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- Folliculometry: description and objectives of the methodology, interpretation of results
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Pregnancy and the birth of a long-awaited child is a miracle, which, unfortunately, is inaccessible to many. Nowadays, most women responsibly and consciously approach the issues of maternity and carefully plan pregnancy.
Previously, for this purpose, basal temperature measurement and other ineffective procedures were performed, but modern medicine offers new ways to solve the problem, one of which may be folliculometry.
What is folliculometry
Folliculometry - This is a method of ultrasound diagnostics that allows you to monitor changes that occur in the female genital organs during one or more menstrual cycles. Today it is the most accurate way to determine the period of ovulation, which allows you to increase the chances of successful fertilization of the egg and the onset of pregnancy. Many couples were able to achieve the desired result thanks to this method. In addition, folliculometry is widely used in gynecology to identify disorders of the reproductive system, to assess the endometrium (the inner lining of the uterus) and the ovaries, and to determine various pathological conditions.
Folliculometry: goals and objectives
The female reproductive system is quite complex, it is based on the follicular apparatus, which is immature follicles. Even in the prenatal period, several million follicles are laid in the girl's body, but about 500,000 remain in puberty. During each menstrual cycle, several follicles are prepared for ovulation, but under the influence of hormonal background, one becomes dominant (several dominant follicles are not excluded) .
It is there that the egg cell matures, which goes into the abdominal cavity from the ovary, is caught by the villi of the fallopian tubes and moves into the uterine cavity, where it meets with the spermatozoa. The process of release of a ripe egg from the follicle and ovary is called ovulation. In the area of the bursting dominant follicle, a corpus luteum (luteal) is formed - a temporary endocrine gland, functioning until the onset of menstruation or up to 12-16 weeks of gestation (before the appearance of the placenta).
Some cycles can proceed without maturation of the egg, they are called "anovulatory", with age, their frequency increases. They may be associated with medication, hormonal disorders, genital diseases, congenital abnormalities, and exposure to various adverse factors. During such a cycle, pregnancy is impossible, therefore it is necessary to identify the cause of the lack of ovulation and eliminate it to restore the ability to conceive a child.
To do this, assign different diagnostic procedures, one of which is folliculometry. It allows to evaluate the functionality of the ovaries and the maturation of the follicles, confirm the presence of the dominant follicle, reveal ovulation, corpus luteum, and determine the thickness of the endometrium, the usefulness of the menstrual cycle, the causes of its irregularity, certain diseases of the reproductive organs (cysts, myoma, etc.). Folliculometry is required to control the work of the ovaries after they are stimulated to perform auxiliary fertilization methods (IVF, ICSI and others).
The main disadvantage of the procedure is the need to continuously monitor changes in the reproductive system. It is worth noting that the procedure can not detect inflammatory changes in the genitals and abdominal cavity, adhesions, with its help it is impossible to assess the patency of the fallopian tubes. Therefore, in addition to folliculometry, doctors prescribe additional procedures.
Indications for folliculometry
Folliculometry is performed in the following situations:
- Infertility for more than one year, provided an active sex life without the use of contraception,
- Hormonal disorders (anovulation, tired ovary syndrome, polycystic ovary and others),
- Stimulation of ovulation with violations,
- Preparing for in vitro fertilization or other assisted reproductive methods, monitoring their results.
How to carry out the folliculometry procedure
Folliculometry - This is an ultrasonic monitoring of cyclic changes. It is carried out by two types of sensors: transabdominal and vaginal. If you prescribe a transabdominal examination, then an hour before the procedure is to fill the bladder. During the procedure, the woman is laid on the couch on her back, you should open the area from the sternum to the pubis. The sensor is smeared with a special solution and carried them over the skin.
If a vaginal sensor is used, there is no need to fill the bladder. A condom is put on the sensor, smeared with a special substance and inserted into the vagina. Any method of procedure is absolutely safe and does not cause pain.
Folliculometry and its timing
The time of the folliculometry is appointed by the gynecologist on the basis of individual cyclic processes. Most often 4-6 examinations are required. With a regular 28-day menstrual cycle, the first study is carried out on the 8-10 day after the onset of menstruation, if it is more than 28 days, then on the 10th day or later, with an irregular cycle, the first study is carried out earlier. Follow-up procedures are prescribed by the diagnostician based on the results. As a rule, they are performed at 1-2 day intervals.
First ultrasound allows you to determine the number of ripening follicles in the ovaries, which reach sizes of 6-9 mm in diameter. The thickness of the endometrium is 3 mm, but of a homogeneous structure without various inclusions.
Second ultrasound do in 1-2 days (most often on the 9-11 day of the menstrual cycle). At this stage, a dominant follicle is detected, which differs from the rest in large sizes (up to 10-15 mm in diameter). Every day it increases by 2-4 mm, reaching 20-22 mm. The thickness of the endometrium at this period is equal to 8-12 mm, it has a linear structure, by the end of maturation the dominant follicle acquires a three-layer structure. If no dominant follicle is detected on the 2nd ultrasound, folliculometry is transferred to the next cycle.
Third ultrasound perform on 12-13 day. During it, a follicle with signs of early ovulation is detected, its diameter is about 22-32 mm. The endometrium of a three-layer structure up to 12 mm thick, if it is smaller, the probability of pregnancy is reduced.
Fourth ultrasound they are performed on day 13-14 to detect ovulation: the dominant follicle is not detected, they show formation with uneven contours, there is free fluid behind the uterus. If these signs are not present, then ultrasound is prescribed for each day until the exact absence of ovulation is detected.
Fifth ultrasound perform on the 15-17 day under the condition of full ovulation. During this period, the star-shaped yellow body is detected, the endometrium is three-layered, up to 13 mm thick.
Sixth ultrasound spend at 21-23 day. At this time, the fertilized egg is introduced into the uterine cavity, so it is important to evaluate the functionality of the endometrium and the corpus luteum. The thickness of the endometrium does not change, but it becomes more uniform, the yellow body increases in size.
Evaluation of the results of folliculometry
Folliculometry allows you to trace the development of follicles, corpus luteum and endometrial changes, as well as confirm ovulation.
Signs of ovulation:
- Identifying the dominant follicle,
- His disappearance and the formation of the yellow body,
- The appearance of free fluid in the abdominal cavity behind the uterus.
But, unfortunately, not all processes can proceed normally, in such cases the procedure reveals:
- Follicle Regression: During this state, the dominant follicle undergoes reverse development. Ultrasonic signs of pathology: reduction in the size of the dominant follicle, the absence of the corpus luteum and free fluid,
- Follicle persistence: This condition means the full formation of the dominant follicle. But ovulation does not occur. Ultrasonic signs: determination of the dominant follicle throughout the whole cycle, lack of fluid and yellow body,
- Presence of follicular cyst: If ovulation does not occur, the follicle can be transformed into a follicular cyst. Ultrasonic signs: an increase in the size of the dominant follicle, no fluid and corpus luteum, preservation of the cyst over several menstrual cycles,
- Formation of the early luteal phase: Ovulation does not occur, but the corpus luteum is formed and progesterone synthesis begins, which causes wrinkling of the follicle. Ultrasonic signs: reduction in the size of the dominant follicle, no free fluid,
- Other violations. Most often, the above states indicate hormonal disorders, although based on one folliculometry, it is impossible to make an accurate diagnosis, because normally a healthy woman has several anovulatory cycles during the year, so the procedure is repeated.
What is this procedure?
What is folliculometry? It is a diagnostic method that implies an ultrasound study to track the dynamics of folliculogenesis - follicle growth. The procedure is carried out within one menstrual cycle, which guarantees a detailed analysis of the features of the functioning of the reproductive system. Folliculometry is usually assigned to women who are at the planning stage of pregnancy.
In what cases is folliculometry shown?
The diagnostic procedure allows you to comprehensively evaluate the work of the internal genital organs, in particular the ovaries, in which follicles mature monthly. Folliculometry will help detect the dominant follicle and assess its viability, find out the likelihood of ovulation in the current menstrual cycle, determine the day of mature egg production, identify violations and abnormalities at different stages of folliculogenesis, notice the neoplasms localized in the ovaries, diagnose diseases of the appendages and find out at what stage the neoplasms are located in the ovaries, diagnose diseases of the appendages and find out at what stage the neoplasms are located in the ovaries, find the diseases of the appendages and abnormalities. failures occur.
A video in which an experienced specialist talks about such an important procedure as folliculometry.
The method has a number of indications:
- anovulatory cycles in which ovulation is absent
- dysmenorrhea (painful periods),
- amenorrhea (absence of menstruation in women of reproductive age),
- hypomenorrhea (scant menstrual flow),
- hypermenorrhea (increased abundance of secretions on critical days),
- failures of a menstrual cycle (increase or reduction of intervals between monthly),
- diseases and dysfunctions of the ovaries (polycystic, adnexitis, multifollicular ovaries, cysts),
- miscarriages, unsuccessful pregnancies in history,
The correct decoding of the folliculometry performed by an experienced specialist will make it possible to make an accurate diagnosis and start a competent effective treatment, identify the causes of infertility, confirm the presence of ovulation, calculate the most favorable days for conception, analyze the probability of multiple pregnancy, and draw conclusions about the need to stimulate ovulation (if it is necessary and appointed by the gynecologist).
What days is the research done?
When should you do folliculometry? Dates of conducting will be determined by the attending gynecologist taking into account the duration of the menstrual cycle, the patient’s problems and peculiarities of the functioning of her reproductive system. So, if it is necessary to determine the days favorable for conception, then it is desirable to begin studies 5-6 days before ovulation in order to track the growth of follicles and to detect the dominant among them. With a cycle duration of 30 days, the first procedure is scheduled for the 10th or 11th day (starting from the onset of menstruation).
Since folliculometry involves diagnosis in dynamics, after the first procedure, the second is prescribed, which is held on the second or third day. A total of at least four ultrasound examinations are recommended, the frequency of which is determined by the gynecologist, depending on the state of the follicles and the speed of their growth. As a rule, the interval between procedures is 1 day, but often folliculometry is performed daily.
Features of preparation for the procedure
To the results of the diagnostic procedure were as reliable as possible, you should prepare for it. This training involves following several rules:
- A few days before the first procedure, you should begin to follow a diet that needs to be followed throughout the study period. Products that increase gas formation are excluded from the diet, as gases in the intestine can prevent good view of the ovaries and follicles. Refuse black bread, cabbage, whole milk, legumes, yeast flour products, grapes, carbonated and alcoholic beverages.
- If transabdominal ultrasound is prescribed, it is necessary to fill the bladder an hour and a half before the procedure, after drinking 1-1.5 liters of non-carbonated water. In this case, folliculometry is desirable to begin after the first urge to urinate, signaling the filling of the bladder. No need to drink before transvaginal examination.
- To empty the bowel and increase the reliability of the results on the day preceding the date of the study, you can take a laxative recommended by your doctor.
- Before the visit to the doctor, perform the necessary hygiene procedures - thoroughly wash the external genitalia.
Often, ultrasound is prescribed in the morning, and before leaving the house you can afford a light snack.
How is folliculometry done?
What is the procedure of folliculometry, is now known. And this research is carried out by two methods:
- Transabdominal. The patient lies down on the couch and exposes the abdominal cavity (from the pubis to the chest). The udoist applies a special conductive gel to the device and begins to move the ultrasonic sensor over the surface of the body.
- Vaginally. The patient should take off the clothes below the waist and underwear (panties), lie down on the couch, bend the knees and slightly set them apart to allow the specialist access to the genitals. An udoist puts a special medical disposable condom on the sensor, inserts the device into the vagina and begins the examination.
The investigated inner space in both cases is transmitted to the ultrasound equipment monitor. The uzist or his assistant records the results, and after the examination you get them in paper form. The conclusion is transmitted to the gynecologist, who diagnoses and draws conclusions regarding further actions.
Decoding the results of folliculometry
Competently decipher the results of the study can only an experienced gynecologist, and the one in which you are observed. He will be able to track the dynamics and, based on folliculometry and other diagnostic procedures, form an overall picture of the state of your reproductive system.
Folliculometry. The best video from a specialist.
An experienced specialist in the size and structure of follicles will be able to track ovulation, as well as identify pathologies of follicular growths: regression (size reduction after their increase), luteinization (premature formation of the corpus luteum), persistence (full growth without subsequent rupture of the bubble).
Reviews of the procedure
Consider some women’s reviews of folliculometry:
- “I tried many methods to determine ovulation, and folliculometry was the most accurate among them. The udoist got good, spoke not only the size of the dominant follicle, but also the thickness of the endometrium of the uterus, which is important when fixing in the wall of the ovum. The procedures helped me to “catch” ovulation, which I missed several cycles in a row. ”
- “I started planning a pregnancy, and it turned out that everything is not as simple as we would like. For me it was difficult to identify ovulation, and in fact only in her conception can occur. My gynecologist advised folliculometry, and I did not regret it at all. The procedure is completely painless, complex preparation is not required. But the main thing is the result. I finally determined the most successful days. ”
- “Just a great method to help everyone planning! Personally, the procedure helped me get pregnant, because the menstrual cycle was unstable, and it was very difficult to track the days of “X”. And here everything is visible, it remains only to try when necessary. Now I am a happy mom, and largely thanks to folliculometry. ”
Knowing what constitutes folliculometry, you can use this study when planning pregnancy to determine ovulation. But the method has other indications, among which are pathologies and diseases of the reproductive system.
Menstrual cycle and changes in the follicle
At the beginning of the menstrual cycle (follicular phase), under the action of follicle-stimulating hormone (FSH), several follicles begin to mature in the ovary at the same time, but only one of them develops faster, in rare cases two or more can develop, which makes it possible to conceive twins.
During the ovulation phase, the luteinizing hormone (LH) stimulates the dominant (one that has developed faster) follicle to grow further and burst, releasing an egg cell. After ovulation, the woman's body enters the luteal phase, where the corpus luteum - the formation in the follicle - grows on the ovary and stimulates the production of progesterone and suppresses the production of FSH and LH.
The final phase is menstruation, during which the corpus luteum disappears.
In medicine, the process of maturation and development of follicles is called folliculogenesis, which includes 3 stages:
- The transformation phase of the predominant follicles into pre-adral, an increase of 10-15 follicles occurs and the formation of a connective membrane in them.
- Phase of formation of the antral follicle, a cavity is formed inside, the further development of the dominant follicle continues.
- The phase of occurrence of the Grafowa bubble, the volume of the follicular fluid increases and a gap occurs with the release of the egg.
On different days of the female cycle, the follicle has different sizes, compliance with the size of some norms indicates the health of the reproductive system and the ability of a woman to become pregnant. From the beginning of the menstrual cycle until the egg leaves the fallopian tube (ovulation), the follicle constantly increases in size, its normal values are presented in the table.
- From about the fifth day, follicles can be seen with the help of ultrasound, their location is on the periphery of the ovary, dimensions - up to 6 mm.
- After the eighth day, the dominant one is detected, since its size is much longer than the others, its capillary grid is visible.
- On the tenth day, it is clear that the remaining follicles regress, that is, they die, decreasing in size.
- After the fourteenth day, the follicle reaches its maximum size and ovulation occurs: the follicle after rupture either does not appear at all, or residual fluid is detected.
When ovulation occurs, a yellow body forms in its place. It is characterized by: uneven edges and an asymmetrical form, it increases sometime until the twenty-fourth day, then gradually decreases.
Causes of abnormal development are diverse:
- malfunction of the hypothalamus and pituitary,
- cysts in the ovaries,
- inflammations and infections of the female genital organs,
- underdevelopment of the ovaries,
- body mass index below 17.5.
It is impossible to calculate the size of the follicle by yourself; for this purpose, folliculometry is performed - an ultrasound study that allows you to track the follicle development. This procedure is recommended for women with infertility or menstrual disorders. The study provides an opportunity:
- determine the exact date of onset of ovulation,
- identify abnormalities in the ovaries,
- monitor the effectiveness of the treatment.
With folliculomethy, one of the four main pathologies can be identified:
- Follicular cyst is a formation in the ovary that occurs when the follicle does not break and the egg does not go into the fallopian tube. He will continue to be in the ovary and accumulate cystic fluid.
- Atresia is a pathology in which the follicle develops to a certain point, and then freezes and dies.
- Persistence - the preservation of the active virus in the tissue of the ovary, in this situation, the follicle develops, but does not rupture (cystic fluid is not formed).
- Luteinization is the formation of the corpus luteum together with the development of the follicle.
The procedure of folliculometry is carried out, as a rule, in three stages:
- At the first ultrasound, antaral follicles are detected (one of which later forms the dominant one).
- The second ultrasound is performed after 3 days: it reveals the dominant follicle, determines its size and, if this is the case, its reverse development.
- On the third ultrasound, its maximum size is determined, which indicates that it will soon break.
It is worth noting that there are situations when the follicle-stimulating phase is lengthened and more ultrasound may be required.
Folliculometry allows the patient not only to identify abnormalities, but also to determine the causes.
Stimulation of ovulation
Stimulation of ovulation medication
Under the stimulation of ovulation in medicine understand the totality of procedures carried out in a medical institution, their goal - the onset of pregnancy with infertility. Infertility refers to a situation where a woman of reproductive age does not become pregnant for a year with regular unprotected sex.
Ovulation stimulation in case of sterility is carried out by doctors in two cases: when it is caused by disorders of the folliculogeneses process and for unclear reasons.
The procedure can be carried out in two ways:
- The introduction of clomiphene, which is a synthetic estrogen, after it is canceled, there is a release of luteinizing and follicle-stimulating hormones and the development of the follicle begins. The procedure is carried out, as a rule, for women under 35 years old.
- After 35 years, the second scheme is used: more intensive stimulation, which can cause multiple pregnancies.
After stimulation, transvaginal ultrasound should be performed, 2-3 days after ovulation. If the procedure was successful, then:
- there will be no dominant follicle,
- a corpus luteum and fluid behind the uterus will be detected.
But if the ultrasound is carried out later than the required period, then the corpus luteum will not be detected.
Follicle maturation: on days of the cycle, causes of unmatched
Follicles are special formations of a round shape, inside which eggs mature. Their number is laid in the girl during intrauterine development.
If initially there are about half a million, then an adult woman has only 500 on average. Follicle maturation - a prerequisite for the formation of a full-fledged egg.
Without this process, a woman cannot become pregnant.
Features of the ripening process
It is quite complex and multi-step. The process of maturation in the ovary in the first phase of the menstrual cycle begins. This is facilitated by the hormones lutein and progesterone. Their insufficient amount can disrupt the balance of the functionality of the reproductive system.
Every month several (up to 10) follicles develop in the female body. However, only one of them reaches the desired size. It is considered dominant. The remaining bubbles begin to regress. If a failure occurs in the hormonal system, then these small formations do not die off, and prevent the dominant follicle from growing to the required size.
In the presence of a normal and regular menstrual cycle, the period of maturation can be determined independently: according to your own feelings, by measuring the basal temperature. In patients who underwent ovarian stimulation, this process is controlled by an ultrasound procedure performed on different days.
The fact that the follicle is ripe and the woman will soon begin ovulation, they say the following symptoms:
- pulling pain, localized in the lower abdomen,
- an increase in the amount of white mucous discharge from the vagina (some patients confuse them with thrush),
- decrease in rectal temperature, which occurs 12-24 hours before the day of ovulation, and then its increase by 0.2-0.5 degrees,
- an increase in the level of progesterone in the blood (it can be determined using special tests),
- change of mood: the woman becomes more sensitive and irritable.
During one menstrual cycle in a woman’s body, a single follicle usually matures. However, in some cases there may be several. There is no pathology in this, it’s just that the patient increases the chance of fertilization of the egg or the onset of a multiple pregnancy.
Why ripening does not occur
The diagnosis of "infertility" is no longer a rarity. And the main reason here is often that the follicles simply do not mature. In this case, you need to do a thorough examination, determine the cause of the pathology and begin treatment. To provoke a violation of the ripening process can:
- Ovarian dysfunction. It is caused by various inflammatory pathologies, trauma, surgery.
- Various violations of the functionality of the endocrine system, in which there is a low production of estrogen, as well as progesterone. The second hormone helps the dominant follicle to grow and develop, and the first contributes to the inhibition of small follicular vesicles.
- Brain dysfunction. It can be triggered by trauma or an inflammatory lesion of the membranes of the organ.
- Increased intracranial pressure.
- A benign or malignant tumor in the hypothalamus and pituitary gland.
- Inflammatory or infectious damage to the internal organs located in the abdominal cavity.
- Frequent stress, depression.
- Early menopause.
- Keeping a strict diet or overweight.
In the case of a violation of the functionality of the reproductive system, a ripe follicle does not appear at all, therefore it is necessary to urgently consult a doctor and undergo treatment.
The above factors can disrupt the process of formation of the presented formation or cause its regression. The follicle can not grow to the desired size or not broken. Ovulation, and, therefore, pregnancy, does not occur. But even if the egg is ready for fertilization, and the endic (endometrium) does not have the desired thickness, it simply will not be fixed in the uterus.
If the follicle matures too soon or very late, this can also be considered a deviation. You also need to pay special attention when a woman on the ultrasound in the ovaries are found numerous bubbles. Here the patient is diagnosed with "multifollicular ovaries".
On the monitor, a specialist can examine a large number of bubbles. They are located on the periphery of the ovary. These bubbles interfere with the development of dominant education, as it cannot normally mature.
If the endik is thin, then the pregnancy may not occur, despite successful fertilization of the egg.
Follicles in the ovary. Maturation dominant
The follicle matures gradually. On ultrasound, you can see it like this:
- on the 7th day, in the area of the ovaries, small bubbles of 5-6 mm are seen, in which liquid is present,
- from day 8 begins the intensive growth of education
- on the 11th day, the size of the dominant follicle is 1-1.2 cm in diameter, while the others begin to regress and decrease,
- From the 11th to the 14th day of the menstrual cycle, the formation value is already approaching 1.8 cm,
- on the 15th day, the follicle becomes very large (2 cm) and bursts - the egg ready for fertilization comes out of it, that is, ovulation occurs,
If the follicular formation has a size of more than 2.5 cm, then we can already speak about the presence of a cyst. In this case, it is necessary to make treatment.
Many women worry if the menstrual cycle is disturbed after hysteroscopy. This procedure is performed to study the inner surface of the uterus.
Most often, it is necessary for the diagnosis of "endometriosis." It should be done on the 6-10 day of the menstrual cycle, while the follicle is maturing for 7 days.
That is, hysteroscopy does not have a significant negative impact on the reproductive function of women.
Stages of follicle maturation
The presented process begins in adolescence. As soon as the girl's body matures, and her reproductive system is ready for the production of high-grade eggs, she has the opportunity to become pregnant.
In its development, the follicle goes through several stages:
- Primordial. At this stage, the female germ cell is immature and becomes covered by follicular cells. Before puberty, there are a lot of noocytes in the girl's body. Further, they become much smaller.
- Primary. Here, the presented cells begin to quickly divide and form the follicular epithelium. Further, a membrane of formation from the connective tissue appears. The egg cell is located closer to it. At this stage, the granular cells of the follicle begin to produce a protein transparent liquid. It is she who nourishes the growing egg.
- Secondary follicle. The epithelium of education is differentiated, it becomes thicker. The follicular cavity begins to form. The amount of nutrient increases as the need for it increases. The shell is formed separately around the egg. She later goes over the nutritional functions.
- Tertiary follicle. At this stage, the presented education is fully mature and ready for ovulation. Its size is about 1.5 cm. Having reached the maximum value (2.1 cm), it breaks, releasing a full-fledged egg cell.
After completion of ovulation, the follicle is transformed into a yellow body. It is of great importance for the normal development of pregnancy in women in the early stages. If the process of maturation is disturbed, the woman cannot become pregnant.
Sometimes it may be necessary to stimulate the maturation of follicles. Generally, maturation is a complex biological process that can be disturbed by various internal or external factors. Therefore, a woman must take care of her health. If you still had to do the stimulation, then you must strictly follow all the recommendations of the doctors.
When to do an ultrasound of folliculometry, how is it done and how to prepare for the study to determine ovulation?
Folliculometry is the monitoring of ovarian activity over time with ultrasound. Ultrasound diagnostics of the ovaries is carried out every few days in the continuation of the female cycle, and, if necessary, several cycles. The task of research is the selection of the right moment for conception.
