Causes of appearance and methods of treatment of single follicles in the ovary. Follicles in the ovaries: their meaning and function. Is it possible to get pregnant with two follicles?

Remember! If a woman has few follicles in her ovaries, only the attending physician will tell you how to treat the pathology and what methods exist to stimulate ovulation. The information below is for informational purposes only.

The number of follicles varies on different days of the menstrual cycle. So, 2-3 days after the end of your period, there are usually only a few of them left. On the 5th day, when performing an ultrasound, you can see on the monitor no more than 10 follicles measuring 2-4 mm, localized along the periphery of the ovary. Gradually they increase, with one of them becoming dominant. It is determined on days 9-10 of the cycle and has a diameter of 1.4-1.5 cm. On days 11-14 of the cycle it grows to 2.5 cm, after which ovulation soon occurs.

A small number of follicles in the appendages is a deviation from the norm, which often prevents conception. A woman's fertility is judged by the state of her follicular reserve. So, if the doctor sees on the ultrasound monitor:

more than 30 follicles – the patient has PCOS;
15-30 – the supply of appendages is normal;
7-14 – conception is theoretically possible;
4-6 – the chances of pregnancy occurring are low;
less than 4 – the probability of “making” a child tends to zero.

Pathology is indicated when the number of follicles in the ovaries is less than 10 and does not change over time, and hormone tests show abnormalities.

Causes of pathology

If a woman has few follicles in the ovary, this means a reduction in the follicular reserve due to age or the following reasons:

constant nervous feelings;
using inappropriate contraceptives;
disruption of the thyroid gland;
increased secretion of prolactin;
autoimmune diseases;
genetic predisposition to early menopause;
stressful environment in the family and/or at work;
disturbances in the functioning of the pituitary gland, which is responsible for the production of hormones;
the presence of bad habits;
living in an area with poor ecology;
diseases of the reproductive sphere;
improper functioning of the endocrine system.

What should you do first if there are few follicles in the ovaries? It is necessary to contact a gynecologist and undergo a comprehensive examination.

Diagnostics

To count the number of follicles on days 1-4 of the cycle, an ultrasound is performed. Based on its results, one can judge how long the patient will remain fertile. So, a woman who has about 20 follicles will be able to conceive a baby within another 20 years, and will enter menopause after about 24 years. 15 follicles located in the epididymis indicate that physiological infertility may occur after 9 years, and menopause after 18. A small number of follicles (less than 4-5 pieces) indicates an extremely low probability of conception.

In addition to ultrasound, an important method for diagnosing the state of the ovarian reserve of the ovaries is an AMH test, which is performed on the 3rd day of the menstrual cycle. The norm for women of reproductive age is 1-3 pg/ml (a value of 0.7-0.9 pg/ml is assessed as normal, but reduced).

To get the correct research result, you must:

a few days before contacting the laboratory, reduce physical and emotional stress as much as possible;
at the discretion of the doctor, do not take hormonal drugs 2 days before taking blood;
do not eat food 3 hours before the procedure;
do not smoke several hours before the test;
refuse to carry out diagnostics in the acute stage of any infectious disease.

Another effective method is to detect the level of FSH on days 2-3 of the cycle. A sufficient number of follicles is indicated by an indicator of 3-8 IU/l, the onset of menopause is indicated by over 30 IU/l. During the same period, the concentration of inhibin B is determined, the content of which below 45 pg/ml indicates a decrease in ovarian reserve and predicts ineffectiveness.

What to do if there are practically no follicles

If there are almost no follicles in the ovaries, this indicates their dysfunction or the onset of early menopause. In this case, the patient usually has a too short menstrual cycle.

In reproductive age, the causes of pathology can be:

genetic characteristics;
autoimmune pathologies;
some viral infectious diseases;
use of inappropriate hormonal drugs;
severe nicotine addiction;
alcohol abuse;
malnutrition;
undergoing chemotherapy or radiotherapy;
surgical interventions on the pelvic organs in the past.

Since the production of hormones is largely determined by the state of the nervous system, deviations from the norm can be caused by constant stressful situations or depressive states, the elimination of which plays an important role in normalizing reproductive health.

Therapy is based on eliminating the causes of identified disorders. Thus, patients with endocrine pathologies are usually prescribed special medications. In case of deviations caused by the use of inappropriate hormonal agents, the treatment regimen is reviewed. Hormone replacement therapy is often prescribed.

What to do if there are few follicles

To improve the situation and prevent the worsening of reproductive problems, it is necessary to eliminate all factors that provoke the development of pathology and eliminate the diseases that caused it.

The follicular reserve is laid down at the stage of embryonic development. With age, the number of potential eggs decreases, which is accompanied by a decrease in estrogen production by the ovaries. In response to this, the hypothalamus is activated, which begins to rapidly produce FSH. This leads to a significant increase in the amount of the latter and the appearance of menopausal symptoms, for the correction of which hormone replacement therapy (HRT) is often used.

One of the HRT drugs intended to normalize women's well-being, prevent osteoporosis and stimulate the process of follicular growth is Femoston. It contains estradiol and dydrogesterone.

Important! Only the attending physician will tell you how to properly treat and conceive a child if the patient has few follicles in the ovaries! Self-medication can lead to disastrous consequences!

For a woman who has been found to have a small number of follicles, Ovariamine may be recommended. The components of this medication are obtained from the ovaries of cattle. During treatment, a drop in the amount of FSH is observed.

Ovariamine is a biostimulant and is characterized by an estrogen-like effect. It may be used in conjunction with other combination therapy drugs. Indications for its use are: adnexitis, climatic period and menstrual irregularities. According to reviews, treatment with Ovariamine helps to increase AMH levels and increase the number of follicles in the ovaries.

Is it possible to get pregnant if there are few follicles in the ovary? The chances of conception remain even in this case. Sometimes it is advisable to stimulate ovulation. To have a long-awaited child, you can resort to the IVF procedure, including using a donor egg.

There are few follicles in the ovaries: is it possible to get pregnant?

more than 30 follicles – the patient has PCOS;
15-30 – the supply of appendages is normal;
7-14 – conception is theoretically possible;
4-6 – the chances of pregnancy occurring are low;
less than 4 – the probability of “making” a child tends to zero.

Pathology is indicated when the number of follicles in the ovaries is less than 10 and does not change over time, and hormone tests show abnormalities.

Causes of pathology

If a woman has few follicles in the ovary, this means a reduction in the follicular reserve due to age or the following reasons:

constant nervous feelings;
using inappropriate contraceptives;
disruption of the thyroid gland;
increased secretion of prolactin;
autoimmune diseases;
genetic predisposition to early menopause;
stressful environment in the family and/or at work;
disturbances in the functioning of the pituitary gland, which is responsible for the production of hormones;
the presence of bad habits;
living in an area with poor ecology;
chronic inflammatory diseases of the reproductive sphere;
improper functioning of the endocrine system.

What should you do first if there are few follicles in the ovaries? It is necessary to contact a gynecologist and undergo a comprehensive examination.

Diagnostics

To count the number of follicles on days 1-4 of the cycle, an ultrasound is performed. Based on its results, one can judge how long the patient will remain fertile. So, a woman who has about 20 follicles will be able to conceive a baby within another 20 years, and will enter menopause after about 24 years. 15 follicles located in the epididymis indicate that physiological infertility may occur after 9 years, and menopause - after 18. A small number of follicles (less than 4-5 pieces) indicates an extremely low probability of conception.

To get the correct research result, you must:

a few days before contacting the laboratory, reduce physical and emotional stress as much as possible;
at the discretion of the doctor, do not take hormonal drugs 2 days before taking blood;
do not eat food 3 hours before the procedure;
do not smoke several hours before the test;
refuse to carry out diagnostics in the acute stage of any infectious disease.

What to do if there are practically no follicles

If there are almost no follicles in the ovaries, this indicates their dysfunction or the onset of early menopause. In this case, the patient usually has a too short menstrual cycle.

In reproductive age, the causes of pathology can be:

genetic characteristics;
autoimmune pathologies;
some viral infectious diseases;
use of inappropriate hormonal drugs;
severe nicotine addiction;
alcohol abuse;
malnutrition;
undergoing chemotherapy or radiotherapy;
surgical interventions on the pelvic organs in the past.

What to do if there are few follicles

One of the HRT drugs intended to normalize women's well-being, prevent osteoporosis and stimulate the process of follicular growth is Femoston. It contains estradiol and dydrogesterone.

Important! Only the attending physician will tell you how to properly treat and conceive a child if the patient has few follicles in the ovaries! Self-medication can lead to disastrous consequences!

oyaichnikah.ru

Follicles in the ovaries - normal number and size, causes and treatment of atresia for conception

The female body is designed in such a way that the birth of a new life depends on the quantity and quality of these small follicular elements in which the egg matures. Expectant mothers should know what processes are happening in their reproductive organs, so that if there are any problems, they can contact a gynecologist in time.

What are follicles

The process of the emergence of human life begins with the fertilization of the egg. What are follicles? These are the elements that protect it, the place where it matures until the moment of ovulation. The egg is securely surrounded by a layer of epithelium, a double layer of connective tissue. The possibility of pregnancy and bearing a child depends on quality protection. On ultrasound it looks like a round formation. The second function of the elements is the production of the hormone estrogen.

The follicles on the ovaries undergo their monthly evolutionary cycle:

several small pieces are starting to develop;
one - antral - begins to increase in size;
the rest shrink and die - atresia occurs;
the largest – dominant – continues to grow;
under the influence of hormones it breaks through, ovulation occurs;
the egg enters the fallopian tubes;
during sexual intercourse, at the moment of meeting the sperm, fertilization occurs;
if this does not happen, during menstruation the egg leaves the uterus along with the epithelium.

By the middle of the menstrual cycle, the follicular apparatus approaches the main stage of its activity. What is a dominant follicle? This is the largest and most mature element that protects the egg, which is ready for fertilization. Before ovulation, it can grow up to two centimeters, and is most often located in the right ovary.

In the mature state, under the influence of hormones, it ruptures - ovulation. The egg rushes to the fallopian tubes. If the dominant element does not mature, ovulation does not occur. The causes of this condition are developmental disorders.

Persistent ovarian follicle - what is it?

Due to hormonal changes that begin in adolescence, during menopause, disruption of the activity of the follicular apparatus is possible - persistence. This can cause a delay in menstruation and bleeding. Persistent ovarian follicle - what is it? The situation means that the security element:

matured;
reached a dominant state;
there was no rupture;
the egg did not come out;
fertilization did not occur;
pregnancy did not take place.

In this situation, persistence occurs - the reverse development of the follicular formation; with further developments, a cyst may form from it. To ensure that the formation can burst, gynecology prescribes treatment with progesterone. What happens during persistence? The following process develops:

hormones continue to be produced;
thickening of the endometrial mucosa occurs;
the uterus is compressed;
the endometrium begins to be rejected;
bleeding occurs.

Primordial follicle

The supply of eggs for a woman’s entire life is laid in the mother’s womb, it is called the ovarian reserve. The primordial follicle is the primary stage of development of the protective element. The rudiments of germ cells - oogonia - are located on the periphery of the inner surface of the ovary and have sizes that are not visible to the eye. They are protected by a layer of granulosa cells and are in a state of rest.

This continues until the girl reaches puberty - the beginning of the menstrual cycle. The course of this period is characterized by:

formation of follicle-stimulating hormone;
under its influence, the growth of the nucleus of the egg - oocyte;
maturation of two layers of outer protective shell;
monthly development of several follicular elements protecting the egg.

Antral follicles

At the next, secondary stage, the follicles in the ovaries continue their development. Around the seventh day of the cycle, the number of cells producing follicular fluid increases. Structural building processes occur:

antral follicles begin producing estrogen on day 8;
the theca cells of the outer layer synthesize androgens - testosterone, androstenedione;
the cavity containing follicular fluid enlarges;
the epithelium differentiates and becomes two-layered.

Preovulatory follicle - what is it?

At the last, tertiary stage of maturation, the egg takes place on a special hill, it is ready for fertilization. Preovulatory follicle - what is it? At this moment, it is called a graafian bubble and is almost completely filled with liquid. Its number has increased tenfold compared to the previous period. The day before ovulation, serious changes begin to occur.

At this time, estrogen production increases, then:

it stimulates the release of luteinizing hormone, which triggers ovulation;
the Graafian vesicle forms a stigma on the wall - a protrusion;
at this point a breakthrough appears - ovulation;
after that, the corpus luteum is formed, which prevents endometrial rejection due to the production of progesterone;
Following ovulation, it forms a pronounced network of blood vessels and helps further the formation of the placenta.

Single follicles in the ovary

How many tragedies happen due to the inability to conceive a child. In some cases, ovarian depletion syndrome occurs. A woman is unable to become pregnant because their functioning stops. Single follicles in the ovary cannot develop to normal size, there is a lack of ovulation, and early menopause occurs. The reasons for this situation may be:

active sports;
starvation diets;
menopause;
hormonal disorders;
obesity.

If there is abnormal development of the follicular apparatus, the woman undergoes regular ultrasound examinations. The real picture and the number of follicles are normal are compared. If there are deviations - increases or decreases - a pathology occurs - the impossibility of conception, the woman begins to be treated. How many follicles should there be in an ovary? During reproductive age, it depends on the days of the cycle:

on the sixth, seventh – from 6 to 10 pieces;
from the eighth to the tenth - one dominant appears - the rest die off.

How many follicles should there be for conception?

In order for a woman to become pregnant, the egg must mature completely. How many follicles should there be to conceive? At the stage before fertilization, it is necessary to have one - high-quality dominant development. He should be ready to ovulate. If an ultrasound examination reveals two such formations, and they both undergo fertilization, twins will be born.

Follicle maturation

Folliculogenesis - the process of growth and maturation of the follicle under favorable conditions ends with ovulation and fertilization. Things don't always go well. In case of developmental disorders, observation and analysis are carried out using ultrasound. Starting from the 10th day of the cycle, the growth of the dominant element is monitored. If slow maturation is observed and ovulation does not occur, treatment is prescribed. During the next cycle, the results are monitored. This way you can increase the speed of maturation and achieve the long-awaited pregnancy.

Follicle size by cycle day

Every month during menstruation, follicles gradually grow day by day. The following process is observed:

until the seventh day, the size of the bubble ranges from 2 to 6 millimeters;
starting from the eighth, the growth of the dominant formation is activated up to 15 mm;
the rest reduce in size and die off;
from 11 to 14 days of the cycle, daily growth is observed;
a mature element can have a size of up to 25 mm.

Many follicles in the ovary - what does this mean?

Deviation from the norm in the direction of increase is considered pathology. A large number of follicles in the ovaries - more than 10 pieces are called multifollicular. During ultrasound, a huge number of small bubbles are observed, which is called follicular ovaries or polyfollicularity. When their number increases several times, polycystic disease is diagnosed.

This situation does not mean the formation of a cyst; it is characterized by the presence of multiple follicular elements along the periphery. This can interfere with dominant development, ovulation and conception. Such problems can be caused by stress or nervous disorders and can quickly return to normal. Conditions caused by:

incorrect selection of oral contraceptives;
endocrine problems;
weight gain;
sudden weight loss.

Few follicles in the ovaries

A woman cannot get pregnant; to find out the reason, she is prescribed an ultrasound. Such a study takes place during the antral phase of the follicular apparatus - on the seventh day of the menstrual cycle. When it is discovered that there are very few follicles in the ovaries, it is possible that the situation was triggered by a decrease in hormone levels. The analysis is carried out using a vaginal sensor. If during examination the follicles in the ovaries are found in the following quantities:

from 7 to 16 – there is a chance of conception;
from 4 to 6 – the possibility of getting pregnant is low;
less than 4 – there is no chance of conception.

Two dominant follicles in one ovary

During the treatment of infertility with hormones, their concentration increases; instead of one, two dominant follicles mature in one ovary. Less often this happens on the left side. Those elements that should have stopped developing under the influence of hormones begin to grow. Fertilization of two eggs may occur simultaneously or with a short interval of time. This will lead to the birth of twins. If a woman has had sexual intercourse with different men over a short period, it is possible that the children will have different fathers.

Why the follicle does not mature - reasons

Developmental disorders have very serious problems - leading to infertility. Why doesn't the follicle grow? There could be many reasons for this:

early menopause - natural or surgical;
disruption of ovarian function;
having problems with ovulation;
low estrogen production;
endocrine disorders;
inflammation in the pelvic organs;
pathology of the pituitary gland.

Interruptions in maturation are caused by: stressful situations, depression, nervous tension. The condition of the follicular component itself plays an important role; it can:

absent;
have a developmental arrest;
do not reach the required dimensions;
be late in maturation;
not develop at all;
delay the moment of formation.

Find out more about what ovulation is.

Video: how the follicle grows

The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

sovets.net

Single follicles in the ovary: what are they, causes, diagnosis

Her ability to conceive and give birth to a child depends on the functionality of a woman’s follicular apparatus. If their number changes, this affects the patient’s health. If there are single follicles in the ovary, the possibility of getting pregnant drops sharply. Moreover, such a pathology can develop not only in middle-aged women, but also in young girls.

In this article we will look at what single follicles in the ovary are, their causes of appearance and treatment features.

What is the disease

A follicle is a special element within which an egg develops and grows. It provides nutrition and protection to the cell. Subsequently, it is the follicle that produces estrogen. Several follicles (6-10) can form in the ovary, one of which will be dominant. It is he who will “grow” the cell ready for conception.

The number of follicles in the female body is strictly defined. It is laid down during intrauterine development. Over the course of a woman's entire life, about 400 follicles become fully ready to form an egg.

On the path of their development, these elements go through several stages: primordial, preantral, antral, preovular. Every day after its formation, the follicle grows and develops. This process is repeated every month.

Antral follicles are formed on the 7th day. At this time they increase in size. The formation contains more cells that produce follicular fluid. Already on the 8th day, the follicle begins to produce estrogen. The epithelium becomes two-layered.

Normally, there should be from 6 to 12 follicles. However, there may be more or less of them. If there are single follicles, a woman is not able to conceive a baby, since her ovaries do not function, the egg does not develop, and, therefore, ovulation does not occur. The patient's risk of early menopause increases.

Reasons for appearance

We can name the following reasons for the formation of single follicles:

excessive and heavy sports training that depletes the body;
early menopause, which is caused by removal of the uterus along with the appendages;
hereditary predisposition;
unfavorable environmental conditions;
strict diets in which an insufficient amount of nutrients enters the body;
hormonal disorders;
sudden increase in body weight;
pathologies of the thyroid gland and pituitary gland;
too low level of estrogen in the blood;
frequent stressful situations and depression;
galactosemia;
damage to the follicular apparatus that occurred during fetal development;
undergoing radiation therapy during cancer treatment.

The combination of these reasons negatively affects not only a woman’s reproductive ability, but also her health in general.

Signs of single follicles

The most important symptom is secondary amenorrhea, which means the impossibility of pregnancy. The fact is that ovulation does not occur, the menstrual cycle is disrupted. In addition, the woman develops other signs:

Constant hot flashes, increased sweating.
Sleep disorders.
Aching pain in the heart.
Secondary infertility, which can still be reversed if effective treatment is started in time.
An unpleasant feeling of dryness in the external genital area, which often leads to painful sexual intercourse.
Decreased libido (sexual desire).
Frequent mood swings, tearfulness, increased irritability.
Decreased performance.

Without proper treatment, this condition can lead to irreversible consequences. For example, without normal hormonal support, atrophic processes develop in the genitals. If signs of the formation of single follicles appear, you should immediately consult a doctor for a thorough examination.

Diagnosis of the disease

Even the dominant follicle may be irregular in shape. This can also prevent conception, as the egg cannot form normally. In order to make an accurate diagnosis, you should undergo certain tests:

External examination, during which the patient’s complaints are recorded. In addition, the doctor should know when the first signs appeared, what factors provoked them, in the woman’s opinion, and whether the symptoms have changed over time. The specialist also needs data on past pathologies, surgical interventions, injuries, and the person’s everyday life.
Study of menstrual function. Here you need data about the first menstruation, the duration of the cycle and its regularity.
Examination of the patient on the chair. The doctor determines changes in the mammary glands or external genitalia, and specific symptoms.
Ultrasound. In this case, a decrease in the thickness of the endometrium, the size of the ovaries, and the absence of follicles in them are determined.
Blood test for the concentration of sex hormones.
Laparoscopy.
Karyotyping.
Echosalpingography.

For further treatment of the pathology, the intervention of a gynecologist-endocrinologist is necessary. The presented pathology is almost always associated with changes in hormone levels, so dysfunction of the endocrine system must be eliminated first.

Features of treatment

If the ovaries cannot fully perform their function, then the woman’s body begins to age faster. Naturally, this negatively affects not only her physical, but also her psychological state. Therapy is selected depending on the cause of the disease. However, the following treatment methods are most often required:

Hormone replacement therapy. A woman has to use drugs that artificially normalize the balance of sex hormones. If the patient has amenorrhea, then estrogens are prescribed to her first.
Physiotherapeutic procedures: electrophoresis, ultrasound.

Folk remedies are a good help in the fight against pathology. But they should be used only after consultation with your doctor. The following recipes are considered useful:

Infusion or decoction of boron uterus. This herb is the leader among all plants used to treat gynecological problems. It restores normal hormonal levels. However, when using the prepared products, the dosage must be strictly observed. You also need to take breaks between courses of therapy. The decoction is prepared very simply: 1 tbsp. l. raw materials are poured with 300 ml of liquid and cooked for 10 minutes. You need to infuse the product for the same amount of time. Drink 1 tbsp. l. up to 5 times a day. The decoction is taken for 3 weeks, after which you need to take a break for 7 days. Treatment must be continued until the woman’s condition improves.
Evening primrose oil. The presented product is considered a natural stimulant of the woman’s reproductive system. The medicine is recommended for those patients who have been diagnosed with single follicles or ovarian wasting syndrome. Additionally, vitamin E is used. The product should be taken as follows: in 1 tbsp. l. oil, the vitamin capsule dissolves, after which the mixture is drunk. This is done three times a day, 60 minutes before meals.
Cabbage juice. You should drink it half a glass a day. It is better to do this in the morning, before meals.
Beet juice. Positively affects estrogen production. Fresh juice should be diluted in half with cold water. It should be taken once a day, 1 tbsp.
Red brush decoction. You need to pour 1 tbsp into a glass of water. l. dry herbs and boil for 20 minutes. Next, the product is cooled and consumed before meals, 1 tbsp. l.

Naturally, folk remedies can restore the normal function of follicle formation, but this method of treatment must be approved by a doctor. Excessive stimulation of the ovaries can only cause harm.

If conservative treatment does not produce results, then surgery may be used. If there are only 3-4 follicles in the ovary, a woman can become pregnant only through IVF.

Possible complications

If a woman has single follicles, what this means can be fully explained by a gynecologist. However, the pathology is considered extremely serious, as it can have serious consequences:

secondary infertility, which becomes irreversible without proper therapy;
early aging of the body, as well as menopause;
increased chances of getting cardiovascular diseases;
osteoporosis (decreased bone density due to poor absorption of calcium);
psychological problems, depression;
decreased quality of life, problems with sexual relations.

These complications can significantly worsen a person's existence. Over time they will only get worse. If atrophic processes occur in the genitals, then the chances of even artificial insemination will drop sharply. Therefore, treatment must be started on time. The absence of menstruation, the cause of which is not pregnancy, cannot be overlooked.

Prevention

To prevent a woman from developing this pathology, it is better to follow certain recommendations from doctors:

It is imperative to eat right. You should not follow strict diets, as sudden changes in weight lead to hormonal imbalance.
All viral infections must be treated promptly.
It is important to exclude the influence of radioactive radiation. If the job involves chemicals, then it needs to be changed.
Any medications should be taken only with the permission and under the supervision of a doctor.
It is important to exclude excessive psycho-emotional and physical stress that negatively affects the formation of follicles.
You should follow the rules for taking hormonal medications.
A woman needs to be regularly examined by a gynecologist.
It is imperative to exclude unreasonable and incorrect ovarian stimulation.

Only proper prevention of single follicles will help avoid the development of this pathology, and also ensure normal reproductive function. The further prognosis (whether the patient will be able to get pregnant) depends on her general condition and the correctness of the selected therapy.

oyaichnikah.ru

There are no follicles in the ovaries: what does this mean, treatment methods

The instinct of motherhood, inherent in nature, manifests itself in women at different times. The desire to plan your future, including pregnancy, does not always coincide with your possibilities. Often, when the desire to continue the family comes, representatives of the fairer sex are faced with gynecological problems of various kinds.

In the doctor's office, a patient may hear that there are no follicles in the ovaries. What does this mean and whether it will be possible to get pregnant are questions that cannot but worry in this situation. It is impossible to answer them unequivocally. Each case must be considered individually.

Natural female cycle

In the natural state, a healthy woman experiences a change in hormonal levels within a month. Estrogens are replaced by progesterone, and the follicular phase passes into the luteal phase. This process makes you feel good. Also, well-functioning hormonal levels are necessary for conception and maintenance of pregnancy.

At the beginning of the cycle, one of the ovaries (or each) forms several follicles (Graafian vesicles). During ultrasound examination, they can be seen on the monitor screen, measured and characterized. Closer to the middle of the menstrual cycle, one (less often there are several) dominant follicle is determined. Having reached a certain size, it opens and releases the egg. This process causes sufficient production of luteinizing hormone. At the site of the burst follicle, a corpus luteum forms. It will support the pregnancy or disappear by the beginning of the new menstruation.

Premature ovarian failure

Faced with the fact that there are no follicles in the ovary according to ultrasound, the woman begins to panic. And for good reason. The chances of natural conception in this case tend to zero. Be careful: we are talking about the complete absence of any follicles. If there is no dominant follicle on ultrasound, but only antral ones, then this situation is completely fixable, and in many situations it is generally a variant of the norm.

We can talk about the prospects for treatment in the complete absence of graafian vesicles once we know the causes of this condition. Premature ovarian failure can occur:

if a woman has been taking hormonal drugs that suppress the ovulation process (oral contraceptives) for a long time;
during hunger strikes, a sharp decrease or increase in body weight, exhausting physical activity;
subsequently frequent stimulation (more often independent use of hormones in inappropriate doses);
after surgical interventions involving the removal of part of the ovary (removal of cysts, resection, treatment of polycystic ovary syndrome).

Predisposing factors for a decrease in ovarian reserve (that is, the supply of eggs) are:

radiation, chemotherapy, toxic medications;
stress, frantic pace of life, chronic fatigue, lack of sleep;
diets, hunger strikes, exhausting workouts;
some viral diseases;
autoimmune processes;
in vitro fertilization or egg donation.

Diagnosis and prognosis of conception

The process of ovarian depletion begins long before the moment when the absence of follicles is established. The patient's main complaint is the absence of pregnancy for a long time.

Ultrasound

An ultrasound examination at the beginning of the cycle (on days 3-5) can determine whether the gland has dominant or antral follicles:

we can speak of a favorable prognosis if there are 10 to 25 small follicles in the ovary;
a decrease in this volume (9 or fewer antral cells) reduces the chances of natural conception; pregnancy in this case is possible after hormonal influence (stimulation);
you need to talk about assisted reproductive technologies if the number of detectable follicles is less than 4;
an ovary without follicles is a bad sign. If there are no “bubbles” in both the right and left ovaries, then this signals the impossibility of pregnancy with one’s own egg.

Normally, ovarian depletion is diagnosed in women at the time of menopause. If there are no follicles in the ovaries of a patient whose age is in the range of 45-50 years, then this indicator can be considered normal. However, in recent years, this symptom is increasingly found in young representatives of the fairer sex. Ultrasound examination with counting of antral follicles can indirectly judge the possibility of pregnancy.

The main reliable symptom of ovarian exhaustion is the cessation of menstruation. Bleeding may also become less intense and short-lasting. Additionally, a woman experiences symptoms such as:

redness of the skin in the chest and neck area;
feeling of heat, increased sweating;
decreased sex drive;
mood swings, depression and aggressiveness;
insomnia;
decreased performance.

By contacting a gynecologist with these complaints, the patient may find out that there are no follicles in one ovary or that cells are missing in both glands.

Blood analysis

However, a more accurate result than counting follicles on an ultrasound will be shown by a special blood test.

A blood test to determine the amount of ovarian reserve should be taken from the 3rd to the 5th day of the menstrual cycle. The results of the study will reliably confirm ovarian depletion. Anti-Mullerian hormone is secreted by a woman's ovarian cells from birth until menopause. The norm for this analysis is considered to be a result of 1 to 2.5 ng/ml. As a woman ages, this figure decreases. To ensure the result is as accurate as possible, you must follow the following rules:

2-3 hours before blood sampling you should not eat;
do not use hormonal medications for 2 days;
the day before the analysis, exclude physical and emotional stress.

The doctor may also order a test for inhibin B and FSH levels.

Is there a cure for this?

What to do if a woman is told there are no follicles?

The procedure is standard,” says obstetrician-gynecologist, doctor of the highest category, candidate of medical sciences, director of the Repromed family clinic Elena Kanaeva. - Consultation with a good gynecologist, assessment of hormonal status and determination of treatment tactics by the doctor. A woman (girl) with a regular menstrual cycle necessarily has follicles in her ovaries. The follicular reserve is assessed on days 4-5 of the cycle. If in doubt, it is better to contact an experienced specialist.

To talk about whether treatment will help, you need to find out why a woman does not have follicles. If the cause of this condition is hormonal imbalance, nervousness or physical activity, then it is possible to correct everything.

In other cases, ovarian depletion requires the use of hormone replacement therapy. The required volume of gestagens and progestogens is selected for the patient. Treatment will help you maintain good health and get rid of the troubling signs of ovarian failure syndrome.

If a woman is planning a pregnancy, then the tactics will be different. It is necessary to understand: if follicles are not visualized for several months, this means that natural conception has been excluded.

For several decades, medicine has been helping such patients feel the joy of motherhood. A decrease in ovarian reserve and a small number of antral follicles in the ovary leaves a chance for natural conception. Stimulation is carried out using hormonal drugs selected individually for the patient. With good growth of dominant follicles, the chance of a natural pregnancy increases.

The absence of follicles even after hormonal correction indicates that it is impossible to do without a donor egg. With the help of in vitro fertilization and subsequent supportive therapy, you can give birth.

If follicles are not visualized in the ovaries, then this is not a death sentence. Additional research, examination of medical history and assessment of the patient’s quality of life will help to conclude whether there is a chance for natural conception. You need to understand that self-medication will not help here. To correct exhausted ovarian syndrome, you need to see a doctor and get an individual prescription. The treatment method will depend on whether the patient wants to become pregnant or improve her condition, get rid of disturbing symptoms.

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2018 Blog about women's health.

Problems with conceiving a child, which many couples experience, can have a variety of reasons, and one of them is multifollicular ovaries in a woman. It should be noted right away that such a diagnosis does not mean a sentence of “infertility”, but in some cases it still requires appropriate correction.

To answer this question, you need to understand the processes that occur in a woman’s ovaries before ovulation, that is, the release of an egg. During the menstrual cycle, follicles mature in each of the ovaries, that is, the membranes that contain the egg - on average, their number varies from 4 to 7. As a result, one or two of them burst, as a result of which ovulation occurs.

In the ovaries of some women, significantly more follicles mature (8-12 pieces) - this is precisely the phenomenon that doctors call multifollicularity, which can be either a temporary phenomenon or even a variant of the norm, or a serious disorder.

Multifollicularity is not considered a serious pathology and is quite compatible with pregnancy. But in some cases, due to the large number of follicles, none of them can mature to normal levels and ovulation simply does not occur. In addition, a woman may experience disturbances in her menstrual cycle or produce eggs that are incapable of fertilization.

Another danger of this phenomenon is that it is often accompanied by hormonal disorders, including hyperandrogenism (excessive production of male hormones) and progesterone deficiency, which can lead to miscarriage. Finally, multifollicularity can eventually develop into polycystic disease - a disease when a large number of cysts appear on the ovaries, and the chances of conceiving a child are significantly reduced.

In other words, it is quite possible to become pregnant with multifollicular ovaries (albeit with some difficulty), but serious problems may arise with carrying the pregnancy to term.

Causes of multifollicularity

There may be several reasons for this phenomenon. These include:

hereditary factor;
disorders of the thyroid gland;
hormonal imbalances;
rapid weight gain or loss;
puberty in girls;
lactation;
severe stress;
taking hormonal contraceptives.

Most of these factors lead to insufficient production of luteinizing hormone by the anterior pituitary gland, which is why too many follicles mature in the ovaries.

Most often, multifollicular ovaries do not manifest themselves in any way, so a woman may not be aware of such a disorder, and it is detected by chance, during an ultrasound examination. But sometimes, for this reason, a woman’s menstrual cycle is disrupted - the so-called “critical days” may be absent for 3 or more months.

Any disruptions in the menstrual cycle that occur over a long period of time should in no case be ignored - this means that ovulation in the body does not occur at all, so it will be impossible to get pregnant.

Indirect signs indicating that multifollicularity has already developed into polycystic disease or is just beginning to develop into this serious disease may be:

oily hair and skin, the appearance of a large amount of acne;
pronounced premenstrual syndrome, nagging abdominal pain before ovulation or during the period of expected release of the egg;
change in voice tone (it becomes lower and rougher);
hirsutism, or in other words, excessive hair growth in different parts of the body, most often the face and nipples.

Diagnosis of multifollicularity

The main way to diagnose this feature is ultrasound, but it is very important to find a good specialist who can distinguish multifollicularity from polycystic disease.

Signs by which multifollicularity can be distinguished from polycystic disease:

Sometimes even the most experienced ultrasound specialist is not always able to distinguish the multifollicular structure of the ovary from polycystic disease, therefore, to clarify the diagnosis, a woman is usually prescribed additional studies.

Treatment of multifollicularity

If a woman with multifollicular ovaries does not experience hormonal imbalances or any other disorders, she does not need treatment, and this phenomenon can be regarded as a feature of the body or a variant of the norm. But in cases where ovulation does not occur within 3-4 cycles, the patient should undergo a joint examination by a gynecologist and an endocrinologist to find out the primary cause of multifollicularity. After this, the doctor prescribes therapy, which is primarily designed to restore hormonal balance in the woman’s body. In addition, it will be necessary to determine the malignant or benign nature of the formations, on the basis of which a decision on further treatment tactics is made.

Treatment of multifollicularity with folk remedies

In the absence of menstruation and infertility, women with multifollicular ovaries often use folk remedies that can treat gynecological diseases, normalize hormone levels and stimulate ovulation.

Before using traditional medicine, you should definitely consult a doctor, as self-medication for multifollicular syndrome can further aggravate the situation and lead to the most dire consequences.

Most often, to correct disorders caused by multifollicularity of the ovaries, herbal preparations, infusions and decoctions of nettle, yarrow, hogweed, red brush, etc. are used.

Folk remedies for the treatment of multifollicularity

Nettle and yarrow	To prepare the infusion in the evening, you need to take a teaspoon of dried yarrow and nettle, pour it into a ceramic container and steam with a glass of boiling water. Leave until morning, then filter and drink. You should take the drug for a month, then take a week's break and resume taking it. Course of treatment – 6 months
Hog queen	Steam a tablespoon of raw material with 200 ml of boiling water and leave in a thermos or in a water bath for 2 hours. Drink a tablespoon three times a day; In addition, this infusion can be used for douching. You can also prepare a medicinal tincture from boron uterus: pour 50 g of the herb into 400 ml of vodka, leave it in the dark for two weeks, then strain and drink 20 k. 20 minutes before meals three times a day. Take it for three weeks, then take a week break. Course – 6 months
Red brush	Take a tablespoon of herb, steam it with a glass of hot water, leave for an hour. Drink 20 ml 30 minutes before meals three times a day. To prepare the tincture, you need to pour 80 g of red brush into half a liter of vodka, leave for a week in a dark place, filter and take ½ teaspoon half an hour before meals, no more than three times a day.

Multifollicular ovaries and pregnancy

If a woman with multifollicular ovaries still manages to conceive a child, she should pay increased attention to her health and well-being.

To avoid any complications, pregnant women who have previously had this feature should be under the strict supervision of a doctor, regularly undergo ultrasound examinations and donate blood to determine the level of progesterone and other hormones.

One of the most serious disorders that many expectant mothers face is progesterone deficiency, which can ultimately lead to miscarriage. In this case, the woman is prescribed medications that maintain the required level of this hormone. Hyperandrogenism, that is, an excess of male hormones in the female body does not always require correction, but in some cases the doctor may recommend taking glucocorticosteroids.

It is better for expectant mothers with multifollicular syndrome to undergo an ultrasound examination with a vaginal sensor, which can accurately determine a very unpleasant, threatening symptom: shortening of the cervix. If this does happen, then in order to avoid premature birth, doctors put stitches on it or install a pessary (a special retaining ring).

Video - multifollicular ovaries

Is it possible to prevent multifollicularity?

It is almost impossible to avoid multifollicular syndrome (especially in cases where its cause is a hereditary factor), but in order to prevent this feature from developing into polycystic disease, a woman must take some precautions.

First of all, she needs to regularly (at least twice a year) undergo preventive examinations with a gynecologist and monitor the level of her hormones. You should not take any oral contraceptives without consulting a specialist, much less abuse such pills. Finally, women (especially those who are prone to obesity) are advised to control their weight, avoiding sudden changes.

To summarize, it should be noted that multifollicular ovaries do not at all mean a woman’s inability to conceive and bear a child. With the right behavior and timely consultation with a doctor, a representative of the fair sex with multifollicular syndrome has no less high chances of becoming a happy mother than everyone else.

What is the ovarian reserve, why is it important to know about it, what tests need to be taken to determine the number of follicles, without which pregnancy is impossible, and who is at risk? Obstetrician-gynecologist Tamara Slukina answered these questions for us.

Tamara Slukina
obstetrician-gynecologist of the first category of the medical diagnostic company "SINLAB"

It all starts before the girl is born

— Tamara Vladimirovna, they are increasingly saying that women decide to give birth to their first child only at about 27 years of age, is this true?

— Yes, indeed, such a trend exists, and gynecologists are not very happy with it. Recently, there has been a shift in the age limits for first-time mothers.

- Why is this happening?

— There are many reasons: urbanization, the desire to get a higher education (and sometimes even two), to succeed socially and professionally, to make sure that you choose the right partner, and so on.

— What age is considered the most favorable for pregnancy?

— Definitely, the best time for the first pregnancy is before the age of 25, when the body is strong and healthy, when there are no serious acquired diseases and the harmful effects of stress factors are minimal.

— What is follicle and ovarian reserve?

— Follicle is a structural component of the ovary, consisting of an egg surrounded by a layer of epithelial cells and two layers of connective tissue. It performs a protective function for the egg, as well as a hormonal one.

Ovarian reserve call the reserve of follicles present in the ovary that are capable of developing further and making it possible for the ovulation of the egg.

Unfortunately, the number of follicles is finite. Even in the womb, at approximately 19-20 weeks, oogonia, that is, the precursors of follicles, begin to form in the ovaries of the fetus. About 7 million of them are laid; by the time a girl is born, the number is already reduced to 1.5-2 million. By the time of the first menstruation, no more than 300-350 thousand remain, and the number gradually decreases.

The highest generative activity, that is, the realization of the maximum number of eggs, is biologically programmed for the third decade of a woman’s life.

The chance of getting pregnant after 30 is halved

— What number of follicles indicates that a woman has a good supply and should not worry yet?

- Approximately 5-15 follicles ranging in size from 3 to 5 mm are considered normal. If there are fewer of them, the situation can be called critical and you should definitely pay attention to this issue.

— Is it true that today women’s reserves run out much earlier than, for example, ten years ago?

— It’s too early to panic. Based on personal experience, I would not say that the situation becomes very critical, but before the age of 30, the probability of becoming pregnant is the highest and, of course, it is desirable that the first birth takes place during this period.

According to statistics, the number of fertile women after the age of 30 is reduced by exactly half, that is, the likelihood of becoming pregnant is significantly reduced. The situation with the new ten is even more complicated: at the age of 40-43 years, the number of representatives of the fair sex who can become pregnant is already 10-15%. Well, among 50-year-old ladies these are completely unique cases.

Accurately assessing ovarian reserve is not a problem today

— Why did nature distribute it so unequally: some have more reserves, others have less?

- These are genetic programs. Some are lucky, some are not. It is impossible to influence this, to somehow increase the body’s reserves. As I already said, the process is irreversible.

— What methods exist for determining ovarian reserve?

— There are 3 components: checking AMH, counting the number of follicles on an ultrasound, and determining the size (volume) of the ovaries.

Definition anti-Mullerian hormone (AMH) by blood test. This is a protein produced in the granulosa cells of the follicle. As a rule, a value above 2.5 ng/ml is considered normal.

Ultrasound indications. Actually counting the follicles and determining the volume of the ovaries (if they are less than 4 cm, then there is a possibility that the ovarian reserve is too small).

Talk to your mom and older sisters. Predisposition to early menopause is a very important factor

— How often do special examinations need to be done to keep the situation under control?

— At risk are women who have undergone surgery, radiation therapy, chemotherapy, inflammatory processes affecting the reproductive organs, and especially if there is endometriosis. They should be very careful.

As for the rest, let’s say, according to the protocol, after 35 years a woman must have an ultrasound scan every year. Previously - only for certain indications. But no one is stopping you from getting examined earlier, just to make sure that everything is fine. This can be done at least as an exception abnormal ovarian wasting syndrome- cessation of egg production, ahead of the aging process, which develops against the background of a hereditary predisposition. In such cases, the reserve can be extremely critical even by 30-35 years.

If your mother or older sisters had a very early menopause, then there is a high probability that you will follow in the same footsteps. Another important signal is frequent disruptions in the menstrual cycle. It cannot be ignored.

Unfortunately, today the environment and, in general, everything that surrounds us has a strong detrimental influence. Take, for example, ordinary plastic bottles that contain bisphenol. When exposed to temperatures above 35 degrees, it becomes estrogen-like. If such a substance enters a woman’s body, it has an extremely negative effect on the follicles. That is, the bottle has been lying in the sun - and here is another negative factor in the piggy bank. In some countries, such containers are already prohibited.

— The main question: what to do with all this?

- It is necessary to at least pay attention to the problem in a timely manner. Don't be too frightened or panicked. Doctors can still stop the process for a short time. As a rule, with the help of hormonal drugs.

We can also talk about prevention. Avoid abortions and any inflammatory processes; if they occur, be sure to consult a doctor, do not delay. Be attentive to yourself and your health.