Her goal is to increase the chances of pregnancy!

To do this, a woman is prescribed hormonal drugs that cause the simultaneous maturation of several follicles in her ovaries.

In each of the follicles, one egg matures, which is collected during puncture.

After fertilization of the eggs, several embryos are obtained.

Drugs to stimulate superovulation:

3. Preparations of human menopausal gonadotropins (HMG) - “Menopur”;

All these drugs are prescribed according to developed treatment regimens or “protocols for stimulating superovulation.”

Currently, several such “stimulation protocols” have been developed and successfully used all over the world, providing for the joint or sequential use of drugs from these groups to achieve the main goal of ovarian stimulation in IVF cycles - the growth of several follicles.

Before stimulation begins, your doctor will discuss with you the stimulation protocol that is most suitable for you.

Types of protocols.

Standard protocol. Gonadotropic drugs are administered from the 2-3rd day of the menstrual cycle (starting dose of r-FSH 250-150 IU). The beginning of the administration of anti-GnRH can be either fixed (from the 6th day of stimulation of follicular growth) or flexible (when the leading follicles reach a size of 14-15 mm).

The time between two injections of anti-GnRH should not exceed 30 hours. It is advisable that injections of r-FSH and anti-GnRH drugs are given simultaneously, at the same time every day, preferably in the evening after 18:00.

The interval between the last injection of anti-GnRH and the administration of hCG should not be more than 30 hours. With the evening algorithm for administering anti-GnRH, the last injection of anti-GnRH is done in the evening, on the day of hCG administration.

In patients at risk of insufficient ovarian response, it is preferable to use gonadotropin preparations containing both FSH and LH.

The duration of administration of gonadotropic drugs is on average 10 days. The choice of gonadotropic drugs and the starting daily dose of a gonadotropic drug is determined by the attending physician, taking into account the patient’s age, ovarian response in previous ISO cycles, basal FSH level, AMH level, ovarian reserve according to ultrasound. Depending on the response of the ovaries, the daily dose of gonadotropins can be adjusted.

The criterion for introducing an ovulation trigger is that the leading follicles reach a size of 18-20 mm in diameter and an endometrial thickness of 8 mm or more. To complete the maturation of oocytes, drugs are administered once as a trigger: urinary hCG 10,000 IU or r-hCG 6500 IU.

Moderate stimulation.(minimal or mild stimulation) – use of low doses of gonadotropic drugs (150 IU or less) for fewer days. The administration of gonadotropins begins on the 5th day of the menstrual cycle, and anti-GnRH - when at least one follicle reaches a diameter of 14-15 mm. This protocol is used in case of high risk of OHSS or late presentation of the patient.

Stimulation using long-acting preparations containing r-FSH. The drug is administered on the 2-3rd day of the cycle and is effective for 7 days. On the 8th day of stimulation, if necessary, therapy can be continued with daily injections of r-FSH. The use of anti-GnRH begins on the 5-6th day after the administration of prolonged r-FSH. Despite the convenience of using this drug for patients (reducing the number of injections and ultrasound), it has not found widespread use due to the higher risk of developing OHSS, even in patients with a predicted normal ovarian response (almost 2 times) compared to patients in the standard protocol .

Stimulation protocols using GnRh a.

Long protocol. In the middle of the luteal phase of the cycle (on average on the 21st day), GnRh-a is administered in the form of a depot form or daily injections. Gonadotropic stimulation begins when desensitization of the pituitary gland is achieved, which usually occurs 7-14 days after the start of GnRg-a administration, manifested by a decrease in the level of estradiol in the blood to less than 50 pg/ml and the onset of menstrual bleeding. Daily injections of a-GnRH continue throughout the period of administration of gonadotropins.

Long protocol using oral contraceptives. This protocol is used in IVF cycles with egg donors and surrogate mothers. To synchronize the cycles in the menstrual cycle preceding the induction of superovulation, oral contraceptives (single-phase) are prescribed. Administration of GnRH a begins at half the daily dose the next day after discontinuation of contraceptives and continues until hCG is prescribed. Gonadotropic stimulation begins on days 1-3 of bleeding.

