There is no dominant follicle cause. Follicles in the ovaries: their meaning and function. What does an ultrasound show?

Folliculogenesis is a cyclic process that occurs in the ovaries under the control of the nervous and endocrine systems s. Its main mechanism is the transformation and transformation of the follicle into a mature egg.

The main stage of folliculogenesis is the formation of a dominant (main) follicle.

The dominant follicle is formed through sequential stages:

The beginning of the formation of many small ones,

Growth and development of small follicles,

Maturation dominant follicle,

Ovulation.

We can say that a mature dominant follicle is an egg that must ovulate. Thus, it becomes clear that in the presence of all the above stages of follicle formation, ovulation ultimately occurs, i.e. pregnancy is possible.

The formation of small follicles begins from the first days menstrual cycle. However, their growth begins only in the hormone-dependent stage, which occurs immediately after the end of the luteal phase. At the same time, the amount of estradiol and progesterone decreases, but the amount of follicle-stimulating hormone (FSH) increases.

It should be noted that the dominant follicle is influenced by many factors that can lead to its death. However, it is designed in such a way that all its processes are aimed at preserving the egg and its fertilization. Therefore, the dominant follicle is “protected” by epidermal growth factor and transforming growth factor (TGF).

5-7 days after the onset of menarchy, small follicles begin to form. They are also called tertiary or antral. There are enough of them a large number of- about 10 pieces. This phase of folliculogenesis is called early proliferation or the beginning of the formation of small follicles. The diameter of these small formations does not exceed 5 mm. They are located in the form of “beads” along the periphery of the ovary. Over time, some of the follicles increase in size and gain strength.

Consequently, the dominant follicle is formed after approximately 10 days of the menstrual cycle, and at this time its size reaches 15 millimeters. Other follicles that fail to gain the required mass regress and die. As a result, we can conclude that there may be more than one dominant follicle. When two or more eggs mature and are subsequently fertilized, a multiple pregnancy develops. This process does not occur often, but such cases have been recorded. Most often this is an iatrogenic cause: medications hormone-based, or IVF. But it is not excluded physiological reason birth of twins and triplets.

By the immediate moment of ovulation, the dominant follicle should reach a diameter of about 20 millimeters (maybe more). At the site of the follicle, a corpus luteum slightly smaller in size than its predecessor.

If fertilization does not occur, then within a week after the egg leaves the ovary, the corpus luteum begins to decrease in size - it regresses. By the time of rejection, the endothelium of the uterus, as a rule, dies, and in its place only an area of impaired echogenicity may remain.

Speaking about folliculogenesis, one cannot help but dwell on the concept of “persistent follicle”.

It is customary to call persistent a follicle that goes through all stages of folliculogenesis, except for immediate ovulation. What reasons may lead to this phenomenon are not fully understood. However, doctors often accept persistence as a variant of the norm, unless, of course, it is constantly recurring.

Sometimes it happens that a persistent follicle turns into a small ovarian cyst. Patients who develop a cyst need to be monitored. If this process does not cause complaints, then treatment is not required.

As a rule, persistent follicles rupture, but it is almost impossible to get pregnant in this situation, because the endometrium of the uterus is too thin for implantation.

INTERESTING! A dominant occurs most often, but with artificially stimulated ovulation it grows on both. And in this case, the chance of conceiving twins increases.

Why is it missing?

When the dominant does not appear, a woman becomes pregnant. The causes of this pathology are as follows:

ovarian cyst;
"sleeping" ovaries;
disturbances in the development of the dominant.

Persistence

When There is not enough progesterone and luteotropin in the body, the follicle, having assumed the desired size, cannot rupture and release the egg. In this case, it is called persistent, and the pathology is called persistence. Her signs are:

there is no fluid behind the uterine cavity;
the amount of estrogen is very high;
and the amount of progesterone is too low;
the corpus luteum does not develop.

ATTENTION! With persistence, the dominant remains on the ovary throughout the entire menstrual cycle, and sometimes it can be fixed even after the end of the cycle. Thus, the body seems to be ready for ovulation, but it does not occur.

