A follicle is a component of the ovary in which the egg is located, surrounded by a layer of epithelial cells and a double layer of connective tissue.
The main function of the follicle in the ovaries is to protect the egg from harmful influences. Inside the follicle, the egg goes through all stages of maturation. Timely ripening and, accordingly, the ability to become pregnant depend on how good the protection is.
The reproductive system of girls develops in the womb, as does the follicular apparatus. During this period, a certain number of follicles are formed, which will remain unchanged throughout life. How many of them are present in a woman’s body? The normal number ranges from 50 to 200 thousand.
Note: After a girl is born, a new stage of development of the reproductive system begins - postnatal. Every month, one cell matures in a woman’s body and, if fertilization occurs, the zygote enters the fallopian tubes. When there is no pregnancy, the membrane is released from the undeveloped egg and menstruation begins.
The follicles in the ovaries, the norm of which is laid down in the body, will not have time to mature during a woman’s life. In the first year, some of the cells in a newborn girl are reabsorbed; this process is called atresia. This occurs due to the action of maternal hormones on the baby’s body and will soon end.
During the transition period, the maturation of the follicle will begin again, which causes the first menstruation. In addition to protection, this gland produces estrogen.
Number of follicles per cycle
Antral follicles develop monthly in the ovaries. In the first days after menstruation, the ovaries may contain 2-5 follicles, the size of which does not exceed eight millimeters.
By the middle of the menstrual cycle, there are up to two large and 5 smaller formations in the ovaries. In the last days before menstruation, one of the largest follicles, which contains a mature egg, has time to grow.
How many follicles should women have in their ovaries? Depending on the period of MC, the number and size of the follicle will change. If there are few follicles, this indicates problems in the reproductive system.
Which follicle is called dominant
There are the following types of follicles: antral and dominant. The dominant one is the one that is most developed, in other words, the largest follicle in the ovary. In the middle of the cycle, several follicles usually mature. The dominant one has a size of 14 mm. The remaining follicles dissolve.
During the period of ovulation in the right or left ovary, the dominant follicle can increase its size to 19-23 mm. It happens that in both ovaries the follicles mature at the same time, respectively, both are considered dominant and two mature eggs are released during the ovulation period.
It does not matter in which ovary the dominant follicle develops, but it must go through the following stages:
- Antrals appear;
- Small ones develop and grow;
- Dominant ones mature;
- Ovulation occurs.
If all stages are successful and a mature egg is released from a mature follicle, the woman can become pregnant.
Common deviations
The number of follicles in the ovaries should not exceed 10; when there are more of them, this is a deviation. Instead of the term “multifollicular”, “follicular ovaries” are often used, so you should not be surprised if you have been diagnosed with this, but you have not found anything about it on the Internet. It is possible to identify follicular ovaries only during examination, having previously done an ultrasound.
Multiple follicles are not always an indicator of the disease. Every woman who experiences stressful situations, is overtired or is in constant nervous tension can have follicular ovaries. There is no need to do anything special in such situations. Once normality is restored, the number of follicles becomes normal by the next ovulation.
There are other factors that can increase the number of follicles and provoke follicular ovaries:
- Occurs due to incorrectly selected contraceptives;
- Problems with the functioning of the thyroid gland and, as a result, ovarian folliculosis;
- A high content of prolactin in the body (in this case, ovarian folliculosis will disappear after the lactation period);
- Deviations in the functioning of the endocrine system.
Note: What to do if such problems arise? If a diagnosis of “follicular ovaries” is made, the doctor will conduct an examination and prescribe appropriate treatment, which should not be ignored. If ovarian folliculosis occurs, the consequences can be serious, including infertility.
The menstrual cycle is divided into two types depending on how many follicles there are and whether there is a dominant one:
- Normal when the egg matures in one dominant;
- MC with deviation means that the egg does not mature, since there is no dominant follicle.
Ovarian folliculosis leads to the accumulation of male hormone and there is a risk of infertility.
When the dominant one didn't burst
It happens that the dominant one develops correctly and in a timely manner until the end of the cycle, and does not burst during the period of ovulation. The egg does not come out and there can be no pregnancy. This abnormality is called a persistent follicle.
If the dominant one in the left ovary does not burst, it means that it remains for another week, after which menstruation begins. If the dominant follicle in the right ovary turns out to be persistent, then over time it can turn into a cyst.
What this means and why this deviation arose can only be told by your gynecologist individually, having done a preliminary ultrasound, and will tell you in what condition the follicular apparatus is.
If the follicle is missing
Due to early menopause or dysfunction, there are no follicles in the ovaries at all. Increasing the number of follicles if there are few of them is easier than restoring the body when there are none. In this case, as with the opposite diagnosis, hormonal treatment is prescribed.
The first signal that occurs when there are no follicles in the ovaries is a failure of the menstrual cycle. If it does not return to normal within 35 days, you should consult a gynecologist.