Ultrasound monitoring of ovarian activity
Folliculometry helps to observe folliculogenesis, allows you to know the date of ovulation, whether you need an artificial stimulation of this process. It is noted that for many married couples, this method of research helped to conceive, finally, a child, although this could have been preceded by years of unsuccessful attempts.
The reasons for which women are recommended folliculometry:
- it is impossible to get pregnant for more than 12 months, while there are regular sex without using contraceptives,
- problems were found in the hormonal sphere (insufficiency of the progesterone phase, pathological changes in the structure and function of the ovaries, anovulation, etc.),
- if a woman needs to stimulate ovulation for any reason,
- if artificial insemination is planned,
- when planning in vitro fertilization.
What helps folliculometry learn?
In addition, folliculometry helps to observe the process of folliculogenesis: to watch how the follicles mature and among them the dominant appears and develops. You can track whether a corpus luteum has formed.
Also during the survey, the growth of the endometrium is monitored, that is, they give an idea of its condition and compliance with certain periods of the menstrual cycle.
Folliculometry helps to observe the process of folliculogenesis
The technique also helps to monitor the functioning of the ovaries, when ovulation is stimulated, in vitro fertilization is performed, and so on.
What is the complexity of the method?
The most significant drawback is the need to conduct research every three to four days, or even more often. So often undergo ultrasound procedures for many patients is difficult. This requires both time and financial costs.
But all these difficulties are surmountable and then seem insignificant if the goal is nevertheless achieved, and the woman has a long-awaited baby.
Specific preparations monitoring of the reproductive system does not imply. It is enough to comply with the general requirements for preparing pelvic ultrasound.
Before folliculometry is performed, two to three days before the first ultrasound examination, products that cause increased gas formation are usually excluded from the diet. These include peas, beans, cabbage, carbonated drinks, etc.
If the intestinal loops are swollen, they will interfere with the normal examination of the organ that is being examined with the help of ultrasound.
Specific folliculometry preparation does not require
It should also be noted that during the ultrasound examination, the bladder should be empty (if a vaginal sensor is used).
How is the survey?
The ultrasound machine helps the doctor to monitor the functioning of the reproductive organs during one of the women's cycles.
Each ultrasound has its own tasks and is carried out on certain days.
First procedure passes, when just ended menstruation. During this period, 2-3 follicles are found in one of the ovaries. Their diameter is from 5-6 to 8-9 millimeters. Толщина эндометрия — 2-3 миллиметра, по структуре он однороден, не имеет включений.
Second time на УЗИ нужно прийти в период с 10-го по 11-й день цикла. В этот раз обычно происходит определение доминантного фолликула. He is ahead in the development of all others, reaching 10 millimeters in diameter. Further, it will increase by 2-4 millimeters daily.
At this time, the proliferation phase occurs in the endometrium - active reproduction of cells of the basal layer. By the end of this phase, the endometrium thickens to 4-5 millimeters, and the size of the dominant follicle already reaches 15 or more millimeters.
If a dominant follicle could not be detected at this examination stage, then ultrasound examinations can be completed in this menstrual cycle. Perhaps the patient requires stimulation of ovulation.
The ultrasound machine helps the doctor to monitor
Third survey a woman should go through 12-13 day of the cycle. At this time, the dominant follicle shows signs of approaching ovulation. Its diameter is already 22-23 millimeters.
The endometrium should already have a thickness of 8-12 millimeters and a clearly traceable structure of three layers. If this is not observed, then the uterus will not be ready to accept the fertilized egg, and pregnancy is unlikely to come.
If all the signs of the onset of ovulation are present, then monitoring continues in a day.
Fourth ultrasound must detect ovulation. If it occurs, the dominant follicle disappears, a body with uneven contours appears in its place, a liberated liquid is observed. If it doesn’t happen, the ultrasound scan is repeated daily until it happens, or until the bleeding starts.
Fifth ultrasound can be done in that case, if the ovulation rates could be found on the 15-17 day of the cycle. In place of the former dominant follicle, a yellow body is formed, having a star-shaped form. Endometrium ceases to be three-layered, but its thickness at this point is not less than 13 millimeters.
On the sixth survey need to come on the 21-23 day of the menstrual cycle. It is at this time that the fertilized egg is introduced into the uterus. During this period, it is necessary to monitor the state of the endometrium (its thickness does not change, and the structure becomes homogeneous) and the yellow body (it can grow).
Evaluation of the results
According to the monitoring data, it is estimated whether the ovaries function well. Unfortunately, the answer to this question sometimes turns out to be negative. In some cases, treatment is required. More details on several options.
- Normal situation. In this case, no stimulation is required, folliculogenesis occurs without failures. On ultrasound, it looks like this: the dominant follicle appears and grows, and then it disappears, and a yellow body appears instead. At this time, free fluid is found in the abdominal cavity behind the uterus.
- Atresia of the dominant follicle. First, it develops as expected, and then suddenly begins to decrease. With this disorder of folliculogenesis, the corpus luteum is not formed.
- Persistence The doctor observes the growth of the follicle, which develops to the desired parameters, but does not break, but remains until the next cycle. This problem usually resolves on its own after a couple of months. The corpus luteum and fluid behind the uterus are not observed.
- LNP syndrome (luteinization of an unovulted follicle) is another problem with folliculogenesis. In this syndrome, it matures to the desired size, but does not burst, immediately turning into a yellow body. The release of the egg does not occur. The ultrasound shows how the dominant follicle loses volume, there is no free fluid behind the uterus.
Medical appointment on the basis of the survey
If the function of the corpus luteum is impaired, the attending physician may advise the administration of progesterone preparations, with anovulatory menstrual cycles - stimulation of ovulation is prescribed. If the monitoring revealed endocrine sterility, that is, stimulation of the ovaries even for several periods did not bring the desired effect, then the doctor will advise you to do in vitro fertilization.
You may also be interested in: Ultrasound of the pelvic organs with CSD
What is the normal follicle size for ovulation?
The size of the follicle during ovulation is crucial for the safe conception. If at the time of ovulation, he did not receive sufficient development, then the pregnancy in this cycle can not count.
The processes of formation and maturation of follicles occur in the follicular phase, which occurs in the first half of the menstrual cycle. At the end of this period, the egg must be ready for conception.
For this to happen, the size of the follicle during ovulation must be sufficient.
Follicle formation occurs in the process of overgrowing of the egg with several layers of connective tissues and epithelium. At the beginning of the menstrual cycle in the ovaries begin to develop several follicles of small size, not exceeding a few millimeters.
By the time of ovulation, only one of the most developed is excreted from the ovary - the dominant follicle. The remaining remain in the ovaries and undergo the processes of reverse development, that is, atresia.
Sometimes several follicles develop, in which case it is possible that twins are born.
Follicle size change by cycles
To determine the follicle size change by cycles, as well as a sufficient follicle size during ovulation with accuracy can be made using diagnostic ultrasound.
This allows not only to trace changes in the size of the follicle in cycles, but also to detect the onset of pathological changes in its development.
When the menstrual cycle is 30 days, if we take the first day of the monthly period as the beginning of the cycle and the last day before the monthly period, then the follicle size in cycles, approaching the norm for conception, will change in millimeters and proceed as follows:
- Of the total number of follicles on day 10, one dominates, the size of which is still small and no different from the rest, not exceeding 13 millimeters. Further changes can be traced using folliculometry, which allows using ultrasonic methods to determine the size of the follicle by development cycles. The growth rate is about 3 millimeters per day. The dominant follicle is formed in one of the ovaries. The rest decreases with time and disappears completely. In a situation where a woman has a problem with conception and she is forced to resort to methods of stimulating ovulation, it is possible that several follicles form simultaneously.
- The second examination is carried out in three days, on the 13th day of the cycle. The size of the follicle in the ovary during this period increases to 17-18 millimeters, the dominant character significantly distinguishes it from the rest, approaching in size to the norm for conception during ovulation.
- In the third survey, it can be observed that at this stage, which falls on the period just before ovulation, the size increased to 25 millimeters, that is, it reached a value indicating that ovulation will occur within the next few hours. At the same time in the follicle there will be a rupture as a result of which the matured egg cell passes through the abdominal cavity into the location of the fallopian tube. About a day, but not more than 36 hours, after that she will be able to undergo ovulation, and if this does not happen, then she dies.
According to a similar scenario, the development of an egg cell in the dominant follicle occurs, which develops and, after rupture, enables the formation of a new organism. But sometimes in this debugged process over the centuries, violations occur when it does not mature enough or is not torn.
What affects the size
In order for the ovulation process to take place, the egg must be sufficiently developed and viable. This can be achieved only in the case when the follicle in the ovary is mature and becomes the right size. When development occurs according to the norm, the egg in it also develops in the right direction.
But since the female reproductive function is affected by various adverse effects, any psycho-emotional stress and the development of stressful situations can have a negative impact on sexual function.
Therefore, if the couple is ready for the upcoming pregnancy, it is necessary to try to protect the future mother from unpleasant events and please her more.
Contribute and cause adverse effects in the work of the genitals can and use over a long period of time contraceptive drugs.
In this case, especially with an illiterate approach to this issue and an incorrectly chosen contraceptive, the processes leading to egg maturation may be disrupted.
The signal for this is a condition in which the woman feels pain in the lower abdomen, the onset of nausea, dizziness, and the presence of previously uncharacteristic discharge. If such cases are detected, urgent consultation is required of a specialist who will appoint the necessary examinations and methods of hormonal adjustments.
Disorders in the thyroid gland are also one of the reasons leading to abnormalities in the development of the follicle. An insufficient amount or an excess of thyroid hormone produced by the thyroid gland has a negative effect on female reproductive abilities.
Violates the processes of development and maturation of follicles in the ovaries, as well as further conception, an excessive level of the hormone prolactin. Most of it should be developed during breastfeeding or during pregnancy. But in some situations, its quantity rises regardless of these circumstances, and the body mistakenly takes this as a signal of pregnancy.
New fertilization at this stage, as it were, is not required, and the work of the ovaries for this reason also stops.
Additional reasons for deviations
Often in women there are violations in ovulation, the causes of which are not very clear. In such cases, it is necessary to promptly identify the reasons for which there is a discrepancy with the accepted norms.
One of the important factors causing such changes in the state of reproductive functions is considered to be dysfunction of some parts of the brain and inflammatory processes occurring in the pelvic area, particularly in the ovaries.
The consequences of increased intracranial pressure, tumor processes in such parts of the brain as the pituitary and hypothalamus, can negatively affect the follicle and cause its insufficient size. Such deviations lead to the following conditions:
- a follicle will not develop in the ovary,
- in the development of possible failures, the stage will stop and the regression will begin,
- size during ovulation will not meet the required,
- there will be no rupture and the release of the egg will not take place.
To possible developmental disorders can also be attributed to the premature maturation of the follicle or, conversely, a delay in size.
The situation is most complicated by the possibility of the formation of persistence, in which the follicle is not ovulated.
A complication resulting from disturbances in the processes of maturation may also be the formation of follicular cysts, which are able to influence reproductive functions in their own way.
Required rate for conception
To track changes in the ovaries throughout the cycle, a survey is used, which allows to evaluate the dynamics of development.
For the implementation of normal ovulation requires the presence of one, rarely two existing follicles, the norm for conception, which will correspond to the size of at least 18 millimeters and not exceed 24 millimeters.
In the case when the dimensions do not correspond to these indicators, there will be more or less of them, then most likely, conception is impossible and there is a need for a survey.
The value of the value during ovulation
It is impossible even for a gynecologist to determine the size of the dominant follicle on their own; only a specialist can make these measurements with the help of special equipment. Only in this way can we determine in which of the ovaries these processes take place and at what stage of development are they located.
In case of some deviations. The survey is carried out on the 8–10 day of the cycle with intervals of 2 days until the time until ovulation is determined. In the case when the pathological processes are further developed and the release of the egg did not take place, the observation continues until the beginning of menstruation.
The size of the follicle is of great importance in the techniques used in case of problems with conception in couples. In these cases, the procedure requires a full-fledged egg, ready for fertilization.
To do this, at the beginning of treatment, hormonal preparations are used, with the help of which they stimulate the growth of follicles, all of which become dominant. The greater their number, the greater the chance of a successful pregnancy. Then, using a puncture, the egg is taken and fertilized in a test tube.
After that, it is transferred to the uterus and monitored for development. In the case when the embryo failed to settle down, the whole procedure is repeated using spare embryos.
Sizes at different stages
Ovulation is a short period of the menstrual cycle, which plays a major role in the process of conception. It is characterized by the release of the female cell in the genital tract. And here, under a favorable set of circumstances, fertilization will take place with a sperm cell.
A follicle that has reached the desired size can be fertilized by a sperm cell.
In general, the cycle consists of two more stages, between which ovulation is located. The first is called follicular.
Its duration varies with each lady and can be 11-21 days. At this time, the follicle develops, in which a cell is formed.
When it reaches the right size, it breaks through the follicle and goes into the fallopian tubes.
In the ovaries, every month immediately after menstruation, several follicles simultaneously begin to grow, their size gradually changing:
- the initial size of each follicle is 1-2 millimeters,
- by 5-7 days, an increase to 2-6 mm is observed,
- by 8-10 days one of them overtakes the rest, having a size of 12-15 mm, while its growth rate is much more,
- the remaining bubbles begin to decrease and gradually disappear,
- the leader continues to grow by 2-3 mm per day.
Watch the growth of the liquid bubble can be on ultrasound. It can reliably indicate at what size the follicle ovulation occurs. The doctor controls the process and reports the most favorable moments for fertilization.
What is the size of the follicle during ovulation can determine the ultrasound
All other methods for determining the day of the cell exit cannot help in this matter. Neither the measurement of the basal temperature, nor the tests, will tell you what size the follicle should be before ovulation, and the device is salivary in that.
Therefore, as the only truthful study, ultrasounds are performed from 8-10 days with a regular rhythm of 28 days and continue at intervals of 2 days, noting how development occurs and what size the follicle has reached before ovulation. The diameter of the bubble to 12-14 days is 24 mm.
Observing such parameters, it is necessary to prepare for this moment. If a woman is planning a pregnancy, she should step up her sex life. After all, we know that our cell is not distinguished by its long life activity. The known maximum today is 36 hours. And on average she lives about a day.
During this time, she goes her way to the right place in the fallopian tube, where the male cell will meet her. Spermatozoa, or rather some of them, can last for 2-3 days.
Therefore, it is advised to conduct sexual intercourse on the eve (the day before the desired day) or 2-3 days for the full conception, and not only during ovulation.
Why size may not reach the norm
The growth of the liquid vesicle, and directly on how large the follicle attains ovulation, is influenced by various factors:
- hormonal disorders,
- long-term use of contraceptive drugs
- violations in the functioning of the thyroid gland,
- the presence of prolactin in the blood during breastfeeding.
Stress can cause insufficient follicle growth
All this can disrupt the menstrual cycle, move the moment the cell leaves for a long time, which is why it is late. In this case, the calculations of the desired day are not relevant, which complicates the process of conception.
Therefore, in order to avoid problems in the form of infertility, a woman needs to control the cyclical nature of her rhythms, pay attention to the regularity of “critical days”, use known methods to detect ovulation. At the slightest failure, you need to look for the cause with the help of a doctor and fix it as soon as possible.
After examining the basic standards and parameters, what size should be the follicle for ovulation, do not forget that the processes in the body are unique and possible variation of the indicators due to external influences.
For normal conception, a full-fledged and ripe cell and a healthy, motile sperm cell are necessary. To get these components, you need to lead a healthy lifestyle, eat rationally, try to get rid of stress, monitor the condition of your genitals, and then the joy of motherhood will become quite real.
При ведении здорового образа жизни беременность не заставит себя ждать
Помните, что решить маленькую проблемку в виде какого-либо гормонального нарушения гораздо легче, чем лечить бесплодие.
Прислушивайтесь к сигналам вашего организма и даже при небольшом отклонении от нормального ритма не поленитесь посетить гинеколога.
In any case, the doctor will tell you how large the follicle at ovulation has reached, and how much is enough for a safe conception.
The size of the day of ovulation
Nature has thought over the woman's body to the smallest nuances, providing her with the opportunity to conceive and give birth to a child. A certain role in the ability to give birth to a baby is played by the size of the follicle during ovulation, the development of which is also cyclical.
This term is called ultrasound procedure for studying the size of the follicle before ovulation or at any other stage of its growth.
Why do we need to study this process, which takes place deep in the ovaries? The fact is that the follicles are the place of origin of the eggs, which are responsible for the long-awaited conception. The follicle size during ovulation must be such that an egg cell can be born in it.
Folliculometry is designed to monitor how the follicle lives, and whether it is ready to ensure the functioning and ovulation of the egg.
What size should an ovulation follicle have?
A woman who seeks to become pregnant is concerned about all the processes occurring in her body. One of those is the change in the size of the follicle after ovulation and up to that.
In order to avoid possible confusion, it is necessary to immediately understand that the beginning of the monthly cycle is considered to be their beginning, whereas the final one falls on the last day before the monthly periods.
Therefore, we present a classic picture of what size the follicle is during ovulation and at the other stages of its development, calculated for a monthly cycle of 28 days in duration:
- The diameter of the follicle during ovulation, which is 5-7 days old, is 2-6 mm.
- With the onset of 8–10 days of the monthly cycle, the size of the dominant follicle begins to be determined during ovulation, in which the egg itself will grow. Its dimensions are approximately 12-15 mm. The remaining follicles, reaching 8-10 mm, gradually decrease and disappear altogether.
- When ovulation occurs, the follicle 24 mm of which hide a mature egg cell, already reaches the age of 11-14 days. Soon he will burst and release an egg ready for fertilization.
Roughly this is the brief life of the follicle. On the other days of the monthly cycle, either the egg can meet the spermatozoon, or the end of its useless existence. Such cycling will continue until the moment when the long-awaited pregnancy does not occur.
Occasionally it happens that a dominant follicle may not burst. It is also likely that there will be a maximum follicle size during ovulation, which is called persistence. The latter is characteristic of the growth of a non-controlling follicle and can cause infertility.
If the normal follicle size before ovulation tends to permanently decrease and disappear completely, then we are already talking about atresia. In any case, the size of the ovulating follicle is very important information for those who have long and unsuccessfully tried to get pregnant.
The purpose of the folliculometry
The method is carried out to assess the work of the ovaries in the dynamics, state of the endometrium.
Folliculometry monitors the process of maturation of follicles, reveals the dominant, makes it possible to determine the moment of ovulation, the formation of the yellow body during one monthly cycle.
The study determines the state of the endometrium, predicts a successful or unsuccessful attachment of a fertilized egg - implantation into the uterus.
The indication for the use of folliculometry is:
- infertility along with the absence of obvious pathologies of the reproductive system,
- hormonal disorders, associated pathologies - anovulation, luteal phase deficiency, polycystic ovary syndrome.
The study is conducted in the process of stimulating ovulation, while preparing women for artificial insemination, IVF procedures.
Objectives of using folliculometry:
- ovarian performance evaluation,
- determination of the maturing follicle,
- identifying the moment of ovulation
- designation of the optimal day of conception,
- determination of the feasibility of stimulating ovulation,
- impact on the sex of the unborn child (sexual intercourse a few hours, during ovulation increases the chances of having a boy, while sex a few days before it allows you to give birth to a girl),
- preventing or increasing the chances of multiple pregnancy,
- overall assessment of the menstrual cycle
- identification of causes of cycle irregularities, causes of infertility,
- identification of pathologies of the reproductive system, gynecological diseases associated with the inability to become pregnant,
- treatment control.
Ways of carrying out folliculometry
The study can be carried out transabdominal, vaginally. In the first case, the diagnosis is carried out as usual ultrasound. A woman lies on her back, her stomach is smeared with a special substance that allows you to better see the picture. The specialist drives the sensor along the belly from the sternum to the pubis.
A picture appears on the monitor, after which the computer summarizes all the images and displays the results. The second method of research - vaginal, allows you to see a more complete picture. The sensor is in close proximity to the ovaries, uterus, endometrium.
A special device is inserted into the vagina. The woman during the study may feel some discomfort, but in general the procedure is painless. What kind of monitoring will be carried out, determines the specialist.
He also determines the timing of the procedure, since the time of the folliculometry has a certain framework.
Special serious preparatory activities are not carried out. On the eve of the study, the woman needs to perform a hygienic procedure for washing away.
If folliculometry will be performed externally, you need to fill the bladder. To do this in about 45 minutes to drink tea, coffee, mineral water. Such drinks stimulate the production of urea.
When conducting a vaginal examination, on the contrary, care must be taken to ensure that the bladder is empty.
In order to improve the effectiveness of the results of the study, a woman needs to stop using food for 1-2 weeks, which causes increased gas formation and bloating. This situation somewhat distorts the results of the study. Do not use:
- fresh cucumbers,
- black bread,
- carbonated drinks,
- whole milk.
In general, proper nutrition increases the chances of the normal functioning of the reproductive system; therefore, a woman must ensure the correct diet if there are problems with conception and a regular cycle.
Dates of folliculometry
A woman has to go through 6 research procedures for a complete picture of the menstrual cycle.
- Folliculometry should be made on the 5–7th day of the menstrual cycle for the first time. Immediately after the end of menstruation. During this time, the development of the egg begins. In one of the ovaries, 2-3 follicles are detected, ranging in size from 5 to 9 mm. Already during this period it is possible to reveal the dominant one, but they are not in a hurry with the conclusions. The structure of the endometrium is uniform, the thickness reaches 2 mm.
- The second ultrasound is performed on day 9-11. It is recommended to do folliculometry for this day of the cycle for the following reasons. Of all the follicles formed, one begins to grow more confidently - it is commonly called dominant. During this period of the cycle, its dimensions reach 10 mm, while the others barely reach 9 mm. Every day the follicle will increase by 2-4 mm. At the end of the development of the egg diameter will be about 22 mm. The structure of the endometrium is linear, 5 mm thick. By the end of the maturation of the follicle, three layers will be clearly visible. If the second ultrasound study did not detect a dominant follicle, there is no point in doing folliculometry on the 13th day of the cycle. The menstrual cycle will be without ovulation.
- The third study should be conducted on the 13th day of the monthly cycle. The main goal is to determine the preovulatory state of the follicle. Its diameter is 22–32 mm. To do folliculometry on this day of the cycle is necessary in order to determine the moment favorable for conception. The thickness of the endometrium is 12 mm, there is a clear structure in 3 layers. If there is a deviation in the formation of the endometrium, the probability of pregnancy is low. Because the uterus will not be able to receive the egg. Conception happens, implantation is not.
- Making folliculometry on the next day of the cycle is recommended for explicitly detecting ovulation. There is no expressive follicle. A free liquid is found instead. In this form, the egg after fertilization is a few days. The follicle is present - a study should be conducted every day until it becomes clear - ovulation will not occur.
- Do folliculometry on the 15-17th day of the cycle, subject to the implementation of ovulation. Instead of a bursting follicle, an asterisk-shaped yellow body is observed. The thickness of the endometrium is 11 mm, the structure of the three layers is lost. The uterus is ready to accept the yellow body.
- On days 21–23 of the monthly cycle, the implantation of a fertilized egg occurs. The purpose of the study is to determine the state of the corpus luteum, endometrium. The size of the yellow body increases, the lining of the uterus again becomes homogeneous structure. In this case, the implantation will occur successfully, which is the beginning of pregnancy. Deviations in the development of the corpus luteum are grounds for assuming that pregnancy will not occur.
It is necessary to do folliculometry on a certain day of the cycle in order to understand how ovulation occurs, the formation of the corpus luteum, the implantation of an egg cell.
After a thorough diagnosis, experts decide to stimulate ovulation, if the ovary is not working properly, to take hormonal drugs to ensure the full development of the follicle, egg, and the readiness of the sexual organ for pregnancy.
During a normal menstrual cycle, the follicle reaches a large size, the egg comes out, a special fluid is formed, it is found with the sperm cell, a corpus luteum appears, then implantation, pregnancy. However, the situation may develop in a different way, then the onset of pregnancy becomes impossible.
- The follicle reaches the desired size, but does not burst, but begins to decrease in size - atresia of the dominant follicle. Ovulation does not occur. In this case, hormonal stimulation should be carried out.
- The follicle reaches the dominant size, remains so until the end of the menstrual cycle. No ovulation. The situation is called the "persistence of the follicle."
- The follicle continues to grow after reaching the dominant size. Ovum does not go out, ovulation does not occur. Instead, a follicular cyst is formed, which may remain for several months, then disappear.
- The follicle fully develops. And at the moment when ovulation should occur, begins a gradual wrinkling. There is an early luteinization of the follicle.
Folliculometry allows you to determine all these deviations. To draw conclusions, to conduct a full-fledged treatment or artificial insemination. In any case, the diagnosis should be carried out if, with full sexual intercourse, pregnancy does not occur within 1 year.
Goals of folliculometry
Folliculometry is a study that is conducted in order to:
- assess whether the ovaries function normally
- confirm ovulation
- calculate the days of the cycle corresponding to ovulation
Preparation for the procedure
Foliculometry does not require special training. For the entire period of the study, those products that increase the amount of gas formation in the intestines are excluded from the diet (they prevent the follicles from being well considered):
If the study will be transabdominal. directly on this day, an hour before the procedure, you need to fill the bladder. To do this, it is advisable to drink at least a liter of water without gas, and then do not urinate.
If a vaginal probe is used for the examination, it is not necessary to fill the bladder. It must be empty. To do this, before you enter the office, you need to urinate.
How is the procedure performed?
How is folliculometry done? The study can be conducted in two ways:
Regardless of how the folliculometry is done, this research can be done not when you are mentally prepared for it. Date must be set in advance, depending on your menstrual cycle.
Dates of the procedure
On what day to do folliculometry, you should tell your gynecologist or sonologist, who will do this on the basis of your cycle.
With a cycle of 28 days, the first study (4 or more of them are made) is assigned between 7 and 10 days. That is, at least a week should pass from the first day of menstruation.
Next, the doctor immediately ultrasound prescribes when to do folliculometry. Usually you need a few studies with an interval of 1-2 days (according to the results of the previous study).
If the cycle is longer than 28 days, the first study is scheduled for 10 days or later, the interval between examinations is maintained the same.
Physiology of the female reproductive system
The follicular apparatus is a few hundred immature follicles. They are laid by a woman in the prenatal period in the amount of several thousand, some of them die in the process of cultivation, and about half a thousand remain for their birth.
Each menstrual cycle, the process of preparing for ovulation begins to go through several follicles. Then, under the influence of hormonal background, only one of them becomes the main candidate for egg producers (less often - several).
It is called dominant. It comes out of its “shelter” in the ovary into the abdominal cavity, it must be caught by the villi of the fallopian tubes and get into their cavity, where they can meet with the spermatozoon. The process of the release of a mature egg from the ovary is called "ovulation."
In place of the follicle, which burst as a result of ovulation, a yellow (luteal) body develops - a temporary endocrine gland. It functions either before the onset of menstruation, or, if the pregnancy has arisen, before the appearance of the placenta (at 12-16 weeks).
There are cycles when the maturation of the egg does not occur. They are called "anovulatory", with age they become more and more. It is impossible to get pregnant during such a cycle.
The conclusion of the ultrasound "depleted follicular unit" means that under the influence of such reasons:
in the ovaries there are few follicles. In order for a pregnancy to occur, it is necessary to detect and treat this cause (or eliminate the influence of harmful factors, to cancel the drugs).
How to decipher folliculometry
This study includes not only the observation of the echographic picture of changes in the uterus and ovaries. A laboratory determination of the level of female genital and some other hormones (for example, those produced by the thyroid gland) is also carried out. Based on ultrasound and laboratory tests, the doctor issues a report, which may be as follows:
1. Normal ovulation. It is characterized by such signs:
2. Persistent follicle. This diagnosis means that although the dominant follicle has fully matured, it did not ovulate. This situation may persist after menstruation. Signs of this condition:
3. Cyst follicular. This is a condition where the follicle not only did not ovulate, but also grew in size (more than 25 mm). Symptoms of such a cyst:
4. Luteinization of the follicle: the follicle was formed, did not ovulate, but in its place a yellow body still formed. Signs:
5. No follicle development:
- follicles are there, but they do not grow
- no yellow body
What women say about the study
Reviews of folliculometry indicate that the study is useful for those who want to get pregnant. “Thanks to such monitoring, one cannot hope for hopelessly,” they write. - After all, during lutealization of the follicle, the basal temperature will behave in the same way as during a normal ovulatory cycle. Но в этом случае забеременеть никак нельзя».
Also, folliculometry allows you to monitor the effectiveness of treatment for infertility. Many reviews indicate that the procedure is quite expensive. In private clinics, the price of folliculometry is 500-700 rubles for 1 session (you need at least 4 of such procedures).
You can make folliculometry in the State Reproductive Centers and on the basis of women's clinics (in which the cost of the procedure is much lower). This study is also conducted in multidisciplinary clinics and specialized gynecological centers that treat infertility.
Thus, folliculometry is the type of research that will help you learn how the ovaries and uterus work, how ovulation occurs, whether the cause of infertility lies precisely in the disruption of egg maturation. The procedure is simple, carried out without much preparation, safe and painless. Its disadvantages are that it requires repeated use and should be carried out strictly on schedule, and not at will.
In the video, an expert talks about folliculometry.
What is and how do folliculometry do?
A woman with a normal regular cycle can roughly calculate when ovulation occurs and a favorable period for conception occurs. Someone is counting on ovulation using fluctuations in rectal temperature, others simply choose the middle of the cycle. As an alternative to these methods, folliculometry was developed.
What is folliculometry is a dynamic observation during the menstrual cycle of the organs of the female reproductive system using conventional ultrasound. This method allows you to determine the days of ovulation or lack thereof, and also reveals the pathology of the uterus and other organs of the small pelvis.
Folliculometry is a dynamic ultrasound that monitors the process of ovulation.
Physiological development of the reproductive system in women
After birth, there are more than a thousand immature follicles in a woman’s ovaries. Until puberty, these follicles grow, but none of them reach the maturity stage.
During puberty, under the influence of certain hormones, the following processes occur in a woman's body, which determine her ability to conceive:
This process is normally repeated almost every month. But there are cycles when the maturation and release of the egg does not occur (anovulatory cycle). With age, the number of viable eggs decreases, and there are more and more problems with ovulation.
To conceive a child, you need to know exactly when ovulation occurs. If there are problems with conception, you need to make sure that ovulation does occur and find out if there are other problems for a woman that prevents her from getting pregnant. For this purpose, and held folliculometry, which allows to answer these and other questions.
How does fertilization take place?
Who does this procedure and why?
Folliculometry is prescribed to women with irregular menstrual cycles, as well as those who can not get pregnant within a year during normal sex life.
The main points you can find out by doing this study:
According to unverified data, with the help of folliculometry, you can predict the sex of the child (sex after ovulation occurs increases the chances of a girl becoming pregnant). Doctors this fact is not confirmed, but such a probability, of course, is.
In addition, when it is carried out, it can be seen when not one but several eggs mature. In this case, the chances of becoming pregnant with twins or even triplets are high.
The disadvantage is the inability to check the condition of the fallopian tubes, the presence of adhesive processes and foci of endometriosis.
When do this research?
On what day the examination is determined by a gynecologist. When calculating the appropriate time take into account the duration of the cycle and its regularity.
With a standard regular cycle of 28-30 days, the first ultrasound scan is performed about a week after the cessation of menstruation.
The first ultrasound is done on a 7-10 day with a normal cycle.
Such ultrasound may need 3 or more. On each subsequent ultrasound, the doctor prescribes when the next procedure is performed. As a rule, between subsequent examinations stand an interval of a day or two.
Important!If the cycle is longer or shorter than the average, as well as in women with an irregular cycle, the doctor may prescribe an ultrasound immediately after the end of menstruation.
How to prepare for the survey?
Specially prepare for ultrasound is not necessary. If a woman is planning a pregnancy, then you should stick to a healthy diet and eliminate alcohol. After determining ovulation on this day, an attempt is made to conceive a child.
If an ultrasound scan is performed through the abdomen, then an hour before the procedure, you need to drink a lot of fluid to fill the bladder. So you can better consider the uterus.
When the test is done through the vagina, the bladder must be emptied.
How does folliculometry go?
Ultrasound of the pelvic organs can be performed in two ways:
This procedure is painless and has no side effects or contraindications. After the first ultrasound, the doctor determines the date and time of the next examination.
The ultrasound procedure is safe and painless.
How to evaluate the results of the study?
To make correct conclusions about the presence or absence of a problem, in addition to an ultrasound examination, a woman undergoes tests for sex hormones during this period. Based on all the data, the doctor can set the following diagnosis:
Progesterone levels increase in blood tests (meaning that the corpus luteum works). The corpus luteum is an endocrine temporary gland that forms on the site of a bursting follicle. Its function to produce progesterone is a pregnancy hormone.
Atresia (reverse development) of the follicle.
In this case, the follicle first grows in size, but not reaching the stage of maturity, the reverse process begins. It is reduced in size and ovulation does not occur. Such a cycle is considered anovulatory. Get pregnant from a woman will not work. Signs on ultrasound:
In the blood, the level of progesterone does not change. This situation can be a one-time, but it can happen all the time. In case of unsuccessful attempts to get pregnant, look for the cause and prescribe treatment.
This follicle grows to the desired size, but it does not break and the egg leaves. The follicle exists during the whole cycle, and in some women it is determined after ovulation. Ultrasound signs:
Estrogen levels are elevated in the blood and progesterone levels are lowered.
The follicle increased, but did not break, but in its place a yellow body formed. On ultrasound:
Progesterone levels rise in the blood because the corpus luteum works.
In this case, the mature follicle enlarges above normal size. Cystic fluid begins to accumulate in it and it turns into a cyst without tearing. Ultrasound signs:
There is a low level of progesterone in the blood and an elevated estrogen level.
Lack of follicle development
Ovulation does not occur and the follicles do not increase in size. On ultrasound:
Blood is low in progesterone.
All cases, except the first, suggest that there are problems with the reproductive health of women that can prevent her from conceiving a child. To eliminate the cause of the problem, you need to reconsider your lifestyle and strengthen reproductive health.
Folliculometry will help calculate the favorable time for conception.
When do folliculometry?
When a woman visits a doctor with problems for which she cannot do without such a diagnosis, she needs to know on which day of the cycle the first folliculometry is indicated.
The doctor usually prescribes the procedure for 8-10 days of the menstrual cycle, depending on its steady-state duration. Then the procedure is repeated at least every 2 days before the expected date of ovulation.
If ovulation does not occur, folliculometry continues until the onset of menstruation.
Thus, the specialist conducts full monitoring of folliculogenesis, on the basis of which it can draw the necessary conclusions. The exact timing of diagnostic procedures and their number is prescribed by a gynecologist, after the initial examination.
There are signs that ovulation is occurring successfully. They are identified by the results of folliculometry decoding:
The results of an ultrasound examination must be confirmed by a blood test - 7 days after ovulation, it should show an increased level of progesterone.
Where do folliculometry and how to prepare?
Ultrasound monitoring is carried out in the diagnostic departments of gynecological centers, in the direction of the gynecologist.
Preparatory measures for the procedure consist in exclusion of gas formation products from your diet that may distort the diagnostic picture.
So, two or three days before folliculometry, one should refrain from raw vegetables, legumes, milk, alcohol, soda, etc. The last meal is no earlier than 12 hours before the examination. The rest of the preparation does not differ from the preparation for a routine gynecological examination.
Anovulation: the main reasons
When conducting an ultrasound monitoring, anovulation may occur, i.e. violation of the ovulation process, when the ovary does not release a mature cell, without performing its normal function, which is the main of the most common causes of infertility in many women.
Such a pathology can occur during reproductive age, during the establishment of a cycle in girls, and also before menopause. As a rule, this is accompanied by changes in the cyclical nature of menstruation and the abundance of discharge.
However, sometimes anovulation is imperceptible, since menstruation takes place normally, but ovulation does not occur. Even a completely healthy woman can have up to 2 cycles of anovulation throughout the year.
Sometimes patients are lost, why the desired pregnancy does not occur, and ultrasound monitoring of the follicles helps to understand this.
The reasons for anovulation may be different:
Only a thorough examination will reveal the true picture of anovulation. The treatment will be directed, first of all, to the elimination of the root cause, which led to violations of the female reproductive system.
All about folliculometry: how and when is performed, what deviations reveals
Changes in the reproductive organs of women are cyclical. Initially, the growth and development of the egg occurs, and the endometrium in the uterus changes in parallel - it is preparing to accept the fertilized egg. In the following, two options are possible: the onset of pregnancy, or the rejection of the endometrium and the launch of a new cycle. Folliculometry monitors ongoing changes, helps determine the day of ovulation and is a diagnostic procedure to determine the pathologies of the ovulatory process.
The doctor examines the surface of the abdomen, examining it from the pubis to the sternum, so you should choose clothes that allow you to quickly expose the desired surface.
For the procedure, you need to grab a towel or diaper, they are laid on a couch, and a package of paper napkins to wipe off excess gel. Immediately before the examination, it is necessary to fill the bladder, for this purpose, over an ½ liter of plain water is drunk for an hour and does not urinate.
The sensor is inserted invaginally, with some discomfort.
Before the study it is necessary to hold a toilet of the genitals. It is not necessary to fill the bladder, it is recommended to urinate before starting the procedure. They take a towel or diaper with them, a disposable condom (special for ultrasound, or the usual smooth).
To clarify some parameters, you may need to use both sensors. An increased amount of gas in the intestines can make diagnostics difficult, so a special diet should be followed before the study: excluding legumes, all types of cabbage, black bread, alcohol, and carbonated drinks.
How does follicle maturation
For the first day of the cycle take the first day of menstruation. At the beginning of folliculogenesis, several follicles grow, all of them do not exceed 2 mm in diameter. On the tenth day of the cycle, it is already possible to see one or several follicles that exceed the rest in diameter (up to 15 mm) - they are called dominant. The remaining follicles begin to regress (the opposite of the development process) and soon decrease to their original level.
The dominant follicle continues to develop and reaches 18–25 mm in diameter by the time of ovulation. Next, luteinizing hormone is released, under the action of which the egg leaves the follicle and exit into the peritoneal cavity with a small amount of follicular fluid. In place of a ripe follicle, a yellow body is formed.
Dates of the study
On which days of the cycle folliculometry is performed, depends on the menstrual cycle. To determine favorable days for conception in women, whose cycle lasts 28 days, the first ultrasound should be performed between 8 and 10 days from the start of menstruation.
For longer or, on the contrary, short cycle, the date is calculated based on the following data: the cycle length varies due to the first phase (duration of follicle maturation), the second phase is 13-14 days, the study should be carried out 5-6 days before the estimated ovulation date .
Example: the woman has a stable cycle, its duration is 32 days. Calculate the date of the first ultrasound for folliculometry: 32 - 14 = 18 (estimated date of ovulation), 18 - 6 = 12 - on the twelfth day of the cycle, the first study is conducted.
If the cycle is irregular, the date of onset of folliculometry is given 3-5 days after the onset of menstruation. In total, it may take from 3 to 6 visits to the doctor, examinations are appointed with an interval of 2-3 days.
Signs of ovulation
The doctor notes the changes in the follicle and determines the date of ovulation from their dynamics. The release of an egg occurred if:
The persistence of the follicle can transform into a follicular cyst. В этом случае увеличившийся фолликул не останавливается в росте, а продолжает увеличиваться (одновременно происходит накопление фолликулярной жидкости). Если фолликул превышает 25 мм в диаметре, при проведении фолликулометрии врач может поставить такой диагноз.
Отсутствие развития фолликулов
In some cases, the follicles may not develop at all, or begin development at the beginning of a cycle, and then regress without the formation of a dominant.
In the absence of ovulation, pregnancy cannot occur, because the egg does not enter the uterine cavity and cannot meet with the spermatozoon. Women who are diagnosed with anovulation should undergo a comprehensive examination to identify the cause of the pathology. It is rather difficult to restore the childbearing function, but with a great desire, normalization of nutrition, lifestyle change and compliance with medical recommendations, a woman has a chance to become a mother.