Dominant follicle 16 mm. The size of the follicle by day of the cycle: normal and with deviation. Ripening in every menstrual cycle

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

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

A bit of theory

Follicles are called special formations in the ovaries, consisting of an oocyte of the 1st order (an immature egg) and several layers of special cells surrounding it. They are the main structural formations of the female gonads, performing endocrine and reproductive functions.

Follicles are laid in utero. They are based on oogonia - primary germinal germ cells that migrate to the germinal ovary at about 6 weeks of gestation. After meiotic division and proliferation, these precursors form first-order oocytes. These immature germ cells are covered with cuboidal epithelium and form the so-called primordial follicles. They will remain in a dormant state until the onset of the sexual development of the girl.

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

At the onset of conception, it is stored under the action of chorionic gonadotropin. The progesterone produced by them contributes to the prolongation of pregnancy. In all other cases, the corpus luteum is reduced, which occurs before menstruation. The accompanying sharp drop in progesterone levels provokes the onset of menstruation with rejection of the overgrown glandular (functional) layer of the endometrium.

A situation is possible when a mature follicle does not ovulate. At the same time, it can continue to increase in size, transforming into a reduced egg. Such formations can be single and gradually absorbable. But sometimes cysts persist for a long time, deforming the surface of the organ. In this case, one speaks of . Such a diagnosis is prognostically unfavorable for conception, it is usually accompanied by persistent dyshormonal disorders and infertility.

How many follicles are in the ovaries?

Not all ovarian follicles initially laid in utero are preserved by the time of puberty and subsequently develop. About 2/3 of them die and resolve. This natural process is called apoptosis or atresia. It begins immediately after the laying of the gonads and continues throughout life. A girl is born with approximately 1-2 million primordial follicles. By the beginning of puberty, their average number is 270-500 thousand. And during the entire reproductive period, only about 300-500 follicles ovulate in a woman.

The sum of all follicles capable of further development is called the ovarian reserve. It determines the duration of the woman's reproductive period and the onset, the number of productive (flowing with ovulation) menstrual cycles and, in general, the ability to re-conceive.

The process of progressive depletion of the ovarian reserve in the ovaries is noted on average after 37-38 years. This means not only a decrease in a woman's ability to naturally conceive, but also the beginning of a natural decrease in the level of basic sex hormones. The cessation of the development of follicles in the ovaries means the onset of menopause. It can be natural, early and iatrogenic.

Graafian bubble formation phase

The amount of follicular fluid progressively increases, it pushes the entire epithelium and the egg to the periphery. The follicle grows rapidly and begins to protrude through the outer shell of the ovary. The egg in it is located on the periphery on the so-called egg-bearing mound. Approximately 2 days before ovulation, the amount of secreted estrogen increases significantly. This feedback triggers the release of luteinizing hormone from the pituitary gland, which triggers the ovulation process. A local protrusion (stigma) appears on the surface of the Graafian vesicle. This is where the follicle ovulates (ruptures).

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

How is the “correctness” of folliculogenesis assessed?

The stages of folliculogenesis have a clear relationship with the days of the ovarian-menstrual cycle. Moreover, they do not depend on the age and race of the woman, but on her endocrine status.

The growth and development of the follicle is primarily regulated by the follicle-stimulating hormone of the pituitary gland. It begins to be produced only with the onset of puberty. At a certain stage, folliculogenesis is additionally controlled by sex hormones, which are produced by the cells of the wall of the developing follicle itself.

Any hormonal imbalance can disrupt the process of maturation and ovulation of the egg. At the same time, determining the level of hormones does not always provide the doctor with all the necessary information, although it allows you to identify key endocrine disorders. Therefore, the diagnosis of violations of the folliculogenesis process is the most important stage in the examination of a woman at the stage of pregnancy planning and in identifying the cause of infertility.

At the same time, the doctor is interested in how large the follicle grows and whether it reaches the stage of the Graafian vesicle. Be sure to monitor whether ovulation occurs and whether a corpus luteum of sufficient size is formed. In anovulatory cycles, the maximum size of developing follicles is determined.