While multiple follicles are not always a cause for concern, missing follicles requires immediate treatment.
More about the antral glands
When artificial insemination ceased to be an innovation, experts began researching the quality and quantity of eggs. This made it possible to understand the likelihood of pregnancy in a particular patient. Therefore, scientists proposed to control the number of antral follicles. What are antral follicles in the ovary?
Antral follicles are those whose size reaches no more than 8 mm. Using ultrasound, the doctor counts their number and determines the reserve of eggs that can be fertilized.
If the formations are small in size from 4 to 5, the stimulation of the ovaries will be insignificant and the likelihood of becoming pregnant is low. When there are more than 5 antrals, conception can occur without the help of specialists. Follicles in the ovaries do not develop during pregnancy.
Polycystic ovary syndrome
Many follicles in the ovary are not uncommon nowadays, and various factors can increase the number of cells. To find out what is the reason for the appearance of many follicles, research is needed. This problem is also known as polycystic disease.
During treatment, several goals are identified depending on why the problem arose:
- Decrease in male hormones in a woman’s body. If there is a lot of testosterone in the body, there are follicles in the ovaries, but their size does not increase to dominant.
- Restoration of normal MC.
- Conception (at the patient's request). To achieve pregnancy, it is necessary to restore normal follicular development and growth.
- Improved metabolism.
Treatment is carried out under the supervision of a gynecologist and may include diets, hormonal therapy or even surgery.
It doesn’t matter whether there are many follicles or few, their number must be brought back to normal. Self-medication is not the best way to restore your health and it is almost impossible to find out the reasons on your own.
A woman's reproductive capabilities gradually decrease with age. The ability to fertilize the female body in a specific period of time is determined by the presence of follicles in the ovary and compliance with the norm of their number. We will try to tell you what role follicles play in fertilization, how many there should be and what their normal parameters are.
The follicle is the main structural unit of the ovaries; it is a vesicle containing a germ cell - an oocyte. Germ cells are laid into the female body from 6 to 10 weeks of intrauterine development in the amount of 1-2 million units. By the beginning of puberty, about 400,000 potential eggs remain in the girl’s ovarian reserve. At the end of puberty, each girl’s ovary contains only about 25,000 oocytes, which continue to die.
The reproductive cell goes through 4 stages of development before becoming an egg:
- Primordial. The embryonic state of germ cells, their size does not exceed 50 microns.
- Preantral. Isolation of cells for subsequent maturation during one menstrual cycle. The diameter of the cells is 2 mm.
- Antral. At the third stage, the follicular cavity is formed. The cell diameter does not exceed 8 mm.
- Preovulatory. A dominant follicle is released, which, under the influence of FSH and estrogen, bursts and releases the egg. The bubble size reaches 26 mm.
In order to assess the ovarian reserve of the ovaries, doctors use ultrasound to measure the number of antral cells. This is convenient, since the size of secondary follicles is several times larger than that of embryonic follicles, and their number is similar. During the reproductive period, the right and left ovaries work with the same activity, therefore an equal number of germ cells mature inside each of them every month.
To determine the size of the ovaries in women, assess the state of the ovarian reserve, calculate the days of ovulation and diagnose diseases of the appendages, a study of the condition and processes in the appendages in dynamics is carried out - folliculometry.
How is folliculometry done? The doctor, based on the individual characteristics of the woman, prescribes 1 of 4-6 examinations on days 7-10 of the menstrual cycle. Each subsequent examination occurs after 1-2 days.
Dominant follicles and their role
The dominant follicle is the preovulatory stage of germ cell maturation. As a rule, from 15 to 26 germ cells mature in the ovaries every month, of which 1, less often 2 or 3 dominants are released on days 7-8 of the menstrual cycle.
Persistent follicle
Monitoring folliculogenesis allows us to identify abnormal development of the dominant, which prevents the egg from being released. As a rule, persistence implies low-quality reproductive material. Without treatment, it may develop into a follicular cyst.
Persistence occurs due to an increased level of male hormones, therefore, to restore reproductive function, a woman is prescribed hormone therapy. The classic treatment regimen consists of taking medications from days 5 to 9 of the menstrual cycle, 8 days before the start of menstruation, ovulation is stimulated using injections.
Lack of follicles
The absence of reproductive units suggests the presence of a low number or complete absence of antral cells, which grow to 8 mm and begin to regress. In this case, the selection of a dominant follicle does not occur. Among the main reasons why folliculogenesis may be impaired are:
- surgical and natural early menopause;
- improper functioning of the endocrine system;
- low estrogen levels;
- dysfunction of the pituitary gland;
- inflammatory processes in the ovary.
Bottom line
Follicles are a structural unit of the ovaries, their quality and normal quantity determine the ability to procreate. Monitoring folliculogenesis helps track ovulation, assess ovarian reserve and detect possible pathologies of folliculogenesis.