Super long protocol. Used in patients suffering from endometriosis. Usually 3-4 injections of depot forms of a-GnRH drugs are prescribed. Gonadotropic stimulation begins 2-3 weeks after the last injection.

Short protocol. Typically used to obtain the maximum possible number of follicles in women at risk of ovarian failure.

GnRH agonists are administered daily from the 1st-2nd day of the menstrual cycle in the usual daily dose. Gonadotropic stimulation begins on the 2-3rd day of the cycle.

The use of the names “long”, “super-long” and “short” protocols is possible only if GnRH agonists are used.

Natural (natural) cycle. An IVF procedure in which a single follicle is punctured during a spontaneous menstrual cycle without the use of any drugs, with ultrasound monitoring of the growth of the dominant follicle. Follicle puncture and egg retrieval are performed when the dominant follicle reaches a size of 16-18 mm.

This protocol is used in the case of contraindications to ISO, the woman’s reluctance to use hormonal drugs, or in the case of the growth of only one follicle against the background of previous ISO in the anamnesis.

Modified natural cycle. It differs from the option described above in that drugs from the anti-GnRH group are used to prevent premature spontaneous ovulation. In addition, in case of insufficient growth dynamics of the dominant follicle, it is possible to use small doses of gonadotropins. When the dominant follicle reaches 16-18 mm, hCG is administered.

The dose of the administered drug to stimulate follicular growth is selected individually, taking into account the woman’s age, her weight and the initial state of the ovaries (their functional reserve) and depends on the response of the ovaries to the treatment.

This reaction is assessed periodically by the level of sex hormones in the blood serum (estradiol) and the ultrasound picture (the number and size of follicles in each of the ovaries, as well as the thickness of the endometrium).

Conducting an ultrasound and determining the concentration of estradiol during treatment with hormonal drugs is called “Ultrasound and hormonal monitoring” and is paid separately.

The method of in vitro fertilization has long moved from the world of fiction to modern reality. After all, a huge number of men and women were able to realize their dream of becoming parents with its help.

All stages of such a pregnancy are essentially the same as during natural fertilization. However, there is one significant difference between them: IVF creates optimal conditions for successful conception. One of these artificially created conditions is stimulation before IVF. Thanks to stimulation, reproductive specialists have the opportunity to obtain the maximum possible number of mature, viable eggs, which increases the chances of pregnancy significantly.

Before carrying out the IVF procedure, the doctor must find out what causes the woman’s infertility by prescribing a series of laboratory tests and hardware tests. The most common “female” reasons for non-pregnancy include hormonal imbalances, which affect the condition of the endometrium and the functioning of the ovaries.

To eliminate all factors that impede conception, stimulation is prescribed for IVF. This is what is called hormone therapy. Its task is to completely suppress the production of natural hormones: they are replaced with artificial ones. This stage is very important, because thanks to it the ovaries work not only correctly, but also in an enhanced mode.

For each woman, a specific treatment system is selected, which is called a protocol. Depending on the protocol, the start of stimulation, medication intake and their dosage are recorded.

Most often, the start of an artificial “attack” with hormones is prescribed on days 3-5 of the menstrual cycle. Under the influence of hormonal agents, the ovaries begin to work intensively in order to reproduce several dominant follicles at once by the due date of ovulation (in natural mode, only one such follicle matures, a maximum of two). The entire process of follicular maturation is clearly monitored using ultrasound diagnostics in order to record “day X” in time.

When the dominants mature to the required size, the follicles are punctured: the reproductologist carefully removes them using an aspiration needle. The more there are, the higher the chances of successful conception.

They are fertilized in vitro with sperm and left to “ripen” in a nutrient medium in a laboratory. After 3 or 5 days (depending on the indications), reproductive specialists select several embryos, which, according to geneticists, are the strongest and most viable. The “lucky ones” are transferred to the woman’s uterus.

Superovulation stimulation protocols

Reproduction specialists have several types of protocols in their arsenal that are used to stimulate the ovaries. The protocol is prescribed by the attending physician based on the identified pathological abnormalities in the woman’s reproductive health, her age, sensitivity to drugs, tendency to allergies and other individual characteristics.