An accessible, informative and at the same time technically simple method is. This is called monitoring the maturation of follicles using ultrasound. It is performed on an outpatient basis and does not require any special preparation of the woman. Folliculometry is a dynamic study. Several repeated ultrasound sessions are required to reliably monitor changes occurring in the ovaries.

In the process of folliculometry, the specialist determines the number, location and diameter of maturing follicles, monitors the formation of a dominant vesicle, and determines the size of the follicle before ovulation. Based on these data, you can predict the most favorable day of the cycle to get pregnant naturally.

With IVF protocols, such monitoring allows you to evaluate the response to ongoing hormonal therapy, set a date for the introduction of drugs to stimulate ovulation and subsequent puncture egg retrieval. The key parameter of folliculometry is the size of the follicle by day of the cycle.

Norms of folliculogenesis

Folliculometry is performed on certain days of the cycle, corresponding to the key stages of folliculogenesis. The data obtained during repeated studies are compared with the average statistical norms. What size of the follicle should be on different days of the ovarian-menstrual cycle? What fluctuations are considered acceptable?

Normal follicle size on different days of the cycle for a woman aged 30 years with a 28-day cycle, not taking oral contraceptives and not undergoing treatment with hormonal stimulation of ovulation:

• On days 1-4 of the cycle, several antral follicles are found, each of which does not exceed 4 mm in diameter. They can be located in one or both ovaries. Their number depends on the age of the woman and her ovarian reserve. The norm is if in both ovaries a total of no more than 9 antral follicles mature simultaneously.
• On the 5th day of the cycle, antral follicles reach a size of 5-6 mm. Their development is quite uniform, but already at this stage atresia of some vesicles is possible.
• On the 7th day, the dominant follicle is determined, its size is on average 9-10 mm. It is he who begins to actively develop. The remaining bubbles will gradually decrease, while they can be determined in the ovaries and during ovulation.
• On the 8th day of the cycle, the size of the dominant follicle reaches 12 mm.
• On day 9, the bubble grows to 14 mm. It clearly defines the follicular cavity.
• Day 10 - the size reaches 16 mm. The remaining bubbles continue to decrease.
• On day 11, the follicle increases to 18 mm.
• Day 12 - the size continues to grow due to the follicular cavity and reaches 20 mm.
• Day 13 - Graafian vesicle with a diameter of 22 mm (this is the minimum size of the follicle for ovulation in the natural cycle). On one of its poles, a stigma is visible.
• Day 14 - ovulation. Usually the follicle bursts when it reaches 24 mm in diameter.

Deviations from these normative indicators in the direction of decrease are prognostically unfavorable. But when evaluating the results of folliculometry, the duration of the woman's natural cycle should be taken into account. Sometimes early ovulation occurs. In this case, the follicle reaches the required size for 8-12 days of the cycle.

IVF follicle size

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

Attention! It must be understood that the timing of the release of the egg (ovulation) is greatly influenced by hormones.

If, during the ovulatory phase, the development of follicular tissue is observed, it is possible to see a sharp increase in the epithelial cocoon, the release of an egg, and then a decrease. As a result, only a yellow body remains in its place, which is the remnant of this very cocoon.

Growth table

For the clearest visualization of the development process, we present a table of its growth below. The data in it are calculated for women 29-32 years of age who do not use oral means, whose menstrual cycle is strictly regular and lasts the required 28 days.

cycle day	Follicle size and number
1-4	Several follicles, the diameter of each of which does not exceed 4 millimeters.
5	Several follicles develop evenly (atresia of some of them is acceptable). Size - 5-6 millimeters.
7	There is a definition of one dominant follicle, the size of which reaches 8-9 millimeters. The rest begin to decline.
8	Here and below, the dimensions of only the remaining dominant follicle are indicated. It has already grown to 12 millimeters.
9	14 millimeters
10	16 millimeters
11	18 millimeters
12	20 millimeters
13	22 mm
14	24 mm. Ovulation occurs.