The normal number for self-conception of a baby is 16-26 follicles in the appendages; if there are less than 15 vesicles, fertilization is possible using auxiliary methods. If there are less than 4 germ cells, then infertility is diagnosed.
Hello, dear readers of the blog site.
I want to tell you about how follicles mature in the female ovary, what the follicle cycle is. How it matures, becomes dominant, and ovulates.
How many situations do I see when a woman literally does not leave the ultrasound room, tracking follicle growth and hoping for ovulation. And if there is no ovulation, then the doctor will definitely recommend hormonal stimulation to induce it.
To make a competent, informed decision about whether you need ovulation stimulation, you need to have at least a little idea of what is happening in the ovaries. And how will this intervention affect them, and it will be serious, because the entire endocrine system will be involved.
I have encountered situations where, after ovulation was stimulated, the potential of the ovaries decreased tenfold. For example, AMH () before stimulation was 0.9 ng/ml, and after it became 0.01.
The ovaries are the main organs for a woman; they are our only source, our only “battery”. And if it “discharges” ahead of time, then there will be no one to make a claim, except to yourself.
What is a follicle?
The follicle is an integral part of the ovary. It consists of an egg cell that is surrounded by epithelial cells and connective tissue.
Her ability to give birth to a child, her health, beauty, youth, performance and quality of life depend on how many follicles a woman has.
Where do follicles come from?
The formation of follicles begins in the early prenatal period. First, the so-called primary or indifferent gonad (sex gland) is formed in the fetus. Then follicles begin to form from its cells.
Until 7-8 weeks, the fetus has no signs of gender, and only after this period does sexual differentiation begin, and it becomes clear whether the baby is growing up as a boy or a girl.
The follicle cycle is the stages of its development, the stages of its growth
As you understand, it all begins with the stage of reproduction, with cell division (mitosis), which begins in the indifferent gonad of the embryo.
After this, the development of the follicle continues. It enters the growth stage, which is divided into small and large growth stages, and then into the maturation stage.
This occurs in several stages - the formation of a primary, secondary, tertiary (dominant) follicle, then - the phase of the yellow and white body. But let's look at everything in order.
Breeding stage
The cells of the sex cords of the primary gonad in a girl begin to divide and form 5-7 million primary follicles. This is called the reproductive stage and the resulting follicles are called primordial.
There are so many primordial follicles (from hundreds of thousands to millions) that in appearance they are somewhat reminiscent of the eggs that are formed in fish at the time of spawning.
The number of primordial follicles that form in a little girl before 5 months of intrauterine development depends on the love and passion of the parents, their age and state of health.
The reproduction stage occurs in the girl’s ovaries only during the prenatal period, and never resumes. This is one of the key differences between the male and female bodies.
Women only have what is laid down only during the follicular proliferation stage. Then the follicles are just wasted. In men, reproductive cells are constantly renewed, until old age.
Formation of the primary (preantral) follicle - small growth stage
Until approximately 7-8 months of intrauterine development, some of the primordial follicles are, as it were, “re-preserved”, and the process of their further development begins.
They turn into primary (preantral) follicles - they undergo the first stage of meiosis - the formation of germ cells with half the set of chromosomes. These are the cells that are needed for fertilization and the beginning of a new life.
In the DNA of maturing eggs, crossing over occurs, that is, DNA strands exchange fragments with each other. Therefore, primary follicles are already different from all cells of the body, and they need to be protected from the watchful eye of the immune system, which seeks to destroy everything foreign. Sometimes this does not work, and one’s own immunity can destroy the supply of primary follicles.
Not all primordial follicles can go through this stage - most of them die at this stage. If a girl had, for example, 5 million primordial follicles, then at this stage there may be only a million of them. The rest disappear, die, this process is called follicular atresia.
By the way, atresia can threaten not only primordial follicles. At any stage of maturation, death and disappearance of follicles can occur.
The speed and extent of atresia depends on many factors. It may happen that the primary potential is great, but pregnancy, childbirth, and the girl’s development in the first years of life were accompanied by illness and stress, and the follicles will die, as if ensuring what happens to the girl, giving energy to it.
But let's return to intrauterine development. Those follicles that have passed the first stage of the maturation process can be said to be the lucky ones; there are not so many of them left compared to the primary number that exists at the reproduction stage.
At the stage of formation of the preantral follicle, meiosis stops for many years. Before puberty, the remaining primordial and primary (preantral) follicles will be at rest, not responding to any hormonal fluctuations. It is known that some follicles can remain in the dormant stage for up to 50 years!
Formation of a secondary (antral) follicle - stage of large growth
The resting stage ends and the follicle cycle resumes starting at puberty. Every month, from several tens to several hundred preantral follicles begin to become active and turn into an antral follicle, which already looks like a small vesicle.