We have already mentioned that all protocols that result in superovulation are based on complete or partial blocking of natural hormonal levels. First of all, we are talking about the temporary “destruction” of natural luteinizing (LH) and follicle-stimulating (FSH) hormone. Their replacement is carried out using synthesized analogue hormones, the dosage of which is selected individually.

In order to monitor the effectiveness of the drugs used, ultrasound examinations are carried out regularly. According to established standards, during ovarian stimulation the endometrium should grow by 1 mm, and the follicle by 2 mm daily. If ultrasound diagnostics record indicators significantly lower, methods of ovarian stimulation can be reviewed on an individual basis, starting from changing the dosage of the drug and ending with its change.

Each protocol pursues very specific goals, regulated by the amount of hormonal agents consumed. Thus, IVF with minimal stimulation aims to collect the maximum number of oocytes in order to subject them to cryopreservation. The fact is that such a treatment regimen copes well with increased follicular growth, but inhibits the growth of the endometrium. Therefore, direct embryo transfer is carried out in other cycles that are favorable for these purposes.

Read details about different ones.

How many days does stimulation last for IVF?

The time period is determined by the doctor, based on the woman’s health condition. Therefore, stimulation of ovulation during IVF lasts differently for each patient.

Thus, a short protocol lasting one month provides for stimulation of the ovaries for 10 days. And for women who have been diagnosed with endometriosis, cystic changes on the ovaries, or fibroids, hormonal treatment is indicated for 30-40 days, which involves the use of a long protocol. In some cases, super-long ovarian stimulation is indicated, the duration of which can reach up to six months.

The duration of the protocol and the intensity of taking hormonal drugs directly depends on the health status, age and reproductive characteristics of the woman.

When stimulated, copious clear discharge may appear. There is no need to be afraid of this: usually this indicates good growth of the endometrium. You should be wary if there is itching, pain, a strong unpleasant odor, or if the color of the discharge is greenish. All these symptoms may indicate inflammation, which is completely inappropriate for you right now.

Stimulation drugs

Stimulation of superovulation can only be achieved with the help of synthetic hormonal agents, the purpose, combination and dosage of which are strictly individual.

The selection of medications is carried out in accordance with the stage being performed.

1. Ovarian stimulation. The main component of the drugs is follicle-stimulating hormone.
2. Fertilization of the egg. The medications stimulate the follicle lining to rupture, regulating the release of the egg at the right time. The main “actor” of such drugs is human chorionic gonadotropin.
3. Attachment of the embryo to the uterine cavity. Here the drugs help to “consolidate the results obtained” in the uterine cavity. Progesterone, being the base of all these drugs, increases several times the chances of successful implantation of the embryo and its further successful development.

Let's look at the most important medications that women encounter at the stage of ovulation stimulation.

Orgalutran

Rare stimulation of superovulation can be achieved without this drug. It allows you to slow down the amount and then completely stop the production of LH and FSH. If stimulation with these hormones has not been previously carried out, suppression of the functioning of the pituitary gland begins immediately after the drug enters the blood.

The average duration of stimulation with Orgalutran is 5 days.

Puregon

It is also a medicine classified as a gonadotropic drug, as it regulates the production of LH and FSH. With the help of the product, several follicles mature at once and the synthesis of reproductive substances is activated.

Used to stimulate natural ovulation and in IVF protocols.

Gonal

Stimulation with Gonal is called “heavy artillery” by reproductive specialists. The drug, produced by an Italian company, is used to treat male and female infertility. It shows excellent results where other drugs have failed.

The use of the medicine requires careful monitoring of follicle growth by ultrasound: as soon as the follicle reaches 17 mm, it is discontinued.

Klostilbegit

Clostilbegit is used in various stimulation protocols. However, most often its use is justified in a “light” protocol, when after stimulation the maximum number of eggs is “collected” for cryo-freezing.

The replantation is carried out in the next cycle, since, despite the excellent effectiveness in maturing the follicles, the medicine reduces the growth of the endometrium, which will not allow the successful attachment of the embryo into the uterine cavity.

Cetrotide

A drug that, while blocking natural ovulation hormones, cannot replace them with artificial analogues in sufficient quantities. As a result, ovulation is “delayed.”

Delaying the onset of ovulation during IVF will be necessary in two cases:

• If superovulation is needed;
• If necessary, regulate the menstrual cycle so as to allow the follicles to fully mature.

Agonist drugs

Agonists (that is, analogues) of gonadotropin-releasing hormone are Diferelin, Decapeptyl, Lucrin-depot and some others. These medications work directly to “eliminate” the functioning of the pituitary gland, thereby creating optimal conditions for the growth of a large number of follicles.

The medications are prescribed 6-7 days after the onset of ovulation. As a rule, 4-5 injections are enough for a successful stage.

Menopur

In IVF, ovarian stimulation with Menopur shows good results.

The drug, the main component of which is human menopausal gonadotropin, is prescribed to stimulate follicular growth, improve the uterine mucosa, as well as active production of estrogen. The drug, obtained from the purified urine of menopausal women, is often used in combination with products containing hCG.

HCG drugs

HCG injections are intended for the final preparation of “maturing” follicles for puncture. The injection is administered two days before the expected collection of finished eggs. HCG drugs are administered once; hormonal control is not required after the injection.

HCG medications may have different names depending on the manufacturer. Most often you can find the name “Pregnil”.

How to inject yourself

Many patients inject themselves. Doctors do not mind if a woman has experience in administering intramuscular injections or has purchased a special device. It allows you to use not a syringe with a needle, but an injector pen.

When making prescriptions, the doctor will indicate which drugs are administered intramuscularly and which ones subcutaneously. This nuance is also described in the instructions. Regardless of the method of drug administration, you should know several important rules for their use:

• The injections are given at the same time;
• The drug is administered extremely slowly;
• If you miss an injection, contact your doctor immediately to find out what to do next;
• Do not increase or decrease the dosage on your own!

Do not forget that before the injection you need to thoroughly wash your hands and disinfect the injection site.

How to behave during stimulation

IVF stimulation is an important period during which a woman experiences a whole range of emotions: from joyful hope to deep despair from fear that nothing will work out. At this important time, the support of loved ones, a stable psychological state, many hours of quiet walks in the fresh air and a healthy diet are very important. Dieting for weight loss and excessive exercise should remain a thing of the past, and an optimistic attitude should become the present and future.

However, a diet is still needed, but not a “weight loss” diet, but a special one. It is important to consume a lot of protein (lean meat, cottage cheese, eggs) and foods with plant fiber, that is, vegetables and fruits. At the same time, use less animal fats and more vegetable fats. Protein foods are needed to prevent ovarian hyperstimulation. And fiber and vegetable fats will promote comfortable digestion, which is very important at this stage. But if you have gastritis or other gastrointestinal problems, coordinate your diet with a gastroenterologist. Most likely, he will advise replacing raw vegetables with boiled ones, and raw fruits with baked ones.

A few more important principles:

• Avoid infectious and cold diseases to prevent excessive stress on the immune system: it has a more important mission ahead of it.
• Avoid coffee and caffeine-containing drinks: they can interfere with hormonal levels and interfere with conception.
• Avoid hot baths and do not go to the sauna.
• Give up cigarettes, passive smoking and alcohol in any doses.
• Avoid taking any medications other than those prescribed by your fertility specialist. All other medications (for example, if you have chronic diseases that require medication) - only as a last resort and in agreement with a reproductologist.

Possible complications

Stimulation of ovulation before IVF involves the use of only hormonal drugs. A prolonged “attack” of synthetic hormones can lead not only to a deterioration in the patient’s general condition, but also to unpleasant complications.

Ovarian hyperstimulation

Multiple pregnancy

Ectopic pregnancy

Occurrence is a rare complication. However, if immediately after embryo transfer you feel severe pain, weakness and dizziness, consult your doctor immediately: the implantation may have occurred outside the uterine cavity.

In general, IVF, if performed by an experienced reproductologist, is a complex, but very effective treatment with a good chance of pregnancy and the birth of a healthy child.

Stimulating the growth and development of follicles is one of the main goals of ovulation stimulation. Stimulation also includes induction of final oocyte maturation, ovulation and support of corpus luteum function.

