The dominant follicle in the left ovary is 20 mm. All about dominant follicles. What is a dominant follicle?

The female reproductive system is a very complex and harmonious “structure”. There can be nothing accidental about it. In order for a woman to be ready to conceive a child at any time of the year, nature created ovulation. This is the name of the process when an egg is released from the ovary. The role of the follicle in this process cannot be underestimated. After all, the follicle is the place where the egg appears and matures.

The outer layer of the ovaries contains many follicular cells. During each ovulation, some of them grow and develop. Soon it becomes visible dominant follicle right ovary (it is larger than its “brothers”). The fate of the remaining cells becomes atresia - reverse development.

The dominant follicle grows rapidly and eventually bursts, releasing a mature egg. If a sperm fertilizes this egg, conception will occur.

How it develops

It is known that folliculogenesis (the process when a follicle develops from the “rudimentary” stage to the preovulatory stage) can only occur in a sexually mature girl. At first menstrual cycle it is impossible to predict which follicle will become dominant (remember that the first day of the cycle is the day when a woman begins her period, and the last day is the one that precedes menstruation). Let's look at what happens to a woman's ovaries before ovulation:

• On the fifth – seventh day of the cycle, all follicular cells without exception are small (their diameter is about five millimeters). They are surrounded by a connective membrane.
• On the eighth - tenth day of the cycle, the dominant follicle is already clearly visible. Its size is about thirteen to fifteen millimeters. An egg will develop inside this formation. Such a “leading” follicle most often appears in the right gonad in women. But it can also form in the left ovary.
• The eleventh – thirteenth days are the period of active growth of the dominant follicle. This “house” for the egg can increase by several millimeters per day. And other follicular cells shrink and soon disappear.
• Ovulation occurs on the fourteenth to sixteenth day of the cycle. By this time, the size of the “champion” is about twenty millimeters in diameter (and sometimes more). Then the follicle bursts and the egg comes out.
• The follicle, which has “released” its contents, begins to change. Soon a yellow body appears in its place. And a small amount of fluid appears in the space behind the uterus.

Nature's wise strategy

It would be wrong to think that follicular cells appear in Eve’s adult daughters “out of thin air.” A girl’s reproductive system begins to develop even before the baby herself is born. A constant number of follicular cells in the ovaries is established. It ranges from fifty to two hundred thousand. In an adult woman it is impossible to increase this reserve.

It’s easy to guess that over the course of a woman’s life, not all the follicles that nature has given her will have time to mature. Therefore, some of these cells are resorbed even in infancy. This process stops by the age of two, only to resume again after five to seven years.

When a girl begins to develop into a girl, the follicular cells begin to mature. As a result, the young lady begins to menstruate.

The most important task that nature has assigned to the follicles is to protect the eggs located inside them from all unwanted influences. In addition, these cells produce the female hormone estrogen. In a month, a woman matures one follicle. Very rarely, two follicles can become dominant.

The absence of follicles can be caused by a hormonal “failure” in a woman’s body. The onset of early menopause is also possible - women under forty are increasingly becoming its “victims”. This situation will affect your periods (they may be delayed for a long time). It is important for a woman who has noticed undesirable changes in her health not to delay visiting a gynecologist. Otherwise, her chances of becoming a mother will significantly decrease (or disappear altogether).

You can’t do without an ultrasound

When a gynecologist is faced with the task of determining whether a woman can conceive a child, the capabilities of ultrasound are used. On an ultrasound, the doctor observes where the dominant follicle appears and what size it reaches. This procedure is called folliculometry.

Ultrasound examination will need to be done several times. For the first time, a woman comes to the ultrasound room on the eighth - tenth day of the cycle. The main object of observation of the specialist is the dominant follicle formed in the left or right ovary of the woman. Next studies will take place every two days until the onset of ovulation is confirmed.

The doctor will find out exact time ovulation, evaluate the characteristics of the corpus luteum. No special preparation is required for the ultrasound procedure. If the probe will be “looking” through your abdominal tissue, you will need to fill your bladder before the procedure. And with transvaginal examination of fluid in bladder there shouldn't be.