The period of maturation of the secondary (antral) follicle lasts up to 300 days. Not all primary follicles turn into secondary follicles; most of them die along the way. Atresia (death) awaits the developing germ cell at any stage.
Tertiary follicle formation – continuation of great growth
The tertiary follicle (Graaffian vesicle or dominant follicle) is formed under the influence of FSH (follicle-stimulating hormone).
Until this point, the follicles were insensitive to pituitary hormones; the main control was by anti-Müllerian hormone (AMH), which inhibited their development.
A very small number of antral (secondary) follicles progress to the tertiary follicle stage. The rest die and undergo atresia.
The vesicle enlarges, the egg inside it goes through all the stages of meiosis, but not yet to the end. Nutrients accumulate in the egg, it prepares to leave the follicle and complete the development cycle.
The tertiary follicle stage lasts approximately 6 days, and ends with the egg being completely ready for ovulation. Externally, this stage can be seen by the woman’s fertilized (stretchable, like the white of a raw egg) secretion of the cervix.
The granular cells of the follicle produce estrogens, and gradually there are more and more of them. The more estrogens, the less the pituitary gland produces follicle-stimulating hormone. The pituitary gland reduces stimulation, receiving news from the follicle that the egg is almost ready. This is called "negative feedback".
But there is also a positive feedback - the more estrogen is produced in the follicle, the higher the level of luteinizing hormone (LH) becomes.
Already a few hours (about 12 hours) before ovulation, granular cells begin to “turn yellow,” luteinize, and begin to produce progesterone. That is, the corpus luteum begins to work.
By the way, you can see it on an ultrasound and decide that ovulation has occurred. But this has not happened yet, and a woman may draw incorrect conclusions about the stage of her cycle.
In addition, the examination itself (ultrasound) is quite capable of blocking ovulation, and a ready-made egg, having traveled such a long way, will never come out.
Normally, the growth of LH continues following the growth of estrogen, and at “peak” LH values, the follicle ruptures and the egg is released into the abdominal cavity - ovulation.
As a rule, several follicles try to mature to the level of Graafian vesicle. They all produce estrogens. But only one reaches full maturity. The rest, as always, are atretic.
Stage of follicle maturation
The period or stage of maturation begins at the moment when the maturing egg cell is located in the oviductal tubercle of the tertiary follicle (cumulus) and is surrounded by the corona radiata. The follicle cycle is coming to an end, but is not yet completed, meiosis is not completed, half the set of chromosomes has not yet been formed.
The maturation stage is the shortest of all. It begins at the peak of LH, approximately 12 hours before ovulation, and ends only after fertilization, approximately 1-2 days.
Meiosis ends completely only after ovulation, provided fertilization has taken place. If it was not there, then the follicle cycle remains incomplete, the egg dies approximately 12-24 hours after ovulation.
Fertilization occurs in the fallopian tube. The penetration of the sperm into the egg is the trigger for the resumption of meiosis; it ends with the formation of half the set of chromosomes.
At this time, the egg already contains sperm chromosomes, and they merge to form a zygote - the first cell from which a child will grow. Essentially, the end of the follicle cycle is the first hours of human life.
After ovulation, a corpus luteum forms in place of the tertiary follicle.
The egg is no longer there. Her cycle is complete. And the follicle itself, as we know it, disappears. In its place, the corpus luteum is formed, in which the motherhood hormone, progesterone, is produced.
The corpus luteum normally exists from 10 to 16 days, sometimes, extremely rarely, up to 12 weeks in the form of a corpus luteum cyst. This does not require any intervention; the corpus luteum cyst disappears on its own.
If fertilization does not occur, then the corpus luteum turns into a white (whitish) body, in which androgens are produced - raw materials for future estrogens. Androgens are, in principle, produced in the theca cells of atretic follicles; they stimulate the development of new portions of maturing follicles.
A woman undergoes menstruation, and a new portion of secondary (antral) follicles enters the stage of tertiary follicle development. They are already ready by this time, they have been ripening for a long time, remember? - up to 300 days! And everything repeats all over again.
If fertilization has occurred, then the corpus luteum exists for 5-7 weeks, giving way to the chorion. It is the chorion, and then the placenta, that takes on the function of producing progesterone, which is very necessary for feeding and warming the child.
We spend our follicular reserves throughout our lives
How many children does a woman have? One or two, maximum three. They used to give birth more. This means that the entire follicle cycle is completed only a few times in a woman’s life. At the start we have millions of opportunities, only a few reach the finish line.
All dying follicles give up their enormous potential, and we live on this potential. Our ovaries constantly “discharge” throughout our lives, releasing the hidden power of possible human lives that did not happen.
Medicine now widely uses ovulation stimulation, encouraging young women to donate eggs, convincing them that it’s okay, there are millions of follicles.
But that's not true. Behind one matured and ovulated follicle there are hundreds of thousands of dead “along the way.” Our “battery” discharges during these manipulations many times faster, like a telephone in the cold.