Cyst

When the follicle fails to rupture and release an egg, but instead continues to grow, it turns into a cyst on the ovary. This cyst is benign education, which occurs due to hormonal imbalance.

The risk of its occurrence is increased by factors such as:

chronic diseases of the pelvic organs;
frequent abortions;
genitourinary operations;
wrong diet.

Such a disorder affects a woman’s menstrual cycle, affecting its duration and regularity. Thus, the cyst interferes with the creation of a new dominant follicle. However, it rarely needs treatment, and usually goes away on its own within two, sometimes three, cycles.

"Sleeping" ovaries

In this case, we are talking about ovarian dysfunction, in which there are simply no follicles, none at all. They don't grow at all. And ovulation never occurs.

Does not ripen for other reasons

Developmental disorders are a pathology in which the follicles stop at one of the stages of development and suddenly begin to regress. In this case, a dominant can be formed, but it will not reach the required size by the time of the ovulation phase.

IMPORTANT! In case of developmental disorders, hormonal analysis does not show any pathologies, completely corresponding to the norm.

What to do?

If there is a suspicion that the dominant is missing, need to see a doctor and undergo a series of examinations. After this, the cause of the pathology will be determined and necessary treatment. Self-medication should not be done so as not to aggravate the condition.

In the hospital the doctor will examine you on the gynecological chair. And since the most common reason for the absence of a dominant is hormonal imbalance, he will prescribe a blood test for hormones.

Moreover, at different stages of the cycle, because for the formation of a dominant each phase requires different amounts of hormones. And the doctor needs to know at what stage and which hormones are not enough.

Also prescribed folliculometry - a procedure that includes ultrasound diagnostics throughout the entire cycle. This allows you to track the work of the ovaries in each phase.

In addition, the doctor will pay attention to the duration of the cycle, because if it is longer or shorter than normal, this is a sign of ovulation disorder.

ATTENTION! The cycle when the dominant is not formed occurs several times a year in absolutely healthy women. This is normal and means that the body is, as it were, resting.

Prevention methods

Preventive measures are aimed at supporting the process of creating follicles and preventing disturbances in the functioning of the ovaries.

These include:

quitting smoking, alcohol, drugs;
a full sex life with regular sexual intercourse;
active lifestyle, nutritious diet;
if possible, avoid stress and excessive physical activity;
taking measures to protect against STDs;
exclusion of abortion;
control of hormone levels in the blood.

And in mandatory must be taken regularly preventive examination in the antenatal clinic.

What treatment is prescribed?

Since most often the reason for the absence of a dominant follicle in hormonal imbalance, treatment is prescribed with hormonal drugs. The schedule for their intake is drawn up by the doctor, depending on how saturated the woman’s body is with estrogen.

A week before menstruation, progesterone may be prescribed in the form of a 1% solution by injection. To stimulate the ovaries to grow and develop follicles, doctors recommend estrogen medications such as Estradiol or Hexestrol. However start on your own hormonal treatment it is forbidden– this will further increase hormonal imbalance.

In addition, if necessary, the doctor can prescribe treatment inflammatory diseases urogenital area.

In conclusion, we can add, What healthy image life - best prevention problems with ovulation. And if the absence of a dominant follicle has already been diagnosed, do not despair: modern medicine can help in recovery.

If there is no dominant follicle in the ovaries, this means that there will be no ovulation and conception is impossible. This is sad news for young couples planning a pregnancy. You can correct the situation by consulting a doctor. A specialist will help you find out the reasons and prescribe treatment.

Possible reasons

Sources of disruption of folliculogenesis (the process of maturation of it and the egg) are malfunctions of the nervous and endocrine systems. Such a disorder occurs at any of the stages of development of the Graafian vesicle:

Early proliferation stage. The formation of small follicles () begins on days 5-7 of the menstrual cycle. About 10 pieces begin to form in the luteal phase, each with a diameter of 5 mm. Located on the periphery of each ovary.
The growth of small follicles against the background of an increase in FSH (follicle-stimulating hormone, which is produced by the pituitary gland).
Growth and maturation of the dominant vesicle. On the 10th day of the cycle, the diameter is 15 mm. The rest regress and die. This also happens due to the production of estrogen DF, which suppresses the growth of the antrum. If on the 12th day of the cycle there is no dominant follicle, then it will no longer exist.
Ovulation. On the 14th day of the cycle, the DF has a diameter of 20 mm, after leaving the ovary, the corpus luteum remains in place of the DF (performs a hormone-forming function in the event of pregnancy). It is an important gland that prepares the endometrium for the implantation of a fertilized egg and its further growth.