Why is development not happening?

The reasons for improper development or even the cessation of growth can be many factors. Consider the most relevant of them:

1. The hypothalamus or pituitary gland is not working properly.
2. Infection or inflammation of the genital organs of a woman.
3. Body mass index less than 17.5.
4. Availability .
5. Underdevelopment or pathology of the ovaries.
6. Oncology.
7. Early onset of menopause.
8. Stress.

The search for causes should begin in hormonal disorders in the female body. Most often, this pathology is the main factor that stops the growth of the follicle in the ovary.

With dysfunction of the pituitary gland, or tumors, the female body begins to experience a deficiency of the hormone FSH, a violation of the regulation of the secretion of active substances by the thyroid gland and ovaries.

Also, inhibition of follicle development can be observed with poor performance or underdevelopment of the ovaries.

What happens before menstruation?

Before the onset of menstruation, the follicles of the primordial order are sequentially transformed into those of the preantral, antral, and preovulatory order. This process is called folliculogenesis.

Normally, folliculogenesis ends with ovulation - the release of an egg that is ripe and completely ready for fertilization. Where the follicle was located, the formation of endocrine active occurs.

Immediately before the onset of menstruation, the dominant follicle ruptures with the release of a sexually mature egg, ready for ovulation. A healthy woman may not even feel the symptoms of a ruptured follicle.

The beginning of folliculogenesis gives FSH, even in the late stage of the luteal phase. This process ends at the peak of gonadotropin release.

One day before the onset of menstruation, the body again experiences an increase in FSH levels, which starts the process over again. The follicular phase in the absence of any disorders or pathologies lasts for 14 days.

After menstruation

Most often, menstruation occurs 15-17 days after the onset of folliculogenesis. After the dominant follicle has completed its development, as already described above, it bursts, releasing an egg ready for fertilization.

It goes into the uterus and fallopian tubes to meet with spermatozoa, and a corpus luteum forms in place of the ruptured dominant follicle.

As for the latter, this neoplasm is a very important transient hormonally active body, functioning for 14 days after its appearance.

It is it that is the main source of androgens, progesterone and estradiol. Further, it all depends on whether the fertilization of the egg occurs or not. If fertilization has not occurred, then the corpus luteum gradually degrades and is brought out along with the rest of the secretions and the unfertilized cell.

In the case of fertilization, the corpus luteum temporarily provides a sufficient level of necessary hormones for the successful development of pregnancy.

Features of the follicular phase

The follicular phase occurs each time at the beginning of the monthly cycle. The main hormone for this period is FSH, which is responsible for stimulating the follicles, as well as providing start-up and maintenance of the process of formation of ovarian elements.

The duration of the follicular phase can vary between 7 and 22 days. In addition to the active development of follicles, this phase is also characterized by the separation and removal of the dead endometrium of the uterus.

The follicular phase can be briefly characterized by three processes:

• cleansing the walls of the uterus;
• development and growth of follicles;
• compaction of the renewed layer of the endometrium in the uterus.

What is the menstrual cycle

The menstrual cycle is the period between regular processes of exfoliation and removal from the body of the spent layer of the endometrium of the uterus.

The cycle is necessary with the inclusion of the first day of menstruation and ending with the first day of the next.

The ovarian follicle is a structural component of the ovary, the main functions of which are to protect the egg from negative effects and the formation of the corpus luteum during ovulation. At early development, there are approximately 4 million follicles in the ovary of the fetus, during the process of 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 at the time of ovulation and form a 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. In 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 the moment of rupture. The remaining follicles begin to undergo a slow process of involution (atresia), their small fragments can be seen on ultrasound throughout the entire menstrual cycle.