Menopause occurs when there are about a thousand primary follicles left. It's up to you to decide whether you want to bring this time closer by using hormonal contraceptives, ovulation stimulation, etc.
Stay young and healthy, take care of your ovaries.
I wish you happiness. :)
Sincerely, Elena Volzhenina.
Follicles are part of a woman's reproductive system. They surround and protect the egg, creating optimal conditions for its maturation. The ability of the female body to conceive a child depends on their quantity and quality. How many follicles are needed for conception? What number of them in the ovary is considered normal? What pathologies are there?
What are follicles?
Follicles are structural elements of the ovary, oval or round formations, inside which the egg is located. Their main function is to protect the female gamete from unfavorable factors and maintain conditions for its growth. The follicle with the egg inside grows and develops, after which it bursts and the reproductive cell exits into the fallopian tube. Follicle-stimulating and luteinizing hormones are responsible for this process.
Stages of development
Follicles that were formed during the prenatal period are called primordial. These are small immature eggs surrounded by a layer of epithelium (oocytes). At 7–8 months of development of the female fetus, their growth begins - the follicles become primary (preantral). They have undergone changes at the DNA level and already have half the set of chromosomes. The surrounding cells begin to divide and grow, and a membrane forms around them. Under the influence of the immune system, many oocytes die at this stage.
The next stage of development (secondary, or antral, follicle) begins with the arrival of menstruation. Each month, the follicles begin to grow, increasing to ten times their original size. The composition of the structures surrounding the egg also changes - now there is a fluid-filled cavity with a multilayer membrane around it. Epithelial cells become granulosa and begin to synthesize sex hormones and gestagens. Typically, no more than 9 follicles reach this stage per month.
The tertiary (preovulatory, dominant) follicle matures on average on days 13–15 of the cycle. More often it is located in the right ovary, since it is better supplied with blood. The follicle bursts and becomes a temporary gland that produces progesterone and estrogen, necessary for the maintenance and development of pregnancy. It is called the corpus luteum and remains active for 10–12 days, after which, if fertilization does not occur, it decreases and disappears.
Normal follicles in the ovaries in women
At birth, a girl’s ovaries contain many primordial follicles (up to 2 million); they are formed at the 20th week of fetal life. By the time the menstrual cycle begins, their number decreases by 5–10 times. New follicles are not formed during a woman’s life. The depletion of their quantity is associated with the onset of menopause.
Ovarian reserve, or the number of remaining follicles, is assessed using ultrasound. This indicator depends on the woman’s age. The norm is the number of antral follicles in the range from 16 to 30. Of these, 4 to 7 should begin to mature; after 10–15 days of the cycle, only one dominant follicle should remain. Factors reducing the indicator are:
- heredity;
- past diseases of the reproductive organs;
- alcohol or drug use;
- endocrine disorders;
- sexual rest for a long period of time.
How many follicles are needed for conception?
For conception, only one follicle is needed, but it must be complete - carry an egg ready for fertilization, grow to the required size and rupture, releasing it out. In order for twins to appear, it is necessary that one tertiary follicle develop simultaneously in both the right and left ovaries, or two at once.
Follicle development disorders
Malfunctions in the functioning of the ovaries and the development of follicles are one of the main causes of infertility. To diagnose disorders, folliculometry is done, which is performed via ultrasound. This method allows you to track all stages of folliculogenesis - the step-by-step process of growth and development of the follicle up to ovulation - and find out which of them fails. Ultrasound of the ovaries with folliculometry can reveal disorders associated with an excess or lack of follicles, their abnormal growth and development.
Many follicles
If there are many bubbles maturing in the ovaries (8 or more), they speak of multiple follicles. Their increased number is not a pathology if ovulation occurs, the cycle is regular, and hormonal levels are not disturbed. In this case we are talking about multifollicular ovaries, which are a variant of the norm. If the cycle is irregular, then multifollicular ovaries are considered a pathology.
If there are more than 30 follicles and there is a disturbance in reproductive function, this deviation is called polycystic ovary syndrome. With it, ovulation does not occur, the follicles do not burst, releasing eggs, but fill with fluid, forming cysts. The causes of polycystic ovary syndrome are not fully understood, but there is an assumption that the syndrome is provoked by an excess of androgens due to an increase in the level of insulin in the blood.
The disease can be caused by heredity, stress, sudden fluctuations in body weight or metabolic disorders. Women who suffer from it often experience symptoms such as acne, excess weight, hypertension and menstrual irregularities. Many people experience excess body hair growth in the abdominal area and face.
Few follicles
A small number of follicles in the ovaries may indicate a decrease in ovarian reserve. The fewer there are, the lower the chances of conceiving a child. The presence of 7–15 bubbles means that pregnancy can occur. A number of 4 to 6 means it will be difficult to get pregnant. The probability of conception with single follicles is extremely low; if they are absent, there is no hope at all.