The absence of a dominant follicle is caused by the following reasons:

infection genitourinary system, inflammatory process reproductive organs. Often – endometritis, adnexitis,;
pituitary tumor;
neoplasm of the hypothalamus;
follicle formation does not occur (“ ”);
the content of the “main thing” is exceeded female hormone» — estrogen;
absence of ovulation if present. The reason is a lack of progesterone and luteotropic hormone (luteotropin);
the persistent blister continues to grow and develops into a cyst, which requires observation. Cystic formation can remain in the ovary for 3 cycles and does not require treatment. Ovulation also does not occur in the presence of a cyst.

The absence of DF often indicates a hormonal imbalance.

Necessary tests

If a woman does not have a dominant follicle, the gynecologist may prescribe tests:

determining the level of estrogen and progesterone in the blood;
diagnostics of the level of FSH (follicle-stimulating hormone), LH (luteinizing hormone);
General blood test. Will it show? chronic inflammation in the body, anemia;
A biochemical blood test will allow you to evaluate the functioning of the liver, kidneys, and pancreas;
blood test for hormones thyroid gland: TSH (thyroid-stimulating hormone), T4, T3.

If there is no mature follicle, will there be ovulation? No, it will not.

Treatment methods

The first thing to do is consult a gynecologist. Remember! Only a specialist will tell you in detail what to do if there is no dominant follicle, what treatment is needed and what the consequences of such a diagnosis are.

In most cases, the patient requires:

Most often, if there is no dominant follicle, replacement therapy is prescribed. One week before the first day of the cycle, injections of 1% progesterone are recommended. Therapy is also carried out with oral forms of drugs. For this purpose they can be used medicines estrogen and progesterone by different schemes, which will be prescribed by the gynecologist. Usually they use Duphaston and Utrozhestan. Prescribing on your own is dangerous to your health!

In order not to look for a solution to the problem of the absence of a dominant follicle, you need to take care of your health from your youth. Remember that smoking, abortion, bad habits, sexually transmitted diseases are an obstacle to the desired pregnancy!

The size and number of follicles play an important role in conception, as they are a reflection of a woman’s ability to give birth, become pregnant and carry a child. The article talks about what causes premature ovarian failure and what it means, what treatment is necessary and how to give birth to children if there are no follicles on ultrasound.

By the time of the first menstruation, more than 300 thousand follicles are found in the ovaries of girls. During life before the onset of menopause, every monthly cycle accompanied by their death after ovulation. If a woman detects, usually in the middle of the cycle, discharge from the genital tract like egg white or clear mucus, this means that the dominant follicle has burst and ovulation has occurred.

From total number only 0.1% of follicles ovulate, the remaining 99.9% shrink. If the dominant follicle, which has stopped developing, begins to decrease without reaching mature size, then the cycle is called anovulatory, i.e. ovulation has not occurred and conception is impossible this month.

Estrogen, progesterone and male sex hormones in minimal quantities are responsible for the functioning of the ovaries. Hormonal disorders worsen reproductive function: the follicular apparatus is depleted, menstruation ends, and conception becomes impossible.

Typically, the dominant follicle develops in one ovary. If two follicles develop simultaneously in two ovaries, then the chances of conceiving twins increase by 2 times, but this requires that they reach their peak development and burst at the same time.

The number of follicles is normal

The menstrual cycle is accompanied by hormonal changes, so the number of follicles in the ovary depends on the specific day:

on the 5th day of the cycle – up to 10 follicles ranging in size from 2 to 6 mm;
from 7 to 9 days of the cycle - from 10 to 20 follicles, one of which (dominant) is up to 15 mm in size, the rest are half as large;
from 11 to 14 days of the cycle - the dominant follicle can reach 25 mm.

Giving a child life becomes possible if there are more than 7-16 follicles. If there are 4-6 of them, then there is little chance. If there are less than 4 or none at all, then natural conception is almost impossible. In the latter case, it is recommended to do IVF, look for a surrogate mother or donor eggs, if the treatment hormonal drugs did not produce results. If a woman has undergone IVF, pregnancy usually occurs successfully and is closely monitored by a doctor.

Not all females ovulate on days 14-16. Depending on the characteristics of the body and the number of days in the cycle, the growth of the dominant follicle can vary greatly from day to day. For example, if the cycle is 40 days, then ovulation is likely to occur on the 20th. Accordingly, on the 14th day of the cycle, the follicles in the ovaries will be smaller.

To track ovulation, the doctor prescribes folliculometry - counting the number and size of follicles.

Reasons for the absence of follicles in the ovaries

After 45 years, the disappearance of follicles is natural process called "menopause". Reproductive abilities for pregnancy gradually decrease until they disappear completely, hormonal function fades, then menstruation stops against the background of progressive depletion of follicular function.

The term “premature menopause (menopause)” is being replaced by “premature ovarian failure,” although the essence of the disease remains common.

Causes of premature ovarian failure (this is complete absence follicles or eggs that do not respond to hormonal stimuli) in reproductive age the following:

genetics;
autoimmune disorders;
viral infections;
toxins;
starvation, unhealthy diet;
excessive smoking;
alcohol consumption;
chemotherapy;
radiotherapy;
on the pelvic organs;
incorrectly administered hormonal therapy.

Due to the close connection of female sex hormones with the nervous system, the absence of follicles on ultrasound may be a temporary phenomenon caused by stressful situations, depression, excessive stress. Usually the next cycle is restored and continues to operate as usual. In other cases, treatment with hormonal drugs is a prerequisite for maintaining health and the ability to conceive a child.

Treatment is necessary for those women whose failure is caused by endocrine diseases, severe fluctuations in weight, unsuccessful use of contraceptives.

What to do if there are no follicles

First, you need to make sure that the doctor who made the diagnosis is competent. It is advisable to contact another specialist and do a repeat ultrasound on a different device in the next cycle.

Before you panic, you should start treating the disease from specialists and at the same time take advantage of the opportunities to solve the problem:

Normalize your lifestyle: quit smoking, give up alcohol, exercise physical activity in reasonable quantities, maintain the regime.
Adjust your diet: give up salty, fatty, spicy foods. Reduce consumption of citrus fruits, pineapples, pears, cabbage, rice. Legumes, vegetables, pomegranates and apples have positive influence for ovulation.
Use traditional methods: sage, plantain, aloe stimulate ovulation.
Inhale vapors essential oils: sage, basil, cypress, anise.
Consult a specialist about vitamin therapy. Folic acid and vitamin E effectively combats insufficient ovarian activity.
Treat viral infections, including STIs.
Eliminate psycho-emotional stress, stress, and, if necessary, use sedatives nervous system(valerian, glycine, etc.)

It happens that the above methods are enough to normalize the functioning of the ovaries and improve well-being, but the main way to solve the problem is to consult a doctor and hormone therapy under strict control.

Depending on the reason that caused the dysfunction, normalize the work female organs eliminating it will help. For example, if the disappearance of follicles occurred due to a sudden weight gain, then its normalization is sufficient for recovery.

Before using additional methods to solve the problem, consultation with a specialist is required.

Diagnostics

To make a diagnosis, it is necessary to conduct a number of studies:

Examination by a gynecologist. It is important to describe in detail your health, symptoms, first signs, past illnesses, surgeries, etc.
Data about the menstrual cycle. It is necessary to indicate the duration of the cycle, regularity, features of discharge, etc.
Blood test for the hormones FSH, TSH, LH, AMH, estradiol, prolactin.
Smear for flora and STDs.
Ultrasound of the pelvis with detailed characteristics of the condition.
Mammography.
Analysis for oncocytology, tumor markers.

Treatment

Therapy is selected based on the cause of the dysfunction. Most often used following methods treatment:

HRT (artificial normalization of sex hormones using drugs).
Physiotherapy (ultrasound, electrophoresis, etc.)

Before prescribing HRT, the specialist is obliged to inform the patient about side effects, contraindications, and positive changes. It is appropriate to prescribe HRT only after hormonal tests have been carried out, otherwise the doctor’s competence should cause mistrust.

If there are contraindications, the patient is prescribed homeopathic remedies and phytoestrogens.

Traditional treatment methods

Facilities traditional medicine It is allowed to use only after consultation with a doctor, otherwise the body’s condition may deteriorate irreversibly due to serious complications.

After receiving permission from your attending physician, you can use the following: healthy recipes traditional medicine:

Cabbage juice. Drink 0.5 cups per day on an empty stomach.
Beet juice. Dilute cold water, take 1 tbsp. l. 1 ruble/day.
Decoction of boron uterus. Add 1 tbsp to 300 ml of water. l. herbs, cook for 10 minutes. Infuse and take 1 tbsp. l. up to 5 rubles/day for 3 weeks, then take a break for a week.
A decoction of lungwort, licorice root, calamus, horsetail or aralia (any mixture of your choice). Add 2 tbsp to 2.5 cups of boiling water. l. plants, drink 100 ml. 3 rubles/day before meals.

Correctly selected hormonal therapy together with other methods gives positive results: hormonal levels are normalized, the patient develops follicles. There is a chance to get pregnant naturally, without resorting to artificial insemination, donors and surrogates.

Normalization of lifestyle, stable psycho-emotional state and good mood have a powerful effect in the fight against disease. Having achieved the appearance of at least 4 follicles in the ovary with the help of treatment, a woman has a chance to become a happy mother of a child born naturally.

Every year doctors record everything more cases women's inability to have children. The development of medicine and technology, unfortunately, does not yet make it possible to completely cure all disorders of the human genitourinary system. More and more couples are faced with the need for artificial insemination or surrogacy, and more and more often doctors are talking about the importance and necessity of family planning.

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

Ovulation and dominant follicle

The follicle is the container for the egg. In the middle of the developmental phase, the dominant follicle is quite noticeable - it is the largest and most well developed of all. Every month, the egg matures and prepares for fertilization - the follicle enlarges 15-20 times, fills with liquid and bursts (approximately on the 14th day of the menstrual cycle). In this case, only one of the many (10-15) follicles fully matures and bursts - the rest stop developing for different stages and die. This is what is called ovulation. When dominant follicles develop in both ovaries, the likelihood of conceiving twins increases many times over. Very often, as a result of hormonal stimulation, several dominant follicles grow, which ovulate and are fertilized simultaneously. This explains the large number of twins and triplets born as a result of artificial insemination or after stimulation of ovulation.

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

How to grow a dominant follicle?

The most common modern method ovulation stimulation is hormonal therapy, in particular, the appointment of clostilbegit. But, despite its widespread popularity, its use is not always justified. Moreover, some women should absolutely not use it. That is why it is so important to be confident in the qualifications of the attending physician and that he has sufficient arguments for prescribing potent drugs. After all, it is known that the higher the effectiveness of the product, the higher the likelihood of unwanted side effects. side effects and the more varied and serious they are.

Remember that the selection of means for stimulating ovulation and the dosage of the selected drugs are purely individual; in no case should hormone stimulation be used without the supervision of a doctor.

Many women report positive dynamics after prescribing a course of vitamin therapy and taking folic acid.

Why is there no dominant follicle?

There may be several reasons why the dominant follicle does not mature and there is no ovulation:

Main condition successful recovery ovulation – adequate determination of the cause of its violation. If this cause has not been identified and eliminated, even repeated stimulation does not always bring results.

Diagnosis of the causes of ovulation disorders cannot be based only on chart analysis basal temperature(even if several cycles are available). Diagnostics must be comprehensive - medical examination, analysis hormonal levels, ultrasound diagnostics development of follicles over a number of cycles (and not as a result of a one-time visit to the doctor).