Folliculogenesis: causes of violation, diagnostic methods


Since birth, all follicles are primordial. Their size is about 0.03-0.05 millimeters. They are so small that monitoring of folliculogenesis at this stage is not informative - they are not visible on ultrasound. The activation process of primordial follicles begins in adolescence, during puberty. This is a complex controlled process. During each menstrual cycle, several follicles begin to grow, but only one (primordial) comes to ovulation. Follicles that do not become dominant, die through atresia (the number of such follicles is about 99% of the originally incorporated).

The final maturation of the oocyte occurs in the last two weeks of its existence, but the preparation for it takes a long time. Under the influence of follicle-stimulating hormone, there is a gradual growth of follicles, and they are classified as primary, secondary. The diameter at this stage is not more than 2 mm. The duration of these phases is several months, so any changes in the reproductive, endocrine system can affect the growth of the follicle and cause a violation of folliculogenesis. Only 10 of the follicles continue the process of maturation in the last two weeks, and the rest undergo atresia.

In the first third of the follicular phase of the menstrual cycle (immediately after menstruation), a dominant follicle appears. It continues to grow to the size of 18-25 millimeters, while its cells produce estrogens and progesterone in a certain ratio. It has been proven that conception is most likely at a preovulatory follicle size of 21 mm. If the sizes are larger, postglutenization is more often observed: the ratio of the produced hormones is disturbed, and progesterone prevails. Regardless of the presence of ovulation, such follicles turn into a yellow body. Such a violation of folliculogenesis is called luteinization of the unvulted follicle.

Folliculogenesis and Conception

When the dominant follicle reaches the preovulatory stage, its cells produce large amounts of estrogen. This provokes the release of luteinizing hormone and follicle rupture - ovulation. In this case, the egg goes into the abdominal cavity, from which then enters the fallopian tube. It is in the fallopian tube that the fertilization of the egg and conception take place.

Folliculogenesis control

Disruption of follicle development and ovulation are a common cause of infertility. To diagnose the cause of infertility, folliculogenesis is monitored. This examination technique consists in ultrasound scanning, and the size, number of follicles, folliculogenesis is determined. Preparation for this study is not required. Often folliculogenesis control is called simply “folliculogenesis” by ultrasound.

Folliculogenesis: when to do

Ultrasonic control of folliculogenesis is performed on different days of the menstrual cycle, which allows to evaluate the dynamics of follicle growth, as well as to determine the presence of ovulation. With a regular menstrual cycle, the first study is conducted 5 days before the expected date of ovulation. Usually, 2-3 sessions are conducted with a certain frequency, but the exact number is determined individually by the doctor. With an irregular cycle, the first ultrasound is done 4-5 days after menstruation. Ultrasound - monitoring of folliculogenesis allows you to assess the state of the endometrium, and the size of the follicles to identify the causes of infertility.

How is folliculogenesis done

Folliculogenesis is monitored using a vaginal probe, as with a classic pelvic ultrasound. Folliculogenesis, reviews of which women leave in specialized forums, is an absolutely painless procedure. The whole study takes 5-10 minutes. Where to make folliculogenesis? You can consult with your doctor who ordered the examination, or by reviews find a good functional diagnostics specialist in your city. Do I need a direction to folliculogenesis? Usually, if the study is carried out in a private clinic or an ultrasound room, a referral is not required, but it is better to take it from the attending physician in order to investigate folliculogenesis without any problems. The price of the study may vary in different clinics.

What will show folliculogenesis monitoring

Ultrasonic control allows you to assess changes in the ovaries and uterus throughout the menstrual cycle. The study on the 9-10 day of the cycle makes it possible to determine the dominant follicle, the size of which at this stage exceeds the diameter of the other follicles. Ultrasound screening is performed several times to evaluate follicle maturation and determine ovulation. A decrease in the size of the follicle, its uneven contours, as well as the appearance of fluid in Douglas space, testify to the ovulation that occurred.

Disturbance of folliculogenesis

In some cases, follicle maturation is impaired, which affects the ability to conceive. The control of folliculogenesis allows to reveal the following disorders:

Ultrasound diagnostic method does not always give accurate information. For example, in the absence of ovulation and follicle regression, all the signs of a normal two-phase menstrual cycle will be visible on an ultrasound. If necessary, the doctor prescribes additional research methods to determine the possible cause of infertility.