Follicle maturation time

The blood supply to the ovaries is significantly increased during the onset of ovulation under the influence of the pituitary hormones - gonadotropins FSH and LH. The formation of new blood vessels leads to the appearance of a follicle shell called the 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 with ultrasound:

• the size of the dominant follicle should be from 20 to 25 mm;
• the cortical plate of the follicle, under the influence of an increase in the 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. In case of unsuccessful fertilization, it quickly overgrows with connective tissue and turns into a white body, which disappears after a while. In case of successful fertilization, the red body under the influence of the chorionic hormone slightly increases in size and turns into a corpus luteum, which begins the production of a hormone called progesterone. It increases the growth of the endometrium 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 a small number of cases, during the process of ovarian stimulation in 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, while “dummy” can only be identified by examining them under a microscope.

The exact cause of the symptom is unknown. However, experts managed to find out that the frequency of the appearance of empty follicles increases with the age of a woman. 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, high levels of insulin in the blood, estrogens and androgens (male hormones) in women. PCOS causes menstrual irregularities, excess weight, acne and age spots, pelvic pain, depression, and excess body hair.

Currently, the most common definition of polycystic ovary syndrome is the 2003 consensus wording of European experts. According to its content, the 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. enlarged ovaries: surface area greater than 5.5 sq.cm, volume greater 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 with greater accuracy will help determine the volume of the ovaries and count the number of immature follicles.

The main treatments for the syndrome are: lifestyle changes, medication, and surgery. Treatment goals fall into four categories:

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

Within 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 treatments. However, many experts recognize that reducing insulin resistance and body weight can affect all treatment goals, as they are the main cause of the syndrome.

Answers on questions

How big does a follicle need to be for ovulation to occur? The size of the follicle should be between 20 and 25 mm. If there is a dominant follicle in the ovary, will there be ovulation? 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, it occurs in which fertilization and pregnancy is impossible. When does ovulation occur with a follicle size of 14 mm? Approximately after 4-5 days when this size is reached. How many follicles does it take to ovulate? One dominant follicle, in rare cases two.

The follicles are part of the gonads of a woman, that is, their integral component. These are special formations in which immature germ cells are under reliable protection. The task of the follicle is to protect the oocytes, and when the time comes, to ensure the safety of the egg during maturation and release on the day of ovulation.

How does growth happen?

Follicles are given to a woman by birthright. Newborn girls have from 500 thousand to a million primordial follicles in their ovaries, the sizes of which are negligible. With the onset of puberty, the girl starts a monthly continuous process of folliculogenesis, which will last throughout her reproductive life and end only with the onset of menopause.

For life, a woman is assigned about 500 germ cells, it is they who will mature one at a time in each menstrual cycle, and on the day of ovulation they will leave the refuge bubble, which has reached its maximum size. After ovulation, fertilization is possible within 24-36 hours. It only takes one follicle and one egg to conceive.

With the onset of puberty, the girl begins to produce a hormone responsible for follicular growth. It is called FSH - follicle stimulating hormone. It is produced by the anterior pituitary gland. Under its influence, the primordial vesicles begin to increase, and already during the next ovulation, some of them first become preantral, and then antral, inside which there is a cavity filled with liquid.

Antral follicles at the very beginning of the female cycle can be from 5 to 25. Their number allows doctors to predict how a woman is capable of self-conception, whether pregnancy is possible without stimulation and the help of doctors. The norm is from 9 to 25 bubbles. If a woman has less than 5 antral-type follicles, then the diagnosis of "infertility" is established, in which IVF with donor eggs is indicated.

Antral follicles grow at about the same pace, at the same speed, but soon a leader begins to form, growing faster than others - such a vesicle is called dominant. The rest slow down growth and undergo reverse development. And the dominant one continues to grow, a cavity with a liquid expands in it, in which the egg matures.

By the middle of the cycle, the follicle reaches a large size (from 20 to 24 mm), with which it usually bursts under the action of the LH hormone. The egg becomes available for fertilization in the next 24-36 hours.

Ovulation Calculator

Cycle duration

duration of menstruation

• Menstruation
• Ovulation
• High chance of conception

Enter the first day of your last menstrual period

Ovulation occurs 14 days before the start of the menstrual cycle (with a 28-day cycle - on the 14th day). Deviation from the mean value is frequent, so the calculation is approximate.