The causes of this pathology may be:
- chronic inflammatory diseases of the pelvic organs;
- alcoholism, drug addiction;
- unfavorable environmental conditions;
- hormonal imbalances;
- psycho-emotional stress;
- autoimmune diseases.
Other pathologies
Normally, under the influence of hormones, the dominant follicle, having reached its maximum size, bursts, releasing the egg. Due to a lack of luteinizing hormone, ovulation does not occur and the tertiary follicle continues to exist throughout the cycle. This pathology is called persistence of the follicle, and the pathology has no pronounced symptoms. The reasons may be:
- physical and emotional overload, stress;
- taking medications that affect the pituitary gland;
- diseases of the pituitary gland and hypothalamus;
- hormonal changes.
Follicular regression is a disorder in which the dominant follicle grows, but then stops developing and shrinks. Ovulation does not occur. If the disorder occurs, menstruation may be absent for a long time. Instead, scanty bleeding is observed a couple of times a year. They last longer than normal menstruation.
If the follicle does not burst and the egg remains inside, as a result of its further growth, a benign formation may develop - a follicular cyst. Usually it does not manifest itself in any way, but sometimes due to decreased functioning of the ovaries, menstruation delays occur. Usually it resolves after 3-4 months. The cause of the phenomenon may be a disorder of the hormonal function of the ovaries caused by infections, inflammatory processes or abortions.
If the egg does not leave the follicle in due time, another anomaly may develop - luteinization of the follicle. Despite the fact that ovulation does not occur, the processes accompanying it continue. A corpus luteum forms inside the vesicle, producing progesterone. The reasons for the violation are:
- stress;
- excess of androgens;
- inflammation;
- infection;
- adhesive process.
How to treat deviations with medications and folk remedies?
Treatment of pathologies can begin only after the necessary diagnostic measures have been carried out. Hormone therapy is often used. It helps restore the disrupted menstrual cycle and increase the chance of conception, normalizes thyroid function, metabolism of fats and carbohydrates.
Follicle-stimulating drugs activate the growth of follicles. Medicines that stimulate the ovulation process increase the level of gonadotropic hormones of the pituitary gland for normal maturation of the egg. An important point of treatment is a healthy lifestyle without smoking, drinking alcohol or drugs, proper rest and the absence of stressful situations.
If the disorders are caused by infections, antibacterial and anti-inflammatory drugs and immunostimulants are used. For the full development of follicles, it is necessary to consume foods containing large amounts of vitamins and microelements. Tocopherol is needed for ovulation and progesterone production, ascorbic acid helps normalize hormonal levels, folic acid helps the dominant follicle mature.
When treating with folk remedies, medicinal herbs are often used. To feel the effect of herbal medicine, it is necessary to take herbal remedies internally for several weeks or even months.
In order for the follicles in the ovaries to mature normally, you can use sage containing phytoestrogen. To prepare the infusion, take 60 g of the dried plant per 400 ml of boiling water, leave for 30 minutes, strain. You should drink 50 ml 4 times a day. With polycystic disease, multifollicular ovaries, and low estrogen levels, the boron uterus helps. It is used to stimulate ovulation and treat gynecological diseases. To prepare the product, take 25 g of dried raw materials per glass of boiling water, leave for 9–11 hours and filter. Drink half a glass 3 times a day.
The red brush plant helps restore hormonal balance by normalizing the production of progesterone and estrogen. For 1 tbsp. l. crushed root, take 300 ml of water, bring to a boil and cook over low heat for 15 minutes, then leave for about an hour. The strained broth is drunk 3 times a day, half a glass.
Traditional medicine suggests treating follicle persistence using an infusion of sage with linden inflorescences. 1 tsp. For each type of dried raw material, pour 300 ml of boiling water and leave for half an hour, filter. The resulting product is drunk 30 ml 3 times a day.
A woman's ability to become pregnant is determined by the follicles in the ovaries, their number and degree of maturity. Knowledge about the norms of physiological processes taking place in the internal organs of the female reproductive system allows us to detect possible deviations in time and receive timely medical care.
Folliculus are multilayered hollow formations surrounded by epithelium and connective tissue. They protect the site where the oocyte matures until ovulation, and also influence the synthesis of estrogen.
Follicles in the ovaries, the normal number of which is about 500 thousand, are formed at birth. They begin their growth during the girl’s puberty and go through certain development cycles. This is an ongoing process that ends during menopause. Most specimens die within a certain cycle as a result of atresia. The rest goes through all stages of evolution.
There are 3 stages of growth:
- small;
- big;
- active maturation.
Each element has one female reproductive cell and follicular cells.