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Folliculogenesis: disorders

Disorders of folliculogenesis can manifest themselves in the following conditions:

    • lack of development of a dominant follicle,
    • stopping the development and reducing the size of the dominant follicle (follicle regression),
    • the persistence of the follicle (the follicle is not torn, the egg does not leave it),
    • follicular cyst (the follicle does not burst, it accumulates follicular fluid, which is converted into a cyst),
    • luteinization of the follicle (yellow body is formed in the absence of follicle rupture).

Disturbed folliculogenesis: lack of ovulation

When folliculometry is performed, one of the main causes of female infertility can be identified - anovulation, which is characterized by the lack of release of a mature egg from the follicle, i.e. lack of ovulation. This pathology can occur in women of different ages: both young and more mature, often noted in the premenopausal period. The main symptoms of anovulation are menstrual disorders and changes in the volume of menstrual flow.

However, anovulation can often occur without characteristic signs and can only be detected in the process of diagnosing infertility using folliculometry.

Anovulation may develop due to the presence of the following conditions in the female body:

        • hormonal imbalance or insufficient stimulation of the ovaries,
        • increased levels of male hormones,
        • inflammatory processes in the female genitals
        • pathologies of the reproductive system (endometriosis, neoplasm, uterus and ovarian cysts),
        • functional disorders of the endocrine system,
        • with intense physical exertion (heavy physical activity, professional sports),
        • obesity due to improper diet and sedentary lifestyle.

Goals and the essence of folliculometry

If necessary, a survey of the woman's body, identifying the cause of infertility, can be recommended such a modern method of diagnosis as folliculometry.

This study is assigned for the following purposes:

        • functional pathologies of the ovaries are identified (or excluded),
        • the readiness of the endometrium of the uterus to the attachment of a fertilized egg is evaluated,
        • confirmed the presence of ovulation is determined by the exact date of its beginning,
        • the viability of the egg after fertilization is evaluated,
        • the risks of multiple pregnancy are assessed,
        • establishes the causes of violation of folliculogenesis and menstrual cycle,
        • analyzes the state of the woman’s hormonal system, as well as the response to hormone therapy,
        • ovulation stimulation is controlled (which is one of the stages of in vitro fertilization),
        • carried out monitoring of ongoing therapy.

With the help of folliculometry, other goals are achieved:

            • detection of diseases of the female genital system,
            • determining the causes of irregular menstrual cycles,
            • determination of endometrial changes and causes of these disorders,
            • general assessment of the female reproductive system.

The folliculometry is performed by women planning in vitro fertilization in order to determine the optimal timing of the collection of eggs for subsequent fertilization.

A true picture of the violation of folliculogenesis allows you to identify a comprehensive medical examination, including folliculometry. The choice of treatment tactics is made in accordance with the reasons that have provoked certain changes in the work of the female reproductive system.

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What is folliculometry

One of the methods for diagnosing the causes of infertility is folliculometry. With the help of this study, they monitor all stages of follicle development, at the same time identifying possible irregularities in a process such as folliculogenesis. Folliculometry is performed using an ultrasound machine, so it is also called ultrasound monitoring. This study allows to control the process of ovulation, since folliculogenesis is a process preceding the onset of ovulation, in which the follicle normally breaks and the egg cell leaves it, ready for subsequent fertilization.

When to conduct folliculometry

Most often, the woman to whom the folliculometry is prescribed is interested in when it is necessary to begin the study. In order to determine the date of the first ultrasound, the doctor needs to know the duration of the patient's menstrual cycle. If it lasts 28 days, folliculometry is scheduled for the 8th or 10th day of the cycle. In this case, the countdown is from the first day after the last menstruation.

However, the duration of the menstrual cycle in different women may vary, be too long or, conversely, shortened. In such cases, the date of the first ultrasound should be assigned by the doctor individually. In the case of a “prolonged” regular cycle, the study is usually given 4–5 days after ovulation occurs. With a short menstrual cycle, the first ultrasound is performed on the 3-5 day of the cycle. At the same time, a study of the state of the endometrium is carried out in order to identify factors that provoke a disruption in the normal activity of the female body. The determination of the number of ultrasound procedures is also carried out taking into account individual indicators of a woman, but their total number should be at least three.

Folliculogenesis disorders on ultrasound

As a result of an ultrasound scan, the following disorders of folliculogenesis can be detected:
• regression of the dominant follicle, due to which ovulation does not occur,
• persistence - no follicle rupture, so that the egg does not have the ability to get out of it,
• follicular cyst - the formation of a cyst during the accumulation of fluid in the follicle, which could not break,
• luteinization - the formation of the yellow body without breaking the follicle (usually caused by ovarian pathologies or hormonal disruption),
• lack of follicle development.

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Folliculometry: the essence of the study

Ovulation Day is determined using several techniques. In cases of suspected anovulation (lack of ovulation), folliculometry is a popular research method, which consists in hardware monitoring of follicle maturation.

This procedure is also assigned to patients before IVF (in vitro fertilization), in order to be able to determine the timing of the removal of the egg with subsequent insemination.

Folliculometry is performed for the following purposes:

  • identification of the functional pathology of the ovaries or its exclusion,
  • assessment of endometrial readiness for the attachment of a fertilized egg,
  • confirmation of the presence of ovulation, precise determination of its onset,
  • assessment of egg viability after the fertilization process,
  • risk assessment of multiple pregnancies,
  • determination of the causes of defective folliculogenesis or menstrual cycle,
  • analysis of the state of the hormonal system of the female body, its response to the prescribed drugs taken,
  • control over the stimulation of ovulation, if it was prescribed (mainly during in vitro fertilization),
  • control over the results of the treatment.

With the help of this diagnostic procedure, the determination of other problems that exist in the female reproductive system is made:

  • diseases of gynecological organs are detected,
  • the causes of the irregular menstrual cycle are established,
  • changes in the endometrium are monitored, the causes of these disorders are determined,
  • a general assessment of the state of the reproductive system of women.

When folliculometry is performed

The first folliculometry is scheduled for the 8-10th day of the menstruation cycle. Repeat the procedure carried out at least once every two days before the date when it is expected the beginning of ovulation. In the absence of ovulation, folliculometry repetition is carried out before menstruation.

The whole process of folliculometry repetition is called complete monitoring of folliculogenesis, according to the results of which the necessary conclusions are drawn by the doctor.

Determination of the exact timing of folliculometry, their number is made by the gynecologist, who conducts the primary study.

Decoding the results of folliculometry helps determine successful ovulation, which can be talked about if:

  • Before the start of ovulation, the dominant follicle with a diameter of 1.8 to 2.4 cm is found,
  • the ripe follicle disappeared and a yellow body formed in its place,
  • fluid is present in the back space of the uterus for several days after the end of ovulation.

In order to confirm the result of the ultrasound, it is necessary to conduct a blood test, which is appointed 7 days after ovulation. The content of progesterone in the blood should be elevated.

Preparation for folliculometry

Ultrasound monitoring is carried out in the diagnostic department of the gynecological center, the direction of the gynecologist is necessary.

Before the procedure, it is necessary to exclude from the diet foods that contribute to gas formation, which can cause a distortion of the diagnostic pattern: raw vegetables, legumes, milk, alcoholic beverages, carbonated water. 12 hours before the start of the survey to conduct the last meal.

Disturbed folliculogenesis: anovulation

Ultrasound monitoring can reveal anovulation — a violation of folliculogenesis, in which a mature egg does not come out of the ovary, i.e. ovulation does not occur. Anovulation is a common cause of female infertility that occurs in patients of different ages: both young and older, as well as during the period before the onset of menopause. Чаще всего характеризуется нарушением менструального цикла и изменением объема выделений.

Однако в некоторых случаях ановуляция проходит бессимптомно и выявить патологию удается только при помощи проведения УЗИ-мониторинга фолликулов.

Развитие ановуляции может провоцироваться следующими состояниями:

  • гормональным дисбалансом либо недостаточным стимулированием яичников,
  • повышенным уровнем мужских гормонов,
  • inflammatory diseases of the reproductive organs of the woman,
  • pathologies of gynecological organs (endometriosis, neoplasms and cysts of the ovaries and uterus),
  • functional disorders of the endocrine system,
  • intense physical exertion in women engaged in heavy physical labor or professional sports,
  • overweight, unhealthy diet and sedentary lifestyle.

Diagnosis and treatment of anovulation

The true picture of anovulation comes to light during a thorough examination, one of the methods of which is folliculometry. The treatment consists in eliminating the causes that caused violations of the female reproductive system, preventing the onset of ovulation, and, consequently, pregnancy.

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Causes of folliculogenesis failure

Under the influence of various negative factors on the woman's body, there may be irregularities in the maturation of the follicle. For successful elimination of the circumstances that led to failure in folliculogenesis, it is important to identify the cause of this disorder. Often this is due to:

  • inflammatory processes that are localized in the pelvic organs,
  • malfunction of the brain, hypothalamus and pituitary gland,
  • hormonal disorders, which leads to endocrine dysfunction,
  • disorder of the hormon function of the ovaries,
  • various stresses faced by women, as well as depression.

Folliculogenesis study

If it is difficult to conceive, a married couple, as a rule, undergoes many examinations, including folliculometry, a procedure that allows you to observe the folliculogenesis of a woman and determine whether she is ovulating, and if it is present, calculate the days of the menstrual cycle most suitable for fertilization.

Folliculometry is performed using an ultrasound machine. This procedure is an observation that is carried out in several visits to the doctor. The first of them is prescribed approximately 3-7 days after the end (with irregular menstruation) or 4 to 5 days before the day when ovulation is supposed to occur.

Monitoring of folliculogenesis allows you to track the changes that occur with the dominant follicle during its development and before the release of the egg from it, as well as to assess the state of the endometrium. The dynamics of the development and maturation of the egg allows an assessment of the reproductive potential of the woman.

This research method is also used in the practice of extracorporeal fertilization (IVF). Folliculometry allows you to determine the stage at which it is best to do the procedure of egg collection.

The fact that folliculogenesis occurs naturally and has no deviations can be indicated by the following data obtained during ultrasound:

  • the presence of a mature, well-formed follicle before ovulation,
  • after the follicle breaks through, its walls self-destruct, and in its place a yellow body appears.

If, as a result of monitoring folliculogenesis, it has become known that ovulation has not occurred, various types of tests are prescribed, an additional examination of the body is carried out to determine the cause of anovulation and the appointment of appropriate treatment.

For the accuracy of the results of folliculometry, it is important to conduct this procedure using high-quality and modern equipment, as well as a qualified doctor who will conduct the examination in accordance with all the rules and established requirements and accurately decode the monitoring results.

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The main stages of folliculogenesis

Follicle maturation is a continuous process. The first follicle matures in the antenatal period, and the last - after the onset of menopause. It is important to understand that due to apoptosis (cell death programmed by the organism itself) many follicles are destroyed by themselves, only a few follicles take part in the maturation and hatching of the egg. By the time of menopause, the number of follicles is depleted, which leads to the cessation of ovulation.
Doctors distinguish 4 stages of follicle development:

  • Primordial (zero) stage. Primordial follicles are those follicles that are formed at an early stage of pregnancy long before birth (their total number before childbirth is about 2 million units). Such follicles have a diameter of about 50 micrometers (they cannot be seen without special devices). Although there are about 2 million of such cells, it must be remembered that due to apoptosis, most primordial follicles die.
  • Preantral (primary) stage. Primordial follicles slowly turn into preantral. The transformation of the first “portion” (about 10 pieces) of primordial follicles into preantral ones occurs during puberty. At this point, the number of all follicles is reduced from 2 million to 300 thousand due to apoptosis. The diameter of the preanthral follicle is about 200 micrometers. The nucleus of the follicle grows and is covered with various chemical compounds. Over time, a special cavity containing the follicular fluid also appears.
  • Antral (secondary) stage. The diameter of the follicle becomes about 500 micrometers. At this stage, estrogen is released into the follicular cavity. Begins a sharp growth of the follicle.
  • Preovulatory (tertiary) stage. The follicle grows to a size of 20 millimeters. The egg cell in the follicle is located on an egg-bearing hill. Such a follicle is considered practically ripe.

The further fate of such follicles is quite simple: normally, 24 hours before ovulation, the production of a large amount of estrogen begins, which leads to the production of luteinizing hormone, which actually triggers ovulation. When ovulation in the wall of the follicle forms a protrusion, which leads to friction, and then - to rupture and release of the egg from the follicle. If the egg is not damaged, then getting sperm on it can cause pregnancy.

When to examine folliculogenesis?

To undergo ultrasound examination is necessary on special days. Usually, a single follicle ultrasound is not enough (normally, the number of sessions should be about 3). You also need to remember that the menstrual cycle in different women lasts differently. Ultrasound examination, depending on the type of the menstrual cycle, is carried out as follows:

  • Regular standard cycle. Usually, female ovulation lasts 28 days (the day on which ovulation starts is considered the first day of the last menstruation). In this case, the first ultrasound examination should be carried out on day 10 after the end of ovulation. Additional sessions can be held on the 15th and 20th day after the onset of ovulation.
  • Regular non-standard cycle. In some women, ovulation lasts less or more. In such cases, an ultrasound examination should be performed 5 days before the onset of menstruation. All additional sessions are prescribed by the doctor individually.
  • Irregular non-standard cycle. In some women, menstruation occurs irregularly, and its duration can be as much as 28 or 23 or even 35 days. In this case, folliculogenesis should be examined 5 days after the end of menstruation. All additional sessions are prescribed by the doctor individually.

What does folliculogenesis monitoring show?

Using ultrasound monitoring, you can track all the major changes that occur in the uterus and ovaries during menstruation. It is important to understand that folliculogenesis is well studied, so doctors are well aware when something goes wrong. If a woman has a regular standard cycle, then normally on day 10, one dominant follicle will be visible on a monitor connected to an ultrasound machine, compared to other immature follicles (the size of a dominant follicle is normally 15 millimeters). If the study shows that there are two or more such follicles, then there is nothing to be afraid of either - this is a variant of the norm. Every day, the follicle grows and increases in diameter. On the day before hatching, its diameter is usually 25 millimeters.

In the study, the doctor also draws attention to the state of the endometrium. Normally, on the day of ovulation, the endometrium should have a three-layer structure with a total thickness of 10 millimeters. On the day of ovulation, a special substance is synthesized in the body - the luteinizing hormone, which actually "triggers" ovulation. During ovulation, a small amount of follicular fluid should also be ejected into the abdominal cavity.

With an ultrasound examination of folliculogenesis, the doctor can determine whether ovulation has occurred or not. If one of the following conditions is met, then the doctor decides that ovulation has occurred:

  • The day before the alleged ovulation in the abdominal cavity ultrasound examination showed the presence of a mature follicle.
  • On the day of ovulation, the dominant follicle is reduced in size or absent.
  • If ovulation is normal, then a small amount of fluid appears in the special cavity (Douglas space) of the abdominal cavity.
  • In place of the mature follicle, a special tumor appears - the yellow body.

However, you need to understand that with the help of ultrasound diagnostics it is possible with a very high probability to determine whether ovulation has occurred or not. However, there are cases when, for example, on the eve of the alleged ovulation, a mature follicle was visualized, and after a few days it disappeared, and a yellow body appeared in its place - however, as a result, it turned out that ovulation did not occur. There are also cases when the dominant follicle was not isolated during an ultrasound scan. That is why doctors prescribe not one, but several ultrasound examinations - an increase in the number of observations can significantly reduce the risk of error.

The process of growth and development of the follicle?

Work changes in the ovaries immediately on the first day of the menstrual cycle. Every month several follicles begin to mature at once during the normal process of growth and development.

Follicles on the fifth day of the cycle appear in a volume of six. They have a fairly small diameter, about two or four millimeters, and are located in the middle of the female genital organs.

After a week of menstruation, follicles increase to six millimeters. Blood capillaries become visible around them.

The next day after this, it is possible to say exactly which of the follicles is dominant, that is, it has chances for further maturation. It has a larger size than others.

After another day, the dominant follicle grows, then it is clearly visualized and is approximately 13–14 millimeters in diameter. At this point, others become smaller and disappear.

On day 11, the dominant species continues to grow. It reaches a size of approximately 16 mm. The next day - 17 mm. At a stage called late proliferation, its cells produced a large number of estrogenic elements.

Exactly two weeks later, it ranges from 18 to 24 mm. Signs of transient ovulation are visible on the ultrasound. A double contour becomes visible, its thickness and irregularities. Visible to his vascularization.

On the 15th day of the cycle or 16, in the case of normal monthly periods, ovulation occurs. Ovulation is a rupture of the follicle and the release of the female cell from it. At the same time, an ultrasound scan shows that he either left or decreased in volume and gave fluid to the walls of the abdominal cavity.

Further, on the place where the vesicle with the egg was located, it becomes visible yellow body with irregular shape and irregular contours. It reaches to 5 days of the big sizes, then decreases. When the next cycle begins or its pregnancy is no longer visible.

Stages of folliculogenesis

Doctors allocate several stages or stages follicle development in the form:

  1. Primordial (zero) stage, which passes from 1 to 5 menstruation day
  2. Preantral (primary) stage passing on 6 — 15 after menstruation,
  3. Antral (secondary) stage on 15 — 20 bottom of the cycle.
  4. Preovulatory (tertiary) stage on 20−26 bottom.

How is it done?

Ultrasound monitoring It is an observation with the help of ultrasound of the processes of changes in the uterus and ovaries throughout the menstrual cycle.

How does folliculogenesis? It is made in the clinic by the usual vaginal examination on day 7−10 cycle ultrasound machine. Procedure is done. 5–10 minutes, then a snapshot of the survey is printed and all its values ​​are recorded.