Also, along with the calendar method, you can measure basal temperature, examine cervical mucus, use special tests or mini-microscopes, take tests for FSH, LH, estrogen and progesterone.

You can definitely set the day of ovulation through folliculometry (ultrasound).

Sources:

1. Losos, Jonathan B.; Raven, Peter H.; Johnson, George B.; Singer, Susan R. Biology. New York: McGraw-Hill. pp. 1207-1209.
2. Campbell N. A., Reece J. B., Urry L. A. e. a. Biology. 9th ed. - Benjamin Cummings, 2011. - p. 1263
3. Tkachenko B. I., Brin V. B., Zakharov Yu. M., Nedospasov V. O., Pyatin V. F. Human Physiology. Compendium / Ed. B. I. TKACHENKO. - M.: GEOTAR-Media, 2009. - 496 p.
4. https://en.wikipedia.org/wiki/Ovulation

The former follicle, or rather the remains of its membranes, are grouped into a new formation - the corpus luteum, which produces progesterone. If conception does not occur, the corpus luteum dies after 10-12 days, and progesterone production decreases sharply before menstruation. During pregnancy, the corpus luteum continues to function until the end of the first trimester.

In the absence of pregnancy, a new stage of folliculogenesis follows the same pattern from the first day of the cycle, that is, from the very beginning of the next menstruation. If a woman's body is working normally, there are no problems with the hormonal background, then ovulation occurs monthly. 1-2 anovulatory cycles per year are considered acceptable. With age, the number of cycles without follicle maturation and ovulation increases to 5-6 per year, but this is normal, since the woman's genetic material is aging, and the follicular supply is depleted.

It cannot be replenished - nature did not provide such an opportunity, and therefore it is important to monitor your health and take care of the ovulatory reserve.

Resizing

It is difficult to say what size a follicle should normally have at one stage or another of its development. The data that exists in the tables is only approximate, they do not take into account the individuality of a particular woman. With each day of the cycle, the size of the bubbles changes, since the process of folliculogenesis is continuous and constant.

At the very beginning of the cycle, the size of the follicles does not exceed 2-4 mm. But as they grow, the diameter of the antral follicles becomes larger, and the number of follicles themselves decreases. By the 8th day from the beginning of the cycle, the dominant follicle is usually allocated, and then only its size is fixed until ovulation.

Table of follicle size by day.

cycle day	Follicle size	Changes
		It is possible to determine the number of antral follicles.
		The number of antral vesicles begins to decrease.
		The dominant follicle is isolated.
		Dominant follicle grows
		Inside the dominant follicle, it is possible to determine the cavity with the oocyte.
		The cavity inside the follicle expands.
		A tubercle is formed on the surface of the follicle, the follicle itself approaches the ovarian membrane as close as possible.
		The stigma is determined on the surface of the follicle.
	21-22mm (allowable 23-24mm)	The follicle is ready for ovulation.

It is not at all necessary that on the 10-11th day of the cycle, in a particular case, the growth of the dominant vesicle is 11-18 mm, since everything is quite individual, but the size of the follicle is still used to predict the ovulation period. For example, a woman with a follicle size of 16 mm will be asked to wait for ovulation, since the size of the bubble does not suggest that the rupture will happen very soon.

It is also important that the size norms are exceeded: if on the 7th-9th day of the cycle or at any other period before ovulation the follicle is larger than 25 mm (26-27, 30-34 mm, and so on), then the doctor will most likely assume cystic formation than the normal ovulatory cycle.

Important! These norms are relevant for women who do not receive hormonal treatment. When ovulation is stimulated, sizes may vary.

How to check?