For what diagnoses is follicle stimulation performed?

Today, stimulation of ovarian function is one of the fundamental methods in the treatment of infertility.

1. Anovulatory infertility associated with ovarian dysfunction (problems with follicle development and ovulation - hormonal dysfunction, polycystic disease).
2. Infertility of unknown origin.
3. Stimulation of “superovulation” in the IVF protocol.

The main task of the doctor when stimulating ovarian function is to ensure the growth of one or many follicles to a preovulatory state, with the obligatory introduction of a trigger (a drug that imitates the peak of luteinizing hormone) of ovulation at the final stage of folliculogenesis.

Stimulation is a serious intervention in the functioning of the female body, so the doctor initially assesses its need.

To do this, before the procedure, the patient and her partner will need to undergo a comprehensive medical examination, undergo a series of tests and exclude conditions that are contraindications for stimulation:

• Contraindications to pregnancy.
• Pregnancy or lactation period.
• Uterine bleeding of unknown etiology.
• Inability to monitor follicle growth using ultrasound.
• Infertility has been treated for more than 2 years.

What and how to stimulate follicle growth: drugs and techniques

Conditions for stimulating follicle growth:

1. Confirmed patency of the fallopian tubes.
2. Satisfactory spermogram indicators.
3. Prolactin levels are normal.

Stimulation schemes

With the normal functioning of a woman’s reproductive system, almost every menstrual cycle, one egg matures.

On average, about ten follicles begin to mature in the ovary - and only one grows before the dominant follicle, in which the egg matures.

In order for several dominant follicles to mature in the ovaries at once, they are carried out stimulation through hormonal therapy.

Depending on the further actions - natural conception, intrauterine insemination, or puncture of oogonia in order to obtain oocytes and their further fertilization in vitro ("in vitro") - the type of hormonal stimulation is selected.

Video: Follicle puncture

1 type of follicle stimulation

Held drugs (clostilbegit, Clomid) that enhance the production of hormones in the pituitary gland and hypothalamus, which leads to stimulation of follicle growth and maturation.

The stimulation process lasts 5 days, starting from 2-5 days of the menstrual cycle.

Folliculometry is mandatory - the doctor monitors the growth of the dominant follicle and assesses the state of the endometrium, then the drug HCG (pregnyl) is administered for planned ovulation.

If after stimulation in the first cycle the dominant follicle is absent, then in the second the dosage is increased.

Often, drugs of this type are ineffective in patients with high blood pressure or who are overweight.

In case of a weak ovarian response to stimulation, with low sensitivity to the drug, it is recommended to stimulate ovarian function with gonadotropins (hormones responsible for the regulation of the sex glands).

Type 2 follicle stimulation

Appointed gonadotropins (puregone, menogon, gonal). The natural development of follicles is simulated - therefore, to correctly select the dosage of drugs, it is necessary to perform an ultrasound on certain days of the cycle.

Stimulation begins on days 2-3 of the cycle. Provided that the follicles grow normally, by the middle of the menstrual cycle the patient is prescribed the drug HCG (pregnyl) for planned ovulation.

After this, to maintain the effective functioning of the corpus luteum, progesterone preparations are taken.

With this stimulation of follicular growth, very good results are often achieved, but the development of ovarian hyperstimulation cannot be ruled out.

Type 3 follicle stimulation

Simultaneous use of clostilbegit and gonadotropins at different stages of follicle growth.

Stimulation begins from 2-5 days of the cycle. Clostilbegit is used for the first 5 days, then gonadotropins are taken for 5-7 days.

When the follicle reaches the desired size, in order for ovulation to occur, a hCG drug (for example, pregnyl) is administered, and from the 16th day of the cycle, progesterone drugs are used.

How many follicles mature when stimulated?

When stimulating the growth of follicles with further fixed ovulation, it is very important to control their maturation by ultrasound monitoring. This allows adjustments to be made to the treatment regimen, since doctors cannot know exactly how the follicles will grow.

On average, ripens from 1 to 10 pieces, but with a weak response to stimulation, none may mature.

The quality of the eggs matured in the follicles is fundamentally important!

