The size of the follicles by the days of the cycle. What should the size of the follicle be normal?

The female organism is periodically reconstructed (natural cyclic changes) due to the influence of hormones that control complex mechanisms relating to its reproductive system (the totality of the organs providing the process of fertilization). For the onset of pregnancy, the obligatory condition - the growth and normal development of ovarian follicles, which act as a kind of "container" for already fertilized eggs, must be observed.

Interpretation of the concept of "follicle"

It is a small-sized anatomical formation that has the appearance of a gland or pouch filled with intracavitary secretion. The ovarian follicles are in their cortical layer. They are the main reservoirs for a gradually maturing egg.

Initially, follicles in the quantitative measurement reach significant values in both ovaries (200 to 500 million), each of which, in turn, contains one sex cell. However, for the entire period of sexual maturity, women (30-35 years old) reach full maturation of only 400-500 specimens.

Internal processes of evolution of follicles

They flow in their pouches and are characterized by the multiplication of granular or granular cells that fill the entire cavity.

Then the granular cells produce a fluid that pushes and spreads them, directing towards the peripheral parts of the follicle (the process of filling the inner cavity with the follicular fluid).

As for the follicle itself, it significantly increases in size and volume (up to a diameter of 15-50 mm). And in content - it is already a liquid with salts, proteins and other substances.

Outside, it is covered with a connective-woven shell. And it is this condition of the follicle that is considered mature, and is called a graaff bubble (in honor of the Dutch anatomist and physiologist Renier de Graaf, who in 1672 discovered this structural component of the ovary). A mature "bubble" prevents the maturation of its colleagues.

What size should the follicle be?

With the onset of puberty (14-15 years), it completely completes its development. It is normal if, in the period of the follicular phase, when the menstrual cycle begins, several follicles mature in both ovaries, of which only one reaches a considerable size, so that it is recognized as dominant. The remaining specimens undergo atresia (reverse development). The product of their life is estrogen - a female sex hormone that affects the fertilization, the birth of a child, as well as the calcium content and metabolism.

Dominant follicle, the size of which on average increases by 2-3 mm every day, at the time of ovulation reaches its normal diameter (18-24 mm).

Generative function as a priority

On the inside, the mature follicle is lined with multilayer epithelium, in it (in the thickened area - egg-bearing tubercle) is a mature, fertile egg. As mentioned above, the normal size of the follicle is 18-24 mm. At the very beginning of the menstrual cycle, its protrusion (resembling a tubercle) is observed on the surface of the ovary.

Further, the walls of the follicle become substantially thinner, which leads to its rupture. So, in place of the graafovaya bubble appears yellow body - an important gland of internal secretion.

Due to a number of hormonal disorders, this rupture can be absent, in connection with which the egg does not leave the ovary and the process of ovulation does not occur. This very moment can become the main cause of infertility and dysfunctional bleeding of the uterus.

Folliculometry: definition, possibilities

This is an ultrasound diagnostic study, through which the process of development and growth of follicles is available. Most often, it is used by women who suffer from infertility or a menstrual cycle. This manipulation allows us to track the dynamics of ovulation by means of ultrasound.

At the beginning of the menstrual cycle, it becomes possible to observe the process of growth of the endometrium, and in the later period - the evolution of the follicle. So, you can determine the exact size of the follicles by the day of the cycle.

When is folliculometry required?

This diagnostic study allows:

• To determine the onset of ovulation to the accuracy of specific days;
• Determine the size of the follicle before ovulation;
• Analyze the operability of the follicular apparatus;
• Plan the sex of the child;
• To establish the integrity of the phases of the cycle of menstruation;
• Calculate the optimal day for the conception of the child;
• Follow the course of multiple pregnancies;
• Diagnose menstrual irregularity;
• Evaluate the individual hormonal background of the patient;
• Monitor the course of the course of the appropriate treatment.

The significance of the indices of the norm and the pathology of the development of the follicle

At the very beginning of its evolution, the indicator in the status of "norm" is the size of the follicle in diameter of 15 mm. Further, as already mentioned earlier, it increases in a day by 2-3 mm.

Many women are interested in the question: "What is the size of the follicle when ovulating?" Normally it is considered - about 18-24 mm. Then a yellow body appears. In this case, the level of progesterone is necessarily increased in the blood.

A single ultrasound is devoid of the ability to build a full-fledged picture of the development (maturation) of the follicle, since it is especially important to check every single stage.

The main pathologies that disturb the maturation of follicles are:

1. Atresia - an involution of the neovulating follicle. To be precise, after education, it develops to a certain point, and then freezes and regresses, thus ovulation does not occur.

2. Persistence - the preservation of the virus, when it is still functionally active, in the cells of tissue cultures or the organism beyond the time that is characteristic of acute infection. In this case, the follicle is formed and develops, and its rupture does not occur, as a result of which luteinizing hormone does not increase. This form of anatomical education is maintained until the very end of the cycle.

3. The follicular cyst is a kind of functional formation localized in the ovary tissue. In this situation, the unvoiced follicle is not torn, it continues to exist, and the liquid accumulates in it, and subsequently a cyst is formed that is larger than 25 mm.

4. Luteinization - the formation of a yellow body, which sometimes occurs without rupture of the follicle, which later also develops. This situation is possible if there was an earlier increase in the value of LH or damage to the structure of the ovary.

Size of follicles by day of cycle

From the very first days of the next cycle with the help of ultrasound, you can see that in the ovaries there are several antral examined anatomical formations, which will subsequently grow. Their increase is due to the influence of special hormones, the predominant among which are follicle-stimulating hormone (FGS) and estradiol. Provided that their level corresponds to the established norm of the content of these substances in the blood, the woman is most often present with stable ovulation, and the anovulatory cycles are observed no more than twice a year.

Antral follicles in ovaries, the size of which is insignificant, should be present, according to the indications of the norm, in both sex glands in an amount not exceeding nine pieces. As a rule, in diameter they are no more than 8-9 mm. Subsequently, it is the antral follicles, under the influence of the corresponding hormones, that will give rise to such an important anatomical formation as the dominant follicle, whose dimensions in diameter exceed them by a factor of 2.5.

On average, the menstrual cycle is 30 days. Somewhere by the tenth day out of the whole aggregate of antral follicles, the dominant one is delineated.

Often the question arises: "What size should the follicle be at this stage?" In the first session of folliculometry, it is practically the same size as the rest (12-13 mm). It is worth recalling that this diagnostic ultrasound allows you to determine the size of the follicles on the days of the cycle.

Also at the first admission the specialist will be able to say exactly how many dominant follicles have already formed. Most often it is the only one (in the right or left ovary). However, in the case when the patient undergoes special ovulation stimulation, such follicles can be several, resulting in a multiple pregnancy, of course, provided that two or more dominant anatomical formations mature.

The second session is held after three days. In his course the doctor:

• Confirms the presence of a dominant follicle;
• Determines the size of the follicle in cycles of menstruation;
• Fixes (if this occurs) the reverse development of the follicle.

A specialist carefully examines both ovaries of a woman. If you track the size of the follicles on the days of the cycle, then the second session in diameter, it is 17-18 mm. This is about 13 days.

In the third session (transvaginal ultrasound), you can see that the size of the follicle before ovulation (peak of its magnitude) took a value equal to 22-25 mm. This indicates a rapid (in the next few hours) its rupture, as a result of which the mature egg will pass into the abdominal cavity, and then penetrate into the fallopian tube. About a day, she is susceptible to fertilization, and subsequently perishes. It should be noted that the viability of the egg is several times less than that of spermatozoa.

There are also cases when the dominant follicle grows at a different rate, which may require more than three sessions of this ultrasound. If the patient repeatedly recorded his regression, then, as a rule, the doctor appoints her daily folliculometry (from 9-10 days of the cycle). This will reveal the beginning of the regression, and then establish the cause of this phenomenon.

So, it is worth recalling once again that it is possible to determine the size of the follicle by cycles during the diagnostic ultrasound investigation - folliculometry. It will allow not only to control the course of maturation of the dominant anatomical formation under consideration, but also to identify the causes of abnormalities that inhibit this reproductive process (if any).

Stimulation of ovulation

In another way, its induction. This is a complex of various kinds of medical manipulations, the purpose of which is the onset of pregnancy. It is in demand in the framework of modern gynecology with regard to female infertility, due to a variety of reasons.

To begin with, it is worthwhile to interpret the concept of infertility - a condition where a woman under the age of 35 can not become pregnant for 12 months, provided that she has an active sexual life, as well as couples (a woman over 35 and a man - 40), whose pregnancy does not occur whiter Half a year.

Indications and contraindications to stimulation

Induction is carried out in two cases:

• Anovulatory infertility;
• Infertility of unknown origin.

The main contraindications for this procedure are:

• Violation of patency of the fallopian tubes;
• Impossibility of conducting a full-fledged diagnosis by ultrasound;
• Male infertility;
• Depletion of the existing follicular reserve.

Stimulation of ovulation does not occur with long-term treatment of infertility (more than two years).

Schemes of procedure

They are expressed by two protocols:

• Increasing minimum doses;
• Lowering high doses.

In the first case, with this manipulation, the drug "Klomifen" (non-steroidal synthetic estrogen) is first administered, which blocks the estradiol receptors. Then the drug is canceled, and thereby trigger the mechanism of reverse interrelation: an increase in the synthesis of gonadotropic releasing hormones and an active release of luteinizing and follicle-stimulating hormones. In the end result, this should lead to the maturation of the follicles. So, we can say that the means "Clomiphene" - an indicator of ovulation.

During this manipulation of ovulation induction, only one follicle ripens, that is, the probability of both multiple pregnancy and accompanying complications (for example, the ovarian hyperstimulation syndrome) is virtually eliminated.

After the time when the size of the follicles reaches 18 mm in diameter (with an endometrium thickness of 8 mm) during stimulation according to the first scheme, triggers (preparations simulating LH surge) are introduced. Then, after the introduction of hCG, ovulation occurs approximately in two days.

The second scheme of manipulation is applicable mainly to women who have a low ovarian reserve and a low probability of effect from small doses of FSH.

Mandatory indications for this manipulation:

• Female age over 35 years;
• The FSH value is more than 12 U / L (on day 2-3 of the cycle);
• Volume of ovaries up to 8 cub. cm;
• Secondary amenorrhea and oligomenorrhea;
• The presence of operations on the ovaries, chemotherapy or radiotherapy.

The visible result should appear by the sixth day. A significant side effect affecting the ovaries, with this method of induction of ovulation - the risk of the syndrome of their hyperstimulation. In the case when the next ultrasound will be identified follicles in the ovaries, whose size in diameter exceeds 10 mm, the doctor regards this as a signal to conduct preventive procedures for this syndrome.

Control ultrasound

It is necessary to confirm ovulation through transvaginal ultrasound. This is just as important as monitoring itself. Earlier it was mentioned the size of the follicle before ovulation (18-24 mm in diameter), but even when the required size is reached, the capsule may not break, and the mature egg will not exit into the abdominal cavity. Follow-up ultrasound is performed 2-3 days after the estimated ovulation time.

At this session, the doctor will check the condition of the ovaries for signs of ovulation:

• A dominant follicle is absent;
• There is a yellow body;
• There is some fluid in the space behind the uterus.

It is important to note that if an expert conducts a control ultrasound in a later period, he will not find any liquid or yellow body.

Finally, it will be useful to once again answer the question: "What is the size of the follicle in ovulation?" This dominant anatomical formation at the time of ovulation matures to a size of approximately 18 - 24 mm in diameter. It is worth remembering that the size of the endometrium and follicles vary depending on the day of the menstrual cycle.