Follicles

Even during intrauterine development, the body of girls begins to form more than 500,000 follicles. Upon reaching puberty, the reproductive system contains about 40,000 such structures. During life, no more than 500 eggs fully mature, and the remaining microscopic oocyte rudiments undergo atresia.

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What does follicle mean?

A follicle is a structural element of the female reproductive glands, which consists of an oocyte surrounded by a layer of connective and epithelial tissue. It contains only one 1st order egg cell, inside of which there is a small nucleus - the "germinal vesicle".

The oocyte (egg cell) is enclosed in a dense glycoprotein capsule surrounded by granulosa cells. Their surface is covered with a thin acellular layer of matrix, around which the theca cell is located.

What does follicle mean?
Follicles in the ovaries

Follicles in the ovaries

Inside the ovaries, oocytes mature, ready for fertilization by sperm. Conception is possible only in the case of their full development and maturation. Hormonal imbalances often lead to the appearance of deviations that provoke the formation of cysts or infertility.

The main task of the follicle is to protect oocytes from destruction and the negative influence of endogenous factors. The eggs located in the female gonads are not yet mature. That is why the success of conception and the course of pregnancy largely depend on the degree of protection of the oocytes from the influence of destructive factors.

Follicles grow poorly

Underdevelopment of the structural components of the ovaries is one of the main causes of female infertility. In the absence of a dominant follicle, luteinizing hormones that stimulate ovulation do not enter the blood. The main causes of insufficient development of germ cells include:

  • Hypothalamus pathologies
  • Dysfunction of the ovaries
  • Contraceptive abuse
  • Consequences of infection in the small genital organs
  • Thyroid pathologies
  • Endocrine disorders
  • Depression and emotional instability
  • Formation of tumors in the pituitary gland

Adequate hormonal therapy allows you to restore the menstrual cycle and the process of oocyte maturation. If conservative treatment is ineffective, ovarian cauterization is prescribed, which involves surgical removal of underdeveloped cells from the sex glands.

Stages of follicle development

Stages of follicle development

Folliculogenesis is the continuous maturation of follicles, which begins in the antenatal period and ends in the climacteric period. Due to apoptosis, most immature female germ cells die. Only a small part of them goes through the entire maturation cycle and takes part in ovulation.

The types of structural elements of the ovaries are determined by the stage of their development:

  • Primordial (embryonic)
  • Preantral (primary)
  • Antral (secondary)
  • Preovulatory (Graafian follicles)

24 hours before ovulation, the production of estrogen increases, stimulating the flow of luteinizing hormone into the blood. It is the peptide hormones that initiate the formation of a protrusion in the follicular sac, from which the oocyte subsequently emerges (ovulation).

Follicle cycle

Follicle cycle

Throughout the menstrual cycle, changes occur in a woman's reproductive system that precede ovulation. The size and location of the follicular sacs are determined by the phases of this cycle:

  • Menstrual (duration 3-6 days) - bleeding from the uterus caused by the rejection of the endometrium
  • Follicular (duration 14 days) - the process of development of new structural elements of the ovaries, which begins with the production of luteinizing and follicle-stimulating hormones that accelerate their growth
  • Ovulatory (duration 3 days) - rupture of the dominant follicle with the subsequent release of the oocyte ready for fertilization
  • Luteal (duration 16 days) - intensive production of progesterone and estrogen, preparing the female body for pregnancy

Mature oocytes are visible to the naked eye on the screen of the ultrasound scanner. Normally, 1 to 3 dominant follicles mature during one menstrual cycle.

General information

Follicles in IVF

The probability of conception is affected by the number of antral follicles in the female gonads. In the absence of pathologies, their number is on average 16-26 pieces. In this case, the probability of successful maturation of the dominant follicle is almost 100%.

An increased content of oocytes in the ovaries often indicates the development of polycystic disease. Gynecological pathology is diagnosed in 65% of cases in patients suffering from infertility. With polycystic disease, the ovulation phase is absent, so the woman cannot become pregnant.

If there are no more than 6 immature follicles in the ovaries, the probability of ovulation decreases to 5%. In this case, conception naturally is almost impossible, so women are recommended to undergo in vitro fertilization (IVF).

Follicles in IVF

Follicle puncture during IVF

Follicle puncture is a minimally invasive procedure aimed at extracting an egg from the gonads. In vitro fertilization of the oocyte and transplantation of the embryo into the patient's uterus are performed.

The process of extracting female germ cells is carried out according to the following scheme:

  1. Under general anesthesia, a thin needle is inserted into the ovary
  2. After the needle penetrates the follicle, the oocyte is collected
  3. The egg is cleaned of epithelium and placed in a special incubator

The prepared oocyte is fertilized with a sperm, after which the embryo is transplanted into the patient's uterus.

Follicle puncture during IVF

Follicle stimulation during IVF

In case of hormonal infertility, it is impossible to extract a mature egg from the ovary due to the absence of ovulation and the biochemical processes preceding it. The chances of successful conception with the help of IVF can be increased by selecting several mature eggs at once.

Hormonal drugs are used to stimulate the growth of germ cells, due to which 8 to 15 follicles are formed in the ovaries. During the puncture, specialists select only the largest of them, the diameter of which is 15-20 microns.

Follicle stimulation during IVF

Growth of follicles during IVF

During the process of superovulation stimulation, doctors monitor the growth rate of germ cells, which is carried out using transvaginal ultrasound. The examination begins five days after the start of hormonal therapy. If the organic structures of the ovaries are insufficiently developed, the dose of medications taken is increased.

The growth rate of female germ cells is no more than 2 mm per day. When the follicle diameter reaches 16 mm, the patient is prepared for a puncture to collect the oocyte. By the time the procedure begins, the condition of the endometrium is assessed, the thickness of which should be between 7 and 9 mm.

Growth of follicles during IVF

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I thank my surgeon, Laura Magomedovna Kappusheva and her entire team. She guided me from our first contact to discharge, carefully, clearly. She saved my ovary, despite having a 10 cm cyst. My surgery went well. In another place, according to insurance, they planned to remove the cyst along with the testicle (teratoma, size and bicolored structure). I didn't agree with this approach. I recommend a second opinion to everyone! Many thanks to the staff at K +31, the managers, for their constant attention, for their support at check-out, and to the nurses and nurses for creating a sense of security and tranquility. The clinic is great!
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