Before performing the stimulation procedure, doctors evaluate woman's ovarian reserve.

An important indicator is the number of follicles in the ovaries that reached 10 mm on days 2-3 of the cycle:

• 5 items– a weak response to stimulation is predicted.
• From 5-7 pieces – a weak reaction is possible, the dosage of stimulation drugs changes.
• 8-12 pieces– a satisfactory response is expected.
• 13-20 pieces– a good response is possible with a moderate risk of developing ovarian hyperstimulation syndrome.
• <20 штук – an overactive ovarian response increases the risk of developing ovarian hyperstimulation.

Why may follicles not grow when stimulated?

The “weak” response of the ovaries to stimulation worries specialists involved in ART (assisted reproductive technologies) and infertility.

We can speak of a “weak” response if, even with the introduction of high doses of drugs, the growth of a maximum of 3 follicles is ensured.

Empty follicle syndrome may also occur - this is a difficult to explain complication that patients encounter when undergoing a hormonal protocol in IVF programs. Empty follicles are those in which no egg has developed.

A weak response from the ovaries - and the occurrence of empty follicle syndrome - is associated with with low ovarian reserve.

The decisive factor in this case is age (critical 37-38 years).

However, sometimes the follicles do not mature in young women.

This is often related to:

1. With premature ovarian failure, which can be caused by genetic defects.
2. With repeated surgical interventions on the pelvic organs.
3. With endometriosis.
4. With chronic anovulation.

How many eggs mature in the dominant follicle when stimulated?

Stimulation of follicle growth only affects their number - therefore, as with the standard menstrual cycle, one follicle can mature only one egg.

In a standard menstrual cycle, follicles grow in approximately the following sequence:

• Day 5-7 of the cycle– follicle size is about 2-6 mm. Normally there should be about 10 of them.
• 8-11 days of the cycle– the appearance of a dominant follicle, its size is 12-15 mm.
• 12-14 days of the cycle– the dominant follicle increases to 18-24 mm. The remaining follicles undergo atresia.

When stimulated, follicles develop according to the same scheme. But, if the ovaries respond well, instead of one large dominant follicle, there will be several of them.

Typically, ovulation triggers are prescribed when follicles reach sizes of 17 mm or more.

Features of follicle stimulation during IVF

During the IVF procedure, for higher results, due to stimulation of ovarian function, several dominant follicles must mature at once.

During ovarian puncture, eggs are removed and then fertilized in the laboratory.

If the procedure is successful and a high-quality embryo is formed, it is “planted” into the mother’s body - where, if implantation is successful, it continues its development. The day of implantation is determined by the doctor based on the results of folliculometry.

All manipulations are carried out under the strict supervision of a doctor!

Unfortunately, today the problem of infertility is very acute for many couples. However, over time, it becomes possible to select adequate therapy, depending on the state of reproductive health of the partners and their age.

The main tasks of a doctor dealing with infertility are not to miss the important things - and not to do anything unnecessary.

A follicle is a component of the ovary that is surrounded by connective tissue and consists of an egg. The follicle contains the nucleus of the oocyte - the “germinal vesicle”. The oocyte is located inside a glycoprotein layer surrounded by granulosa cells. The granulosa cells themselves are surrounded by a basement membrane, around which there are cells - theca.

The primordial follicle consists of oocytes, stromal cells, and follicular cells. The follicle itself is practically invisible, its size is on average 50 microns. This follicle is laid before birth. It is formed thanks to germ cells, they are also called oogonia. The development of primordial follicles is promoted by puberty.

A single-layer ordinary follicle consists of a basal plastic, a follicular cell forming a transparent membrane, and a multilayer primary follicle consists of a transparent membrane, an inner cell, and granulosa cells. During puberty, follicle-stimulating hormone (FSH) begins to be produced. The oocyte grows and is surrounded by several layers of granulosa cells.

The cavitary (antral) follicle consists of a cavity, an inner layer of Theca, an outer layer of Theca, granulosa cells, and a cavity containing follicular fluid. Granulosa cells are already beginning to produce progestins. The diameter of the antral follicle is on average 500 microns. The gradual maturation of the follicle with the formation of its layers gives rise to the production of female sex hormones, including estrogen, estradiol, and androgen. Thanks to such hormones, this follicle turns into a temporary organ of the endocrine system.

