5th day of the cycle, the 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 day 7, 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 be reduced, and they can be detected in the ovaries during ovulation.
• On the 8th day of the cycle, the size of the dominant follicle reaches 12 mm.
• On day 9, the vesicle grows to 14 mm. The follicular cavity is clearly identified in it.
• Day 10 – 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 increase due to the follicular cavity and reaches 20 mm.
• Day 13 – Graafian vesicle with a diameter of 22 mm (this is the minimum follicle size for ovulation in the natural cycle). At one pole of it, stigma is visible.
• Day 14 – ovulation. Typically, a follicle that reaches 24 mm in diameter bursts.

Deviations from these standard indicators in a downward direction are prognostically unfavorable. But when assessing the results of folliculometry, the duration of a woman’s natural cycle should be taken into account. Sometimes early ovulation occurs. In this case, the follicle reaches the required size on days 8-12 of the cycle.

Follicle size during IVF

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

A woman's ability to conceive and bear a child is determined by the number of follicles in the ovary. The expectant mother must have an idea of ​​the processes occurring in the reproductive organs. Knowing how many follicles should be in the ovaries normally will allow her to receive timely medical help if danger arises.

Follicles are structural components of the ovary, consisting of an egg and 2 layers of connective tissue. The number of these elements depends on the age of the woman. A pubescent girl has about 300,000 follicles ready to produce eggs. In a woman aged 18-36, about 10 elements mature every 30 days. At the very beginning of the cycle, 5 structural components can mature simultaneously, then 4, then 3. By the time of ovulation, there is only one of them left.

No need to worry

Normally, the number of follicles in the ovaries is determined by the day of the cycle. If, a couple of days after the end of your period, numerous follicles are present in the ovaries, this is normal.

The middle of the cycle is characterized by the appearance of 1-2 elements, the size of which is slightly different from the rest. Then a mature egg begins to emerge from the largest follicle. The size of this element allows us to call it dominant.

The number of follicles in the ovaries can be determined using ultrasound of the appendages. This procedure is carried out using a vaginal sensor. So the specialist finds out the number of antral follicles, the size of which varies between 2-8 mm. Their number is interpreted as follows:

• 16-30 is normal;
• 7-16 - low level;
• 4-6 - low probability of conceiving;
• less than 4 - probability of infertility.

An ultrasound scan most often reveals 4 to 5 follicles. Less commonly, 2 to 3 elements are visualized. In preparation for in vitro fertilization, a woman is prescribed hormonal stimulation of follicle maturation. Therefore, during the course of the study, from 4 to 6 mature elements may be discovered.

Size by day

With each critical day, there is an increase in the volume of follicles by day. Until day 7, their size ranges from 2-6 mm. Starting from the 8th, active growth of the dominant follicle is observed. Its size reaches 15 mm. The remaining elements gradually decrease and die. On days 11-14, an increase in follicles is observed. The volume of a ripe element often reaches 2.5 cm.

Deviation from the norm

It is important to know what level of follicles is considered a deviation from the norm. More than 10 elements are called . Sometimes during the examination many levels of miniature bubbles are detected. This phenomenon is called polyfolicularity.

If more than 30 elements are detected during the study, then the woman is diagnosed. This pathology is an obstacle to the formation of a dominant follicle. Ovulation and conception become questionable. If the disease develops against the background of stress or emotional stress, then treatment is not carried out. Medical help is needed when polycystic disease is provoked by:

1. Sharp weight loss.
2. Rapid gain of extra kilos.
3. Endocrine pathologies.
4. Incorrect selection OK.

The follicular component may be completely absent or stop in its development. Often there is a delay in its formation or delay in maturation.

If the number of follicles decreases, the woman also has problems conceiving. In order to find out the exact cause, the doctor prescribes an ultrasound examination. It is carried out when the follicular apparatus is in the antral stage. This is observed on days 6-7 of the cycle. The main provocateur of a decrease in the number of follicles is a decrease in hormonal levels.

In some women, follicle maturation occurs during lactation. If their size varies from 6 to 14 mm, this indicates that a mature egg will soon be released. Then ovulation will occur and your period will begin.

Development of dominant and persistent follicle

Uneven development of follicles in the ovaries is often observed. Some women reveal the presence of dominant elements in both organs. If they ovulated at the same time, this suggests that the woman can conceive twins. But this is rarely seen.

You need to sound the alarm when a follicle is identified. This often indicates improper development of the dominant, which prevents the egg from being released. Over time, it appears against this background.

Persistence occurs on the left or right. The main provocateur is the increased production of male hormone. Improper treatment leads to infertility.

To resuscitate the reproductive system, a woman is prescribed hormonal treatment. Therapy is carried out in stages. From days 5 to 9 of the cycle, the woman is prescribed the use of pharmacological drugs. 8 days before the arrival of the critical days, the patient is given hormone injections. The duration of such treatment varies from 4 to 7 days. In the interval between the use of drugs, stimulation of the pelvic organs is carried out. The woman is prescribed laser therapy and massage.

Main reasons for absence

When there are no follicles in the ovaries, we can talk about hormonal imbalance. Other factors that provoke the lack of follicle development include:

• natural early menopause;
• improper functioning of organs;
• surgical early menopause;
• decreased estrogen production;
• pituitary gland disorders;
• the presence of an inflammatory process.

Presence of single elements

Some women are diagnosed with ovarian depletion syndrome. Due to the cessation of organ functioning, a woman cannot conceive and bear a child. Single follicles develop poorly, ovulation is absent. This leads to early menopause. The main cause of this condition is excessive physical activity. The risk group includes professional athletes and women doing men's jobs. Other reasons include menopause, a sharp increase in weight, and hormonal imbalances. This phenomenon is often observed in women who adhere to a very strict diet.

Timely treatment helps many women. You can prevent the development of a dangerous disease by calculating your menstrual calendar. If the cycle is irregular and often goes astray, then you should immediately consult a doctor.

Over the course of a woman's entire life, the ovaries produce a strictly defined number of follicles. Deviation from the norm does not always indicate the occurrence of a dangerous pathological process. But if a woman ignores this signal from the body, this will lead to dire consequences.