It is at this time that one dominant follicle can be seen on the device, which has a diameter of 12–15 mm, compared with the others, which, under normal conditions, are several times smaller. Rarely, when there are several dominant species. In the future, you can see how it increases and on the day when ovulation is observed, its size reaches the maximum value specified earlier.

In the study of ultrasound pay attention not only to folliculogenesis, but also to the endometrium. During the origin of ovulation, its thickness should be from 9−13 mm. Then the luteinizing hormone enters the body, which contributes to the readiness of the release of the female cell for fertilization. At the same time a small number of follicular fluid falls on the inner walls of the ovaries.

Suitable cycle period

To carry out the first examination, you need to wait for the 8th day of the cycle for the woman and do the examination. If it is permanent, but not normal in duration, it is prescribed for several days (in general, it is 4-6 days) before possible ovulation. The number of such ultrasounds determined by the attending doctor.

On average, only two surveys. If we are talking about an irregular period of menstruation, then the first monitoring is carried out 3 days after their completion. Find out what the appropriate period for the survey can be a specialist directly.

The final part of folliculogenesis

The final part of folliculogenesis - egg release. If this does not happen, an ultrasound provides detailed information about the violation. Possible violations:

  • Regression (atresia) follicle. Occurs when the dominant follicle is clearly drawn, grew in volume, but then suddenly stopped developing and disappeared altogether, due to which ovulation did not occur,
  • Persistence - not a normal course of folliculogenesis, where the bubbles with an egg cell break through not in time and do not develop further,
  • Follicular cyst. The dominant type of cells grows as it should, but does not burst at the right time, remains in the ovaries and does not help ovulation take place,
  • Luteinization is a violation of the folliculogenesis, where the yellow body looms when the follicle is not torn. One of the reasons for this process is a large amount of male hormones, and the second reason is a pathology in the female genital organs,
  • Do not develop dominant and ordinary types, because of which it is impossible to talk about ovulation.

If the monitoring did not occur due to the above circumstances, the doctor conducts a number of other additional studies and analyzes. Later, based on their results, he prescribes a treatment, the purpose of which is to normalize the hormonal background and stimulate ovulation.

We recommend to read: why the monthly painful and what to do to reduce the pain?

Causes of heavy periods with thick blood? The answer is to look here.

Average price for ultrasound monitoring of folliculogenesis in Moscow - from 2000 to 10 600 rubles. In the central region it varies from 2500 to 4500 thousand rubles. Across Russia this price fluctuates from 1500 to 6000 rubles, depending on the chosen clinic.

Video: how does the process called folliculogenesis occur?

Подготовка к материнству: что такое фолликулогенез и чем грозят его нарушения?

Фолликулогенез научными словами – это непрерывный процесс созревания женских половых клеток – яйцеклеток – каждая из которых находится в фолликуле. Why is this process so important for the female body and what is the danger of its violations that may occur in a woman? How to diagnose and treat them?
The ovule during the formation period passes through the follicle stage, but not every follicle becomes an ovum capable of fertilization.

Follicles containing eggs are laid in a woman long before her own birth - during embryonic development. Their number is limited - out of a million oocytes in the fetus, hundreds of thousands will remain by the puberty period. During the menstrual cycle, the egg matures, it reaches a peak of fertility - ovulation and fertilizes. If fertilization does not take place, the egg cell dies and is brought out with residues of the endometrium - the inner mucous layer that lines the uterus from the inside and increases during the maturation of the egg, preparing a favorable environment for attaching the fertilized egg to the walls of the uterus. If fertilization has not occurred, the endometrium is exfoliated and brought out. It happens during menstruation.

4 phases of folliculogenesis

Folliculogenesis can be divided into 4 phases:
• Zero stage - Primordial. At this stage, the follicles are only formed, it occurs even during intrauterine development, long before birth. Such follicles can be up to 2 million, the diameter of each follicle is up to 50 micrometers and most of them die in the process of fetal development.
• Primary stage - Preantralnaya. At this stage, coinciding with the beginning of the pubertal maturation of the girl, the follicles begin to mature. There are already about 250-350 thousand, with a diameter of 180-200 micrometers, new chemical compounds are starting to appear inside the follicle, as well as a cavity with a follicular fluid.
• Secondary stage - Antral. The follicle grows and reaches a diameter of 500 micrometers. The follicle grows dramatically due to the release of estrogen into the cavity of the follicles.
• Tertiary stage - Pre-ovulatory. The follicle is almost ripe: it forms an egg-bearing hill, in which the egg cell is located and the size of the follicle grows to 18-20 millimeters. This stage is the last in folliculogenesis.

Simply put, folliculogenesis is the process of development of the eggs in each menstrual cycle. Its violations lead to infertility. To identify violations of modern doctors use ultrasound monitoring, which consists of a series of ultrasound examinations.

Disturbances of folliculogenesis: the cause of female infertility

Normally, during the preovulatory stage, a significant amount of estrogen is produced in the follicle, which leads to the production of luteinizing hormone and starts the process of ovulation. The bulging of the walls of the follicle during ovulation leads to friction and rupture, provokes the release of the egg from the follicle into the falopian tube and can be fertilized if the spermatozoon enters it and there are no serious pathologies.

Pathological conditions associated with the violation of this natural process may prevent a woman from becoming a mother. Therefore, doctors recommend ultrasound monitoring of folliculogenesis in order to detect its abnormalities and correctly approach the treatment of the disease.

The main disorders of folliculogenesis:

• Follicle regression: during normal growth, the vesicle with the egg reaches a certain size, but there is no rupture and the follicle shrinks back to its original size,
• The egg cell matures, but does not come out of the follicle, which may occur due to hormone mirror disturbance, in particular, with an excess of progesterone, the concentration of which, in turn, increases with stress,
• When several follicles develop in the same way, and none of them dominate or go into the uterine cavity,
• A cyst in the ovary causes the follicular vesicle to fill with fluid instead of ovulation,
• Luteinization - the proliferation of the corpus luteum when the follicle has not yet broken,

With each of these disorders, pregnancy cannot occur.

Ultrasound monitoring of folliculogenesis: when do they conduct this study?

Ultrasound examination of the process of maturation of the follicles will help the specialist not only to assess the state of the follicles and identify violations, but also to predict the onset of ovulation and choose the best period for conceiving a child. For a qualitative monitoring of indicators over time and a more accurate diagnosis, several monitoring procedures are needed on different days of the cycle. The exact number of them can only recommend a doctor.

The first monitoring of folliculogenesis is recommended by the doctors for 8-10 days after the onset of menstruation - at this time the dominant vesicle of the follicle should already stand out quite well, from which an egg will later be released. A mature dominant vesicle does not in itself guarantee ovulation, and if hormonal disturbances are possible deviations at the time of rupture of the bubble - it may not occur, therefore the doctor prescribes additional hormonal studies to recreate the full clinical picture.

If the menstruation is not regular - most often stop for 3-5 days after the last day of the month for the first ultrasound. Also during monitoring, the thickness of the endometrium is assessed - at the time of fertilization, the endometrium should be 10–12 mm thick.

Ultrasound of folliculogenesis: the definition of ovulation

The purpose of ultrasound monitoring of folliculogenesis is the diagnosis of ovulation. On ultrasound, the doctor will see the already broken bubble of the dominant follicle or that it has completely disappeared. In place of the observed follicle, the yellow body should begin to grow. The combination of these factors means that the egg is already in the uterus awaiting fertilization. Before this event, sexual intercourse is desirable, since spermatozoa remain viable for up to 36 hours, and the exact time of release of the egg from the follicle is almost impossible to predict.

The main advantage of ultrasound of folliculogenesis is its absolute safety and painlessness, the procedure does not require preparation and compliance with special additional conditions, but, of course, care and organization will be required, since examinations must be carried out on certain days.

Make an appointment with a qualified specialist in the diagnosis of gynecological pathologies of the medical center "Gravimed" can be by phone +38 (044) 333-61-08. The administrator of the clinic will be able to choose the most convenient time and will register you at the reception.

What is folliculogenesis

Follicles exist in the body of a woman from birth. During puberty during menstruation, about 300 of them begin to develop and grow. In process of development they pass such stages:

  • primordial,
  • primary,
  • secondary,
  • preovulatory

All follicles are initially called primordial. Only a few reach the preovulatory stage, and only one is involved in the ovulation process. This follicle is called dominant. It is the process of follicle development from primordial to preovulatory that is called folliculogenesis.

In the process of folliculogenesis, the structure of the particle itself changes: an epithelial membrane is formed, in which a cavity is formed, containing an egg cell suitable for fertilization. The breakthrough of the wall of the preovulatory follicle, in which the egg cell enters the fallopian tube, is ovulation.

The size of the dominant follicle formed is 18-25 mm. But an egg cell that came out of a follicle that has reached about 21 mm in size is considered more suitable for conception. After the release of the egg, it gradually collapses, and a yellow body appears in its place.

Types of folliculogenesis disorders

Occasionally, an examination can reveal a violation of folliculogenesis. Problems with the correct course of this process can lead to impairment of health, in particular, to the inability to conceive a child.

The main pathology of the follicle:

  • atresia (regression),
  • persistence
  • luteinization
  • lack of development
  • follicular cyst.

When atresia on ultrasound can be traced, as the dominant follicle goes through the stages of formation and development, but at some point stops growing and begins to decrease. Ovulation in this case does not occur.

When the persistence of the follicle develops, but at the right time does not break its wall, that is, the egg does not fall into the fallopian tube. The follicle can continue to exist in the body and remain there for some time.

Luteinization is a process in which in the absence of a gap a yellow body forms. Often the cause of the pathology becomes a violation in the structure of the ovaries or hormonal failure.

Lack of development means that the dominant follicle does not develop at all.

With a follicular cyst, as in the case of persistence, the element grows to the desired size, but the wall does not break through. At the same time, follicular fluid accumulates in it, which causes the formation of a cyst.

If the study found one of these pathologies, this does not mean that a woman cannot become pregnant. It is quite possible to treat it, the main thing is not to postpone treatment and seek help from a specialist. A number of additional tests will help you find a competent treatment aimed at normalizing the hormonal background and stimulating normal ovulation. It is impossible to postpone for later. The faster the examination, the greater the likelihood of a positive result.


After consulting with the gynecologist, the woman herself decides whether she needs such strict control of the folliculogenesis process. But if there are symptoms of the presence of pathologies, failure of the menstrual cycle or, on the contrary, inability to conceive a child, monitoring the process of ovulation is the best way to determine the cause of the problem.

With a cycle of 28 days

With a perfect regular process in 28 days, the first ultrasound is most often done for 8-10 days. By this time, the dominant cell is already allocated, and all the others are significantly lagging behind in its growth and begin to decrease.

Along with the growth, the level of the hormone of the first phase gradually increases, which reaches its peak with a liquid formation of 18-25 mm. A large amount of estrogen provokes the release of luteinizing hormone, which is a precursor of ovulation.

More or less than 28 days

If the length of the regular cycle is less than or greater than 28 days, then by tracking folliculogenesis, the days of the cycle to start an ultrasound are chosen 4-5 days before the expected release date of the egg. At this point, the dominant follicle reaches approximately 12-15 mm in diameter (sometimes there are two).

Every day it increases in diameter, reaching the desired parameters. The frequency of monitoring is regulated at the discretion of the physician. Usually the examination is carried out 2-3 times.

With irregular menstruation

With irregular menstruation, on which day of the cycle it is better to begin monitoring folliculogenesis, the gynecologist will tell. As a rule, the beginning of the study choose 3-5 days after the end of menstruation. Inspection also includes the determination of the thickness of the endometrium, by the expected time it should reach 12 mm. In this case, the number of monitoring individually: every 1-2 days.

Ultrasound and folliculogenesis monitoring will help determine which day of the cycle it is best to conceive.

When you need an ultrasound of folliculogenesis

The goal during the ultrasound of folliculogenesis may be different. In some situations, especially for the control after treatment of gynecological diseases, research is done at the beginning of the cycle to determine whether and how many liquid formations have appeared. This issue is particularly relevant in the preparation of IVF, when several cells need to be taken. Then the observation of their development goes through the entire first phase, until the release of the egg.

Ovulation Monitoring or Foliculometry

The completion of folliculogenesis monitoring will be confirmation of the fact of ovulation, which is recognized by the following manifestations with ultrasound:

  • the disappearance of the dominant observed on the eve, or the destruction of its wall,
  • the presence of free fluid in the Douglas space,
  • in place of the bubble begins to grow yellow body.

When one is found on the monitor, the doctor is convinced that the cell, which is already in the abdominal cavity, is on its way to fertilization. So, before this event, sexual intercourse is necessary, so that the male cell has time to infiltrate the egg cell.

Advantages and disadvantages of the survey

Plus ultrasound monitoring of folliculogenesis in absolute safety and safety, and its implementation does not require any special conditions.

This requires a certain amount of money and time, since it takes place on certain days.

The survey has its pros and cons, but it is absolutely harmless to women

In addition to folliculogenesis, with the help of ultrasound, you can also:

  • identify the pathology in the reproductive system of a woman (myoma, cyst, developmental anomaly, etc.),
  • understand the causes of menstrual disorders,
  • to trace the state of the endometrium at any stage of the cyclic process.