The most questions arise when the egg does not come out of its shelter (that is, ovulation does not take place). To understand what led to such a violation, you need to continue research until the girl begins her period. It is important to determine what reasons prevented ovulation from occurring, and also to figure out what happened to the follicle next. If it decreases and disappears, the situation is not too alarming. A persistent follicle, one that has not ovulated but continues to develop, can cause more problems for a woman. It is this that can become a follicular cyst.

What could influence the development of a “leader”

Every month, several follicles mature in a woman’s gonads. One of them becomes dominant. Expert observations confirm that such a “leading” follicle more often appears in a woman’s right ovary. There is nothing strange here - in mature women, the right sex gland is more active.

However, the left ovary also successfully produces “houses” with eggs. The main thing is that every month, against the background of smaller follicular cells, a large one is formed. If this follicle released a mature egg, ovulation was successful.

Irregular menstruation and prolonged unsuccessful attempts to get pregnant are key signs that a woman has problems with ovulation. There are several factors that block the development of the largest follicular cell:

• Oral contraceptives. Contraceptive drugs may negatively affect follicular development. Fortunately, this effect of the tablets is reversible. It is enough for a lady to give up contraceptives, and in a couple of months ovulation will be restored.
• Hidden infections.
• Diseases thyroid gland. Situations when the functionality of the thyroid gland is reduced or increased negatively affects not only the sexual sphere, but also the entire body of a woman.
• Excessive production of the hormone prolactin.

The listed factors can significantly reduce a woman’s reproductive capabilities. But, fortunately, many violations in female body Medicine can eliminate it. The main thing is to find out in a timely manner what exactly is preventing ovulation.

Return to normal

When a woman has very few follicles in her gonads, this is abnormal. An excessive amount of them can also cause doubts in the doctor about the health of women's ovaries. If a woman does not form a dominant follicle, the egg does not mature, and menstruation does not occur, it is obvious that the disturbances in her sexual sphere are serious. But in most cases they can be eliminated with properly selected drugs.

If the examination confirms the presence of a persistent follicle in a woman, the doctor will prescribe her a course of hormones. A situation where a woman’s dominant follicle does not develop also requires competent treatment. A patient with this disorder is prescribed medications that stimulate ovulation. The effectiveness of treatment can be judged by ultrasound examinations (they will show whether a dominant follicle has appeared in one of the gonads).

Coordinated work of all organs reproductive system women are the key to a successful pregnancy. Once a month there comes a period of time when conception can occur. These days, one of the eggs leaves the follicle after it ruptures and is sent to the uterine cavity.

When sexual intercourse occurs during the period of ovulation, there is a high probability of the fusion of female and male reproductive cells, the formation of a zygote, and then the gradual formation of a new person. If a couple in love who has been trying to conceive a child for a long time fails, perhaps the reason lies in impaired maturation of the dominant follicle.

What it is?

This is the receptacle for the egg, after which ovulation occurs.

Even during embryogenesis, the laying of structures occurs that will later house eggs.

On average, a girl has about 200 thousand follicles in her ovaries.

In girls who have reached puberty, a regular menstrual cycle is established, in one of the phases of which the formation and release of germ cells occurs.

Several follicles can mature at the same time, but in the future one of them will experience increased growth. It is from this that the egg will subsequently be released. This structure, which dominates its counterparts during the maturation process, is called the dominant follicle.

Sometimes there are cases where two dominant follicles are formed, but normally only one is needed. When it bursts, ovulation occurs and conception is possible.

Graafian vesicles, which lag behind the dominant one in development, undergo a process of reverse development and disappear. After fulfilling its function, the dominant follicle also transforms. It turns into the corpus luteum, which has its own hormonal effect on the course of the menstrual cycle and pregnancy. There may also be disturbances in the development of follicles.

These include:

1. – these structures of the reproductive system, having reached a certain size, stop further growth, but their involution does not occur. They continue to reside in the ovaries. The most justified reason that can explain this phenomenon is considered to be that the follicle wall is too thick or strong;
2. Premature regression– when the vesicles either do not reach the required size, or they do, but reverse development occurs even before the eggs leave them;
3. Cyst formation– occurs if the capsule has not been opened and the follicle continues to grow. A cyst or several such neoplasms are formed, which can not only lead to infertility, but also to disruption of the functions of other body systems.

