What is a follicle and why is it necessary for fertility?

Per Normal menstrual cycle A follicle develops that contains an egg. Therefore, you may consider the term “follicle” synonymous with egg. But it is not. So what is a follicle and what is its role and importance in fertility and ovarian health and how many follicles should be present in the ovary? In this article, we have collected useful and practical information about ovarian follicles and their related problems and fertility.

What is an ovarian follicle?

Ovarian follicles are small fluid-filled sacs inside a woman’s ovary. They secrete hormones that affect the stages of the menstrual cycle, and when their number reaches 300,000 to 400,000, a girl matures and her period begins. Each has the potential to release an egg for fertilization. Follicles and their size and condition are an important part of fertility evaluation and fertility treatment.

Evaluation of follicles includes pelvic ultrasound scan of the uterus and ovaries, as well as anti-Müllerian hormone blood test. A pelvic ultrasound scan evaluates the size and number of follicles in your ovaries, called an antral follicle count. The results of this scan, as well as your blood test, allow the fertility specialist to assess your fertility and therefore your ability to conceive.

Follicles are not eggs, but sacs in which eggs develop and are tested for fertility.

Ovarian follicle structure and stages of its development

Ovarian follicles are the basic units of female reproductive biology, each of which contains an egg, either an immature egg or an egg cell. These structures periodically begin to grow and reproduce, culminating in ovulation, which is usually an egg ready for fertilization. They are also composed of granulosa cells and theca follicles.

Primary follicle

All follicles exist as primordial follicles in the female body. At birth, the ovaries contain about 1 to 2 million primordial follicles of reliable origin. It takes about a year for the primordial follicles to develop to ovulation. Primary follicles are surrounded by cells called granulosa cells, which are the primary producers of estrogen.

Secondary follicle

Granulosa cells begin to increase estrogen production. The inside of the follicle also forms small sacs of nutrient-rich follicular fluid. Next, the antrum, which is the fluid-filled cavity of the follicle, is formed.

Antral follicle

Another name for tertiary follicles is antral follicle. Their growth occurs through secondary follicles that form the antrum. At this stage, doctors can see third follicles in ultrasound.

Graafian follicle

This is the stage at which the mature follicle can ovulate.

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After ovulation, the follicle is emptied and turns into a corpus luteum. The corpus luteum consists of follicular theca cells and granulosa cells. It is responsible for the production of progesterone in early pregnancy.

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Theca forms an inner and outer layer around the granulosa cell and also produces steroid hormones. Both theca and granulosa cells synthesize estrogen, preventing the growth of additional follicles and affecting the ovarian cycle.

Let’s get acquainted with the most important terms related to the ovarian follicle:

Ovum cell or ovum: An egg is released once a month. The nucleus of this egg is called a germinal vesicle or a vesicle or a small bag.
Ovarian cumulus: A group of cells called cumulus cells or “parietal granulosa” cells surrounds the egg both in the ovarian follicle and after ovulation.
Membrane: It contains many granulocytes.
Granulosa cells: Granulosa cells or follicular cells are the cells that surround the egg inside the follicle, their number increases directly in response to high levels of gonadotropin in the blood or their decrease occurs in response to increased testosterone.

What is the normal number of ovarian follicles?

It’s hard to say how many follicles are normal in each ovary because you can’t actually count them all. This is because primordial follicles (known as primordial until they start growing) are too small to be seen with the naked eye and cannot be picked up in any test.

Although several follicles can begin to grow with each cycle, usually only one follicle releases an egg, and the other follicles degenerate.

When primordial follicles begin to mature and grow, as Antral follicles are known Antral follicle count (AFC) or basal antral follicle count is a way to count follicles that are capable of growing to maturity. They are measured and counted through transvaginal ultrasound. The number of antral follicles varies every month.

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Usually, if the number of primary follicles is 6-10, it is normal. If this number is less than 6, ovarian reserve can be considered low, while high reserve is greater than 12. These tests don’t show all of the follicles a woman has on her ovaries, just the amount of visible antral.

The number of 6-10 follicles is known as a normal follicle in the ovary.

Finally, the number of follicles in the right and left ovary is related to the age, general health and lifestyle of the woman. However, more follicles do not necessarily guarantee successful conception. Egg quality is key.

Normal ovarian follicle size

In a normal cycle, among the antral follicles, one called “dominant” is selected. This follicle differs from others in terms of size and rapid growth. Finally, a mature or De Graaf follicle will be ready to “ovulate”. The rest atreate, meaning they disappear or die as part of a programmed biological process. Before ovulation, the average diameter of the dominant follicle is 22-24 mm (range 18-36 mm). It is the only marker that can easily predict ovulation.

Ovarian follicles and fertility

A human female has approximately 2,000,000 eggs in her ovaries at birth. By reaching maturity, their number decreases to about 400,000. During menopause, the ovaries have about 1000 eggs left.

There is only one egg in each follicle, and the number of follicles constitutes a person’s ovarian reserve. Not all follicles mature enough to release an egg. Depletion of the reliable source of mature follicles results in a low ovarian reserve status, meaning that one is less likely to become pregnant.

Doctors use transvaginal ultrasound to determine the number of follicles and fertility.

Why is the follicle important?

Ovarian follicles play a key role in your reproductive health. and perform the following tasks:

• Protection of immature eggs
• Feeding the eggs until they are ready for ovulation
• Secretion of hormones that regulate the menstrual cycle

Also, examining the size, number, and quality of follicles is very important in the treatment of infertility. The cause of ovarian changes and problems related to fertility is abnormal follicle growth and an excessive number of ovarian cysts.

Complications related to ovarian follicles

Some of the following conditions can affect ovarian follicles and lead to complications:

polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome affects 6 to 12 percent of women of reproductive age. Polycystic ovary syndrome can cause the release of androgens (male sex hormones that women also have), acne, and excessive body hair growth.

People with this disease have too many immature ovarian follicles in their ovaries. PCOS prevents follicles from growing, so they cannot release egg cells.

Functional cysts

If the follicle does not release an egg or fluid, an ovarian cyst may develop. These are not cancerous, but they may cause pelvic pain. Conditions that lead to the formation of ovarian cysts include PCOS and endometriosis. Some people may not need treatment because the cysts go away without intervention.

Premature ovarian failure

Primary ovarian failure or premature ovarian failure occurs when the ovaries stop working before the age of 40. This condition causes irregular periods and reduced fertility. It may start in adolescence for some people. Premature ovarian failure may occur in people with a low follicle count or genetic disorders.

Infertility problems related to problems with your ovaries, follicles, or menstrual cycles can also include:

• Hormonal imbalance prevents ovulation
• The eggs in the follicle have not grown and matured normally
• Infections that damage the eggs in your ovaries
• Obstruction of uterine tubes
• The inability of fertilized eggs to implant in the uterus

Ovarian cyst rupture

Most ovarian cysts are harmless and common in reproductive age. People with ruptured cysts may experience:

• Vaginal spotting
• Flatulence
• Sudden back pain

Some people may need surgery for complications from ruptured ovarian cysts.

How to diagnose diseases affecting ovarian follicles

Medical professionals may use the following tests to diagnose diseases that affect ovarian follicles:

Pelvic ultrasound: This scan helps doctors check the size of the ovaries and the number of follicles.
blood test: These tests can help measure hormone levels and check if a person has diabetes or high cholesterol. Hormone level tests can help determine the condition that is causing high hormone production.
laparoscopy: This is a surgery that is performed under anesthesia. The doctor inserts a specialized tool into the abdomen to check the cysts and ovaries.

Strengthening ovarian follicles

Depending on the different physical conditions and lifestyles that people have, some actions help to strengthen the ovarian follicle and treat related complications. Including:

Supplements: Calcium and vitamin D supplements may be helpful for people with primary ovarian failure. This is because they may be at a higher risk of developing osteoporosis.
Birth control pills: Birth control pills can help regulate menstrual cycles, treat PCOS, and reduce the risk of ovarian cancer.
Lifestyle changes: If you have PCOS, get tested for type 2 diabetes. The doctor may suggest regular exercise with the aim of reaching or maintaining a suitable weight.

last word;

Ovarian follicles are sacs inside the ovary that house and protect your undeveloped eggs until ovulation. When it comes to women’s fertility, ovarian follicles and their quality are one of the important indicators. Some conditions that can affect ovarian follicles include PCOS and ruptured cysts.

If symptoms such as irregular bleeding, pelvic pain or back pain occur, or to check your fertility status, you should consult a gynecologist.