Of course, it is impossible to measure the follicles on your own. The only way to do this is to visit a doctor and do a folliculometry. This is a type of ultrasound examination (ultrasound), in which the state of a woman's ovaries is observed in dynamics. The first ultrasound is usually done immediately after the end of menstruation, usually on the 7th-8th day of the cycle there is every opportunity to estimate the number of antral vesicles. Then ultrasound is done several times with regularity in 2-3 days in order to be able not to miss the day of ovulation.

The ultrasound doctor, based on the average size of the follicle, will tell you when it is better to stimulate ovulation, when it is better to prescribe the procedure for the removal of eggs by ovarian puncture in the IVF protocol, and will also be able to say with certainty whether there was ovulation in the current cycle at all.

Folliculometry is necessarily carried out to establish the nature and causes of infertility, as well as to decide on the appropriateness of stimulation.

At the very first procedure, a woman may be surprised to hear that quite a lot of follicles are maturing in her ovaries. For antrals, this is completely normal. Anxiety is caused by situations when there are either too many or too few such bubbles. If there are 26 or more, the doctor will suspect polycystic ovary syndrome, in which conception is impossible without prior treatment.

If there are less than 5 antral vesicles (a single follicle, 2, 3, 4 follicles), this means that the woman is infertile, so the follicles do not grow even with stimulation - IVF and ovarian function stimulation are not carried out in this case. IVF with a donor oocyte is acceptable.

The optimal amount for conception without problems is 11-25 follicles. It is this amount that indicates a normal follicular reserve and fertility level. With an amount of 6-10, they speak of a reduced follicular reserve, a woman can be stimulated.

Causes of violation of folliculogenesis

The processes of folliculogenesis proceed under the guidance of the hormonal background and depend on the concentration and ratio of the hormones FSH, estradiol, luteinizing hormone, progesterone, testosterone, prolactin. Therefore, any deviation in the endocrine accompaniment can cause a disruption in the maturation of the follicles, which will lead to the fact that maturation will proceed either too slowly or rapidly. In the first case, late ovulation is possible, in the second - early. Any of them is not too favorable for normal conception.

Folliculogenesis disorders are varied. For example, during persistence, there is no rupture of the follicular membrane. This phenomenon is usually associated with insufficient levels of the hormone LH. In this case, the egg overripes, dies, and the follicle continues to be present on the surface of the sex gland for several more weeks. This causes a failure of the menstrual cycle, conception during this period is impossible.

With luteinization of the follicle, the corpus luteum begins to develop before the rupture occurs, so ovulation also does not occur. And if the follicle does not mature to the desired size, stopping its development suddenly, then they talk about follicle atresia. In all cases, the process of ovulation is disturbed - a woman cannot conceive a baby.

The reasons why the development of follicles is disturbed are numerous. There are temporary factors, after the elimination of which the cycle is restored, and a woman can become a mother without the help of doctors.

There are more serious reasons that require mandatory treatment, the help of reproductive specialists, embryologists and other specialists who are able to give a woman the happiness of motherhood even in seemingly hopeless cases.

Temporary disruptions can cause:

• excessive physical activity, professional sports;
• passion for mono-diets, sudden weight loss or weight gain in a short time period;
• chronic stress, emotional instability, worries;
• work at an enterprise with a high level of occupational hazard (with paints, varnishes, nitrates, on a night shift, in conditions of strong vibration and enhanced electromagnetic radiation);
• trips and air travel, if they are associated with a change in climate and time zones;
• cancellation of oral contraceptives;
• diseases transferred in the current months with an increase in body temperature.

Often, women do not notice a violation of follicular maturation at all, because we do not always pay due attention to the delay in menstruation or more abundant discharge.

Among the pathological causes of impaired follicular maturation, various diseases and conditions can be noted in which the endocrine background is disturbed:

• pathology of the pituitary gland, hypothalamus;
• dysfunction of the ovaries;
• inflammatory and infectious diseases of the genital tract and pelvic organs;
• trauma to the ovarian tissue, the consequences of surgery;
• violation of the thyroid gland, adrenal cortex.

Hormonal failures are often preceded by childbirth and abortion, bad habits, long-term use of antibiotics, antidepressants, anticoagulants.

What to do?

In violation of the growth of follicles and ovulation processes, hormonal treatment is usually used. Home remedies, traditional medicines (upland uterus, sage and others) cannot solve the problem that exists at the metabolic level, increase the supply of follicles or build up the endometrium, help follicles grow.

Preparations containing FSH help to accelerate their growth and achieve a mature follicle and full ovulation. They are prescribed by a doctor in strict individual dosage("Klostilbegit", "Clomiphene" and others). The rate at which follicles grow per day is controlled by folliculometry. When the growth reaches the desired parameters, an injection of hCG 10000 is administered, after which ovulation begins 24-36 hours later.

Follicle growth stimulants You can not appoint yourself on your own and take it uncontrollably. This can lead to very sad consequences.

The cyclic changes that occur in a woman's body are caused by hormones, so the size of the follicle before ovulation plays a significant role. At the beginning of menstruation, only a few follicles mature. One reaches the required diameter - dominant, others develop the other way around, that is, they atreze.

The diameter of the follicles is important to know in the presence of infertility. At the initial stage of treatment, hormonal drugs are used that stimulate the growth of follicles. After that, they acquire the dimensions of the main follicle, where the maturation of the egg ready for fertilization takes place.

A successful pregnancy is possible if there are a large number of eggs. It is important to know the exact size of the follicles after ovulation in order for the long-awaited conception to take place.

Measurement of basal temperature

Ovulation is the time of the menstrual cycle when the mature egg enters the abdominal cavity. The onset of this moment is expressed by various signs. The most noticeable are pain in the lower abdomen, increased sexual desire and discomfort.

To find out the features of your menstrual cycle, every woman should know her basal temperature. It is measured early in the morning, when you have not yet got out of bed. The results are required to be entered into a graph, where indicators are marked on one axis, and the day of menstruation is marked on the other.

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In most of the fair sex, the temperature is first lowered, and only then does the increase occur. It is generally accepted that ovulation begins after 12 hours from the moment of decrease. To say exactly when the egg will be released, you can carefully analyze the graphs of several months of monitoring the temperature of the body.

It is worth remembering that the egg did not exit into the abdominal cavity if the temperature did not change. At the time of ovulation, rectal temperature will increase by about 3 bars. Doing folliculometry and doing tests will not hurt every woman.

When examined in a antenatal clinic, some signs are visible, the main of which is clear mucus on the cervix. Allocations tend to crystallize over time. To determine ovulation, many today use a device called Baby Plan.

What is folliculometry

The most accurate way to determine is folliculometry. This procedure is based on the use of ultrasound and allows you to track the maturation of the egg, as well as fix the size of the endometrium in the first part of the cycle and outline the exact timing of the release of the egg in the second period.

To get the right information, the observation process needs to start from the 8th or 10th day after the onset of menstruation and repeat after a time interval of 2 days. If the egg is released during this time, then the procedure stops. If not, then it continues until the next menstruation.

Medicine cannot give an exact answer to the question of what is the size of the follicle during ovulation. Gynecologists say that its dimensions should be from 18 mm to 24 mm. The indicators directly depend on the characteristics of the body of the representative of the beautiful half of humanity and on the regulation of the hormones of folliculogenesis.

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To correctly determine the moment of ovulation, you need to understand the time frame of the cycle. The first day is the date of the start of menstruation, and the last is the day before the start of the menstrual cycle. The standard cycle is 28 days.

It is characterized by the following indicators. In a week, the diameter of the follicle reaches from 2 mm to 6 mm. On the tenth day, a dominant follicle can be identified, the size of which can range from 12 mm to 15 mm. Other follicles during this time decrease and disappear, and the development of dominant growth will be 3 mm per day.

The ovulation phase occurs on the 12-14th day of the menstrual cycle. The size of the follicle at this time should be 24 mm. After that, it will burst, and the egg will come out. Her life will last about 36 hours.

Spouses who dream of conceiving a child should monitor the time of ovulation with the utmost responsibility. If everything goes well, then after a while a new person is born.