Important! If the normal maturation of the dominant follicle is disrupted, ovulation does not occur, which leads to infertility. Therefore, when its signs appear, a woman herself or with her partner can come to a specialist to determine the reason for the impossibility of conceiving. The doctor will conduct an examination, which will include a blood test to evaluate hormonal levels and ultrasound of the ovaries, and will offer options for solving the problem.

Why is it formed in the right or left appendage?

Two dominant bubbles may form at once.

But in the overwhelming majority of cases, only one, responsible for further ovulation, actually grows.

There was no difference between the dominant follicles that developed in the right and left ovaries.

It is only noticed that more often this process is carried out in the right uterine appendage. There is no reliable explanation for this, although there is a theory that maturation on the right occurs predominantly in right-handers due to the prevailing action nervous system on this side. It is also worth noting that the right ovary is larger than the left, and its blood supply is more intense.

Sometimes dominant follicles are formed simultaneously in two uterine appendages.

The reason for this may be:

1. Genetic predisposition– if a woman has had twins in her family, then there is a high probability that she will suffer the same fate;
2. Hormonal imbalance- can be caused by taking medicines, abrupt withdrawal, nervous or physical overstrain;
3. Irregular sex life , When intimate relationships very rare.

Also, often the presence of a dominant Graafian vesicle can be detected in both one and the other ovary in girls who have not previously given birth, but have already crossed the threshold of their thirties. Apparently, in this way nature increases their chances of getting pregnant.

If two dominant follicles develop in one appendage, this is not considered a pathology. All of the above etiological factors play a role in similar situation. In each of them, an egg matures, and if no disruption occurs in these processes, two ovulations will occur in one cycle. After sexual intercourse, double conception is possible, leading in the future to the birth of twins.

Note! If a girl whose body has two dominant follicles had sexual contacts with different partners, there is a fairly high probability that she will simultaneously give birth to children from different fathers.

An ultrasound examination visualizes the presence of one or more dominant follicles. They differ from other vesicles in size - at the last stage of formation, follicles reach an average of 22 mm.

Does maturation occur in every cycle?

Yes, normally ovulation - the rupture of the follicle and the release of an egg from it should be observed in each menstrual cycle.

If this does not happen, it means that there are some pathological changes in the female body that require more detailed study.

It is also considered normal if there are two non-ovulatory cycles per year that do not follow each other (for example, in January and then in February).

A one-time failure of a function can occur after exposure to any strong internal or external factor, but its occurrence on an ongoing basis is a reason for concern. If a girl notices that disorders have occurred in the activity of her reproductive system, and they do not go away for a long time, she needs to seek advice from a specialist. The sooner this happens, the better.

Stages of development

The reproductive system begins to emerge during embryogenesis. In the fetus, it is represented, among other things, by immature oocytes (immature eggs), surrounded connective tissue. These cells with a completely unformed membrane are called premordial follicles. At puberty, they begin to produce estrogens, participate in the regulation of the menstrual cycle, and become preantral. One of them becomes dominant and also undergoes some changes necessary for reproductive function.

Stages of formation of a dominant follicle:

1. Elementary- occurs along with the appearance of menstruation, the intensity of growth increases as it approaches the hormone-dependent stage, when the level of progesterone and estrogen decreases, and follicle-stimulating hormone is actively synthesized. There are biological mechanisms in the female body that negatively affect this process, but thanks to epidermal and transforming growth factors, the vesicle receives protection. It gradually fills with liquid and increases in size, reaching about 5 mm. Now this is the tertiary or antral follicle;
2. Middle of development– closer to the 10th day of the cycle, the dominant vesicle increases to 15 mm and gains strength. At the same time, the rest stop growing and regress. By the time of ovulation, it becomes another 5 mm larger. Next, the egg is opened and released;
3. Finite– gradual regression and transformation of the follicle into the corpus luteum. After transformation, it begins to secrete other hormones and perform slightly different functions.