A mature follicle (Graafian vesicle) consists of an outer layer of the theca, an inner layer of the theca, a cavity, granulosa cells, a corona radiata, and an ovarian tubercle. Now the egg is located above the oviductal tubercle. The volume of follicular fluid increases 100 times. The diameter of a mature follicle varies from 15 to 22 mm.

What size should a follicle be?

It is impossible to answer this question unequivocally, since the size of the follicles changes during the menstrual cycle. Follicles are fully formed by the age of fifteen on average. Their sizes are determined only with the help of ultradiagnostics.

We will most accurately analyze the norm of follicle size by day of the menstrual cycle.

In the first phase of the menstrual cycle (days 1–7 or the beginning of menstruation), the follicles should not exceed 2–7 mm in diameter.

The second phase of the menstrual cycle (8-10 days) is characterized by the growth of follicles, their diameter generally reaches 7-11 mm, but one follicle can grow faster (it is usually called dominant). Its diameter reaches 12 - 16 mm. On the 11th -15th day of the menstrual cycle, normally the dominant follicle should increase every day by 2 - 3 mm, at the peak of ovulation it should reach a size of 20 - 25 mm in diameter, after which it bursts and releases the egg. Meanwhile, other follicles simply disappear.

This is what the follicle growth pattern looks like. This is repeated monthly until pregnancy occurs. For a more visual and understandable definition, we provide you with a table by which you can understand whether your follicles are maturing normally.

What is a dominant follicle?

A dominant follicle is considered to be a follicle that is ready for successful ovulation. During natural ovulation, it stands out due to its size. As we said earlier, although all the follicles begin to grow, only one of them (in rare cases - several) grows to a size of 22 - 25mm. It is he who is considered dominant.

Generative function as a priority. Let's figure out what it is.

There are two components to the function of the ovaries.

The generative function is responsible for the growth of follicles and the maturation of an egg capable of fertilization. Hormonal function is responsible for steroidogenesis, which changes the uterine mucosa, helps not to reject the fertilized egg and regulates the hypothalamic-pituitary system. It is generally accepted that the generative function is a priority, so if it fails, the second one loses its abilities.

At what follicle size does ovulation occur?

Ovulation is the release of an egg from a ruptured mature follicle. In this case, the size of the follicle during ovulation becomes 15 - 22 mm (in diameter). To make sure that you have a full-fledged follicle by the time you ovulate, you need an ultrasound examination.

Empty follicle syndrome

Currently, two types of this syndrome are described: true and false. What differentiates them is their hCG level. We can say that thanks to IVF technology, scientists have examined under a microscope the phenomenon when the follicle is “empty”.

According to statistics, in women under 40 years of age, this syndrome occurs in 5 - 8% of cases. The older a woman gets, the higher the number of empty follicles. And this is no longer a pathology, but a norm. Unfortunately, it is impossible to accurately and immediately diagnose this syndrome. To do this, you will need to completely eliminate damage to the ovaries (structural abnormalities), lack of ovarian response to stimulation, premature ovulation, hormonal imbalance, defects (pathologies) in follicle development, premature aging of the ovaries. That is why there is no such diagnosis as “empty follicle”.

But scientists have found the reasons that accompany the development of the syndrome. Namely: Turner syndrome, incorrect time of administration of the hCG hormone, incorrect dose of hCG, incorrectly selected IVF protocol, incorrect technique for collecting and washing the material. As a rule, a competent reproductive specialist will carefully collect anamnesis before making this diagnosis.

Polycystic ovary syndrome

Otherwise it is called Stein-Leventhal syndrome. It is characterized by impaired ovarian function, absence (or altered frequency) of ovulation. As a result of this disease, follicles do not mature in a woman’s body. Women with this diagnosis suffer from infertility and lack of menstruation. It is possible that menstruation occurs rarely - 1-3 times a year. This disease also affects the disruption of hypothalamic-pituitary functions. And this, as we wrote earlier, is one of the functions of the proper functioning of the ovaries.