The egg can be released into the abdominal cavity even at a size of 35 mm. A 16 mm follicle can also enter the uterine cavity, which is due to the individuality and uniqueness of each individual case.

Ovulation has taken place if:

• at the time of ovulation, a mature follicle was seen;
• a week after the planned ovulation, progesterone in the blood rises markedly;
• the increase in the follicle occurred in dynamics;
• the follicle disappeared after a possible ovulation;
• instead of a follicle, a corpus luteum formed;
• an unknown fluid formed behind the uterus, which indicates a rupture of the follicle.

Pathological manifestations and causes

The development of the egg can be disrupted due to frequent stress, hormonal disruptions and medication. The causes of pathology are:

1. Poor functioning of the thyroid gland. The reproductive system of a woman depends on thyroid hormones, the excess and deficiency of which adversely affect her.
2. Hormonal disorders.
3. An excess of a hormone such as prolactin, which slows down the growth of eggs. The follicles do not enter the maturation phase, as the body perceives this as breastfeeding, and pregnancy is not needed.
4. Long-term use of contraception. The remedy is chosen incorrectly if the processes of egg development are disturbed. If the general state of health worsened when taking the pills, side effects appeared, then you need to urgently visit a doctor.

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Often, women are faced with violations in the maturation of the egg. It is important to identify in time the reason why ovulation does not occur and the size of the follicles does not reach the norm. One of the factors is dysfunction of the ovaries and parts of the brain. Inflammation in the pelvic organs also adversely affects the development of the egg.

Increased pressure inside the skull, neoplasm of the pituitary and hypothalamus have a negative impact on the development of the egg. The consequences may be different:

• there will be no follicle in the ovary;
• the development of follicles will fail - they will stop at one stage and begin to regress;
• follicles cannot reach the desired size;
• there is no release of the egg.

Follicle maturation at an early stage or delay is also an indicator of a violation of the ovulation process. In the worst case, follicle persistence or follicular cyst development occurs.

Persistence is called the process of the existence of a non-ovulated follicle, which can persist even after the menstrual cycle.

The occurrence and treatment of cysts

Sometimes there are situations when the rupture of the follicle did not take place. This can happen due to walls that are too thick or hormone production problems. The situation becomes more complicated if the follicle transforms into a follicular cyst.

With the disease, the following symptoms are observed:

• the occurrence of heaviness in the groin;
• sexual contact and physical labor cause pain;
• the appearance of intermenstrual bleeding;
• painful sensations in the last days of menstruation intensify.

For diagnostics, specialists use the study of the abdominal walls and vagina. When the presence of a cyst has been recorded and the size has been determined, the doctor prescribes treatment.

With a small neoplasm, the doctor prescribes oral contraceptives. For sizes greater than 8 mm, suturing is performed. If the leg of the cyst interferes with the process of blood circulation in the ovary, then it must be removed urgently.

In order not to become a victim of a follicular cyst, you must follow the basic rules:

• take phytotherapeutic agents to regulate hormonal levels;
• do not abuse sunburn and hot baths;
• start taking vitamins;
• do exercises and various physical exercises.

Many formations disappear after 8 weeks without treatment. A visit to the antenatal clinic will eliminate the occurrence of problems of this kind.

It is not possible to independently determine the size of the follicle during ovulation. The exact answer in what state the egg is in will be obtained after an ultrasound diagnosis, which will make it clear when ovulation occurs.

When an egg of a non-standard size leaves the ovary, you should not count on pregnancy, because it is defective. During the monthly cycle, several follicles develop, but only one remains, which reaches the required dimensions, the rest decrease and disappear.

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It is rare to observe when 2 or more equivalent eggs are released.

Women who cannot become pregnant for a long period should consult a gynecologist to identify violations. The determination of the size of the follicle should be carried out under the supervision of a qualified specialist who will notice changes in time, identify possible pathologies in the development of the egg and, if necessary, draw up a treatment plan.