Important! Development may be disrupted, and this is manifested either by the appearance of persistent forms that do not mature further, but do not disappear, or by pathological growth without rupture, resulting in a cyst. Such deviations may not have a significant impact, but if a negative impact occurs they must be eliminated.

Why might he be missing?

The absence of a dominant follicle may be due to hereditary predisposition or hormonal imbalance, but we can say for sure that it does not bode well.

This physiological formation, containing an egg, plays one of the main roles in the process of conception.

If it is not there, the woman is unable to get pregnant.

If such a situation arises, you should seek help from a specialist. He will conduct an examination, the purpose of which is to find etiological factors pathology. Having found out the cause, the doctor will prescribe appropriate treatment. Basically, it involves the use of hormonal drugs. It is thanks to them that you can influence the maturation of follicles and significantly increase the likelihood of conception. At correct use hormones active in certain phases of the cycle can regulate it and restore fertility.

Expert opinion

Olga Matveeva

Gynecologist-obstetrician
6 years experience

IN human body everything is calculated and provided to the smallest detail. Long before the birth of a child, mechanisms and structures appear that in the future will be responsible for the continuation of his family. These amazing processes can be disrupted, but modern medicine helps in solving such problems. For any woman, especially for one who wants to become a mother, it is important that there are no malfunctions in the functioning of the reproductive system. Impaired follicle maturation, often leading to infertility, is a reason to consult a doctor. Nowadays, there is every opportunity to eliminate the problems that caused many families to fall apart decades ago.

The follicles in the ovaries are an integral part of the female reproductive system, which make it possible to conceive a child. Deviations from the norm in the development of these elements are fraught with unpleasant pathologies and sometimes infertility.

Ultrasound of the ovaries. Follicles

The ovarian cycle consists of two phases - follicular and luteal. We are interested in the first one.

The follicle contains an egg, which is surrounded by a layer of epithelial cells and two layers of connective tissue. Whether a woman can get pregnant and carry a baby depends on how reliably the egg is protected and whether it can be preserved. Thus, the main thing functional value these structures - to provide the egg with protection from negative influence various factors, which is very important during pregnancy. One such formation matures in a month.

All follicles in the ovaries contain an egg that is not fully mature. It will finally mature only after the fertilization process.

One more, no less important function Such formations are the production of the hormone estrogen. In the fairer sex, follicles are continuously formed throughout life. Of these, 99.9% die and do not ovulate. And only one, rarely 2-3 follicles undergo ovulation.

Dominant follicles and their role

The dominant follicle is the element that is the largest and most mature, providing protection to the egg ready for fertilization. Before ovulation, it is capable of reaching two centimeters in size. Usually located in the right ovary.

Having reached a state of maturity and being under the influence of hormones, the dominant follicle ruptures and the ovulation process occurs. The egg rapidly moves towards fallopian tubes. If the dominant element does not mature, then there will be no ovulation.

There are situations when dominant formations mature in both ovaries at the same time. There is no need to worry about this. Most likely, such a woman has every chance of conceiving twins after ovulation. However, this is only possible if the dominant elements in both the right and left ovaries have both ovulated at once. This doesn't happen often.

Number and norm of follicles in the ovaries

Follicles in the ovaries are counted based on the day the menstrual cycle starts. If multiple follicles are detected a couple of days after the end of your period, this is not considered a deviation.

The middle of the cycle will be marked by one or two elements that will be larger in size than the rest. At the end of the cycle, only one will remain large. An egg should come out of it, which at that moment is ready for fertilization. The rupture of the formation itself is manifested by the beginning of the menstrual cycle.

Find out more about the number of follicles in the article.

Deviations from the norm

If the quantitative composition of follicles in the ovary exceeds 10, this is considered to be a violation. Such a pathology can be diagnosed only by ultrasound results. Moreover, their number does not change at all over the course of the cycle. During ultrasound examination noted big number small bubbles. If their number increases several times, the woman is diagnosed with polycystic disease. characterized by the formation of multiple follicular formations along the periphery.

Polycystic disease can interfere with the formation of a dominant element, the ovulation process and conception. The development of such problems can provoke nervous disorders and stress. In this case, polycystic disease does not require special treatment, and the deviations will easily return to normal.

However, in some cases, underdevelopment of follicular elements requires special therapy. These include the following:

• if oral contraceptives were chosen incorrectly;
• if endocrine problems occur;
• when dialing excess weight or, conversely, sudden weight loss.

If the follicles in the ovary are higher than normal, this does not necessarily mean that polycystic disease has developed or is a signal of any illness. It is likely that the reason for this was overwork, stress, and constant emotional overstrain. In this case, after the first ovulation their number returns to normal.

Since obesity can provoke follicular failure and lead to an imbalance in the functioning of the ovaries, women are advised to monitor their diet and pay due attention to physical activity.

Every woman must regularly visit a gynecologist-endocrinologist. This will allow you to promptly identify the pathology and promptly begin to treat it.

Only a gynecologist can determine why the follicles in the ovaries are formed abnormally from the norm after undergoing certain tests and a special examination.

Persistent follicle

The question of what a follicle is is asked by those who have received a similar diagnosis. Pathology means that the formation of the dominant element occurred as it should until the very moment when it was supposed to burst. This did not happen and the egg, accordingly, is not released. Regardless of where the appearance of a persistent follicle was diagnosed on the right or left ovary, ovulation does not occur. The cause of the disease may lie in hormonal imbalances in a woman, in cases where the male hormone is present in excess. If you do not intervene in such a process in a timely manner, then the development of infertility is possible.

The essence of treatment comes down to hormonal therapy.

On initial stage medications are being taken that will suppress male hormones in the body.

The second stage involves the introduction of hormones intramuscularly. In addition, it is necessary to carry out massage procedures, laser therapy, and ultrasound effects on the pelvic organs.

Lack of follicles

However, sometimes it happens that the follicular structures on the ovaries are completely absent. The reason for this lies in the early onset of menopause or failures in the functioning of the ovaries. In this case, the doctor prescribes hormonal treatment. You can find out about the presence of such a problem by irregularities in the menstrual cycle.

The body of the fairer sex must produce a certain number of follicles. If there are more or less of them, this is always considered a deviation. Sometimes everything can end in the development of infertility. Therefore, when faced with menstrual irregularities, a woman should immediately contact a doctor to determine the cause and prescribe the necessary treatment.

Ovarian follicle - structural component ovary, the main functions of which are to protect the egg from negative influences and form corpus luteum during the period of ovulation. On early development There are approximately 4 million follicles in the fetal ovary, during birth the figure decreases to 1 million, and during puberty it drops to 400 thousand. As a result, only about 400 follicles will have a chance to finally mature during ovulation and form the corpus luteum.

Menstrual cycle

Early phase

At the beginning of the menstrual cycle, the ovary contains 5-8 follicles less than 10 mm in size. During the process of maturation, one of them (in rare cases two) becomes dominant, reaching a size of 14 mm. On the 10th day of the cycle, it begins to distance itself and increase daily by about 2 mm until it ruptures. The remaining follicles begin to undergo a slow process of involution (atresia), their small fragments can be seen on ultrasound throughout the menstrual cycle.

Follicle maturation time

The blood supply to the ovaries increases significantly during the onset of ovulation under the influence of pituitary hormones - gonadotropins FSH and LH. Education of new blood vessels leads to the appearance of a follicle shell called theca, which gradually begins to surround it from the outside and inside.

Ovulation period

Two criteria that allow you to determine the maturity of the follicle and impending ovulation using ultrasound examination:

• The size of the dominant follicle should be between 20 and 25 mm;
• the cortical plate of the follicle, under the influence of an increase in internal fluid, slightly deforms one of the walls of the shell.

As ovulation occurs, the follicle stretches in size, protrudes slightly above the surface of the ovary and bursts - ovulation occurs.

Luteal phase

After ovulation, the walls of the empty follicle thicken, and its cavity is filled with blood clots - a red body is formed. If fertilization is unsuccessful, it is short term overgrows with connective tissue and turns into white body, which disappears after some time. If fertilization is successful, the red body, under the influence of chorionic hormone, increases slightly in size and turns into the corpus luteum, which begins to produce a hormone called progesterone. It increases endometrial growth and prevents the release of new eggs and the onset of menstruation. The corpus luteum disappears at the 16th week of pregnancy.

Empty follicle syndrome

IN small quantity In cases of ovarian stimulation during the treatment of infertility, patients may experience the so-called empty follicle syndrome. It manifests itself with adequate levels of estradiol (a hormone produced by follicle cells) and normally growing follicles, and “dummies” can only be identified by examining them under a microscope.

The exact cause of the symptom is unknown. However, experts were able to find out that the frequency of empty follicles increases with a woman’s age. In most cases, the appearance of the syndrome does not reduce the patient’s fertility: follicular maturation and the number of eggs remain normal.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a set of symptoms caused by abnormal ovarian function, increased content insulin in the blood, estrogens and androgens ( male hormones) among women. PCOS causes menstrual irregularities, excess weight, acne and age spots, the occurrence of pain in the pelvic area, depression and excess body hair.

Currently, the most common definition of polycystic ovary syndrome is the one adopted in 2003 by European experts. According to its content, a diagnosis is made if the examination is carried out during the first six days of the cycle and the woman simultaneously has two of the three symptoms:

1. increased size of the ovaries: surface area more than 5.5 sq.cm, volume more than 8.5 KB.cm;
2. the presence of at least twelve immature follicles less than 10 mm in size, most often located on the periphery of the ovary;
3. the presence of stromal hypertrophy.

The examination is performed using an ultrasound machine and 3D ultrasound. The latter will help to determine the volume of the ovaries and count the number of immature follicles with greater accuracy.

The main methods of treating the syndrome are: lifestyle changes, medication and surgical intervention. Treatment goals fall into four categories:

• reducing the level of insulin resistance;
• restoration of reproductive function;
• getting rid of excess hair growth and acne;
• restoration of a regular menstrual cycle.

For each of these goals, there is significant controversy regarding optimal treatment. One of the main reasons for this is the lack of large-scale clinical trials, comparing different kinds treatment. However, many experts recognize that reducing insulin resistance and body weight may have an impact on all treatment goals, as they are the main cause of the syndrome.

Answers on questions

What size must a follicle be for ovulation to occur? The follicle size should be between 20 and 25 mm. If there is a dominant follicle in the ovary, will ovulation occur? Ovulation will occur if an egg develops in the follicle and it is not empty. Can ovulation occur without a dominant follicle? No, he can not. In this case, a condition occurs in which fertilization and pregnancy are impossible. When does ovulation occur with a follicle size of 14 mm? After about 4-5 days when reaching given size. How many follicles must there be for ovulation to occur? One dominant follicle, in rare cases two.

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 each 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 childbearing age monthly, 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. Per process proper development follicles are 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 education appears if there is no ovulation. The reason for this pathological change is hormonal disbalance, which most often occurs due to dysfunction of the cerebral cortex. On appearance follicular cyst The following factors also influence:

• Poor nutrition;
• Chronic diseases;
• Irregular intimate relationships;
• Mental disorders;
• Frequent abortions;
• Surgical intervention for diseases 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 are diagnosed with inflammatory diseases genitourinary area. Prolonged stress and depression, abortions also lead to impaired maturation of the dominant follicle.

What to do to restore correct work ovaries, the gynecologist will tell you after complex diagnostics, which we talked about above. Hormone therapy is most often prescribed.

Gynecologists often prescribe. This drug is popular in Russia, but it should be used with great caution and only under the supervision of the attending physician: medicine has many contraindications. In addition, some patients are strictly prohibited from using it.

It should be remembered that any potent hormonal drugs with uncontrolled use may harm your health rather than help. Therefore, self-medication in this case is unacceptable.

To maintain the reproductive system, an appointment is also prescribed folic acid and multivitamins. In this case, the selection of drugs and dosage is selected individually, depending on age and general condition woman's health.

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. Stimulation may be needed 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?

- Normal 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 is restored and normal cycle? In most cases hormonal disorders can be adjusted.

“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.