Treatment here can proceed in two ways. These are surgical and medicinal (conservative). The surgical method often involves resection with removal of the most damaged area of ​​ovarian tissue. This method leads to the restoration of a regular menstrual cycle in 70% of cases. For the conservative method of treatment, hormonal drugs are mainly used (Klostelbegit, Diana-35, Tamoxifen, etc.), which also help regulate the menstrual process, which leads to timely ovulation and the desired pregnancy.

Folliculometry: definitions, possibilities

The term folliculometry is commonly understood as monitoring a woman’s reproductive system during the menstrual cycle. This diagnostic allows you to recognize ovulation (whether it happened or not), determine the exact day, and monitor the dynamics of follicle maturation during the menstrual cycle.

Monitoring the dynamics of the endometrium. For this diagnosis, a sensor and a scanner are used (it’s more common for us to call it ultrasound). This procedure is absolutely identical to the procedure for ultrasound of the pelvic organs.

Folliculometry is prescribed to women to determine ovulation, evaluate follicles, to determine the day of the cycle, for timely preparation for fertilization, to determine whether a woman needs ovulation stimulation, to reduce (in some cases increase) the likelihood of multiple pregnancies, to determine the reasons for the absence of a regular menstrual cycle , detection of diseases of the pelvic organs (fibroids, cysts), to control treatment.

This procedure does not require strict preparation. It is recommended only during these studies (usually an ultrasound is done more than once) to exclude from the diet foods that increase bloating (soda, cabbage, brown bread). The study can be carried out in two ways: transabdominal and vaginal.

Values ​​of indicators of norm and pathology of follicle development

We described the normal indicators both by day and during ovulation above (see above). Let's talk a little about pathology. The main pathology is considered to be the lack of follicle growth.

The reason could be:

• in hormonal imbalance,
• polycystic ovary syndrome,
• dysfunction of the pituitary gland,
• inflammatory processes of the pelvic organs,
• STD,
• neoplasms,
• severe stress (frequent stress),
• breast cancer,
• anorexia,
• early menopause.

Based on practice, health workers identify such a group as hormonal disorders in a woman’s body. Hormones suppress the growth and maturation of follicles. If a woman has a very small body weight (plus there are also STD infections), then the body itself recognizes that it cannot bear a child, and the growth of the follicles stops.

After normalizing weight and treating STDs, the body begins to grow follicles correctly, and then the menstrual cycle is restored. During stress, the body releases hormones that contribute to either miscarriage or stopping the growth of follicles.

After complete emotional recovery, the body itself begins to stabilize.

Ovulation stimulation

Stimulation is usually understood as a complex of hormonal therapy that helps achieve fertilization. Prescribed to women diagnosed with infertility for IVF. Infertility is usually diagnosed if pregnancy does not occur within a year with regular sexual activity (without protection). But there are also contraindications for stimulation: impaired patency of the fallopian tubes, their absence (except for the IVF procedure), if it is not possible to conduct a full ultrasound, low follicular index, male infertility.

The stimulation itself occurs using two schemes (they are usually called protocols).

First protocol: increasing minimum doses. The purpose of this protocol is the maturation of one follicle, which excludes multiple pregnancies. It is considered gentle, since its use practically eliminates ovarian hyperstimulation. When stimulated with drugs according to this scheme, the size of the follicle usually reaches 18 - 20 mm. When this size is reached, the hCG hormone is administered, which allows ovulation to occur within 2 days.

Second protocol: reduction of high doses. This protocol is prescribed to women with low follicular reserve. But there are also requirements for it that are considered mandatory indications: age over 35, previous ovarian surgery, secondary amenorrhea, FSH above 12 IU/l, ovarian volume up to 8 cubic meters. When stimulating this protocol, the result is already visible on days 6-7. With this protocol there is a high risk of ovarian hyperstimulation.

Control ultrasound examination. This study is usually performed transvaginally. The purpose of the study is to confirm ovulation. This ultrasound should normally show that there is no dominant follicle, but there is a corpus luteum. There may be some free fluid behind the uterus. An ultrasound is performed strictly 2 - 3 days after expected ovulation, since if you are late, you may not see the corpus luteum, and the same fluid.