Types of follicles
In accordance with the stage of development, elements are divided into certain types:
| Primordial | This type includes immature elements that are located in the superficial parts of the ovary. They have a flat shape. They are located in large numbers, but the sizes are the smallest. |
| Primary, or preantral | This type includes awakened elements that have entered the maturation phase. They are larger than previous follicles and have a cubic shape. |
| Secondary or antral | Folliculus at this stage have a more mature form. They are multilayered, and cavities filled with liquid are formed between the layers. There is an additional thecal membrane, which appears before the cavities and is decisive in the identification of this element. |
| Tertiary, or preovulatory, or mature | Elements of this type reach maximum development and therefore have the largest size. Their cavities are filled with liquid and surrounded by a theca membrane. |
Stages of development by day of the cycle
The maturation of elements occurs continuously. During the growth stages, their active formation occurs.
Follicles in the ovaries, the normal number of which in girls reaches about 6 million, directly depend on the maturity and health of the parents. Reproduction of elements occurs during intrauterine development. During life, they are spent in the same quantity as they were formed earlier.
There are 3 stages of development. At the first preantral stage, follicles consist of a nucleus and epithelial cells. Before this they are in a state of rest. During puberty in girls, the elements move to the stage of small growth. 
The elements are gradually covered with new layers and microscopic fluff. They become multi-layered and begin to secrete the female hormone estrogen. At this stage, capillaries and connective tissue are formed. The amount of fluid in the cavities begins to increase.
During this period, various diseases during childhood, stress, and anxiety can negatively affect the number of folliculus.
Some of the elements die, and some move to another stage - great growth. At this time, the egg accumulates nutrients, and a cavity with follicular fluid is formed. The cells begin to produce large amounts of estrogen.
The third stage is the shortest. The follicle begins to mature 12 hours before ovulation and disappears 2 days after fertilization. If the process is successful, cell division continues, and the maturation stage ends with the formation of a haploid set of chromosomes.
The role of the dominant follicle
Selection of the dominant follicle occurs in the third developmental cycle. The element size is approximately 20 mm. It develops normally if the body is healthy and there are no pathologies.
In the fluid that fills the follicular antrum, the estrogen content increases sharply. A rise in its level causes the release of luteinizing hormone and ovulation. When the wall of the dominant follicle ruptures and the egg is released, the process of reduction division is restored.
Normal number of follicles in the epididymis by age
Follicles in the ovaries, the normal number of which serves to determine the morphological criteria for age, depend on the hormonal activity of the body. An important argument evaluating the reproductive system is age. The main patterns of follicle development depend on the hormonal regulation of body functions. 
Starting from adolescence, under the influence of hormones from the anterior pituitary gland, cyclical changes occur in the ovaries in girls. The endocrine system controls each folliculus.
The genetically determined stock of folliculus by age is:
- at the moment of birth there are 2 million immature elements;
- 11 thousand pieces are lost every month;
- by the time of puberty, 300–400 thousand remain;
- Before the onset of age-related menopause, 1000 pieces are lost. monthly;
- By the age of 47-50, the ovarian reserve is depleted.
As a result, by the age of 45, a woman has a low probability of conceiving, despite the fact that menstrual cycles and hormonal activity of the ovaries persist.
Normal number of follicles during pregnancy
The follicles located in the ovaries have their own norm, which is an assessment of the upcoming superovulation during fertilization.
Their number is interpreted as follows:
- less than 5 – infertility;
- 5-7 – low probability of fertility;
- 8-15 – pregnancy is possible;
- 16-30 – normal;
- more than 30 – polyendocrine syndrome, accompanied by impaired ovarian function.
During pregnancy, the female body is not completely freed from the folliculus. Only those that have awakened with a dominant follicle are destroyed. The rest are dormant and awaken after the birth of the child.
Normal number of follicles during menopause, menopause
With the onset of menopause, changes occur in the functioning of the genital organs and hormonal imbalance. Follicles in the ovaries, the number of which is limited, change sharply and shrink during menopause. It is their absence that determines the decrease in estrogen levels. As the number of periods decreases, the folliculus also decreases.
The norm of follicles in the ovaries during menopause changes along with the level of hormones During menopause, the elements significantly complicate the course of the last independent menstruation. During this period, the ovaries decrease in size and are susceptible to various diseases. If they begin to increase, then this may be caused by the development of a cyst, polycystic disease, or malignant tumor.
It is important to visit a gynecologist once every six months during this period in order to diagnose the disease in time.
How do follicle sizes normally change during the cycle?
At the beginning of each menstrual cycle, under the influence of follicle-stimulating hormone, new folliculi begin to develop in the ovaries.
The process of folliculogenesis with a standard cycle of 28 days occurs as follows:
- at the age of 5 days, the size of the antral follicles is up to 5 mm;
- by day 7 they increase at a rate of 1 mm per day;
- on day 8, a dominant is selected. It continues to grow at a rate of 2 mm per day and reaches sizes of up to 15 mm. The remaining folliculi regress and disappear;
- The ovulatory phase occurs on day 14. The dominant follicle reaches a size of 24 mm, then it bursts and an egg is released from it.
The average lifespan of an oocyte is from 12 to 24 hours.
What is folliculometry and why is it performed?
The technique monitors the growth and development of the folliculus in the ovaries and helps determine the possibility of conception. Ultrasound examination is recommended to be performed from the eighth to tenth day of the menstrual cycle. On the eighth day, the dominant follicle will be noticeable.
An ultrasound examination is performed to obtain the following information:
Repeated folliculometry is carried out subject to the presence of an ultrasound of the pelvic organs, completed no later than 6 months ago.
A repeat series of ultrasound examinations is carried out in order to:
- establish the fact of ovulation;
- determine the phases of the menstrual cycle;
- find out the day the egg is released;
- perform in vitro fertilization;
- diagnose infertility;
- control the effect of hormonal drugs on the ovaries.
When performing folliculometry, attention is paid to the maturation of follicles and the endometrium.
Disorders due to improper development of the dominant follicle
If the development of the dominant folliculus is disrupted, ovulation does not occur, since the oocyte cannot come out. In such cases, observation and ultrasound are performed. Starting from the 10th day of the cycle, the growth of the dominant folliculus is monitored. If it matures slowly, the egg cannot be released from the ovary. In this case, treatment is prescribed. During the next cycle, observe the result.
Violations in the development of the dominant element can occur for various reasons:
Pathology in the maturation of the dominant is caused by depression, stress, and nervous tension.
Possible deviations
Follicles in the ovaries, the number of which may be exceeded or underestimated, may stop growing or developing to the desired size. In this case, the woman does not ovulate. The cause of deviations is detected using ultrasound and determining the level of sex hormones in a woman.
Persistence
The pathology is caused by an imbalance of hormones, which is necessary for the regulation of the menstrual cycle.
Persistence can be recognized by the following symptoms:
- low level of progesterone in the blood;
- increased estrogen levels;
- the dominant follicle exists for a long time;
- there is no luteal phase of the menstrual cycle;
- there is no corpus luteum and fluid in the retrouterine space.
Therapy is aimed at normalizing hormonal levels. Doctors prescribe medications that reduce estrogen levels in the follicular phase and increase progesterone levels in the luteal phase of the menstrual cycle.
Exceeding the size norm
Excessive enlargement of the follicle may indicate a cyst. The formation is a cavity filled with fluid, sometimes with blood or pus. In this case, the diameter of the folliculus exceeds the norm and becomes more than 30 mm. In this case, it is necessary to puncture and suction the follicles. 
The pathology causes disruptions in the menstrual cycle and painful symptoms in the lower abdomen.
Absence
Temporary absence of folliculus is mainly associated with the psychological state of the woman. As soon as the body is restored, the elements are formed again.
Failures can be caused by the following factors:
- incorrectly selected contraceptives;
- endocrine diseases;
- a sharp change in weight up or down.
The disappearance of the folliculus over the age of 45 is a natural process, as menopause occurs.
Regulating the process of follicle maturation
The main goal of therapy is to restore the normal menstrual cycle and relieve the woman of infertility. You can achieve results by stimulating ovulation, reducing or increasing the number of antral follicles.
Stimulation of ovulation
Stimulation of ovulation is carried out after undergoing comprehensive diagnostics aimed at identifying the causes of pathologies in the menstrual cycle. Antiestrogenic agents are prescribed to stimulate the production of estradiol and follicular growth. 
Cyst prevention is carried out using injections of hormonal drugs Praegninum or Gonakor. Stimulation is not carried out if the ovarian reserve is depleted during menopause and if the fallopian tubes are obstructed.
Decreased number of antral follicles
If the folliculus content is increased, therapy is aimed at normalizing the hormonal balance. You can regulate the production of follicle-stimulating and luteinizing hormone, estrogens, prolactin and progesterone using combined oral contraceptives.
Depending on the pathology, medications are prescribed:
Combined hormonal drugs are used to treat menstrual irregularities, reduce or eliminate ovulatory syndrome.
Is it possible and how to increase the number of antral follicles?
The production of anti-Mullerian hormone affects the number of folliculus. With the help of a vitamin complex, as well as preparations containing biologically active substances, it is possible to increase the stimulation of ovarian functions and increase the chances of successful maturation of eggs.
But it is impossible to enhance the production of the hormone with medications, since the number of folliculus depends on the genetic characteristics of the body and the age of the woman.
The oocyte develops inside the follicles in the ovaries. Changes in hormonal levels and the possibility of conception depend on the norm of their quantity. Deviations from the norm may result in a risk of various pathologies. There may be several reasons for violations, so it is important to undergo a qualified examination to avoid infertility.
Article format: Mila Friedan
Video about folliculometry
What is ultrasound folliculometry: