Here’s a look at a condition that appears to be normal ovulation —- luteinization of unruptured follicles syndrome (LUFS).
A large percentage of women who are using terms like “trying to conceive” and “preparing for pregnancy” are struggling with ovulation. Some are winning the battle and some are losing the battle.
Doctor, I have been ovulating every month with ovulation test, why am I not pregnant?
Doctor, I have an ovulation test every month with ultrasound and it has grown into a cyst, why is it not happening?
Doctor, I took my basal body temperature and there is a biphasic curve, does it mean I am ovulating normally?
Doctor, is it most accurate to take blood test for progesterone during the luteal phase to determine whether there is ovulation or not?
Doctor, if my period is normal, does it mean I am ovulating normally?
Whether you are pregnant or not is not really determined by ovulation. However, regular ovulation by the ovaries is an important part of fertility. Ovulation disorders account for about 20% – 30% of female infertility. Among the many factors that affect ovulation, it is important not to mention a condition that appears to be normal ovulation – luteinization of unruptured follicles syndrome (LUFS).
What is this disease?
Unruptured follicular luteinization syndrome (LUFS) is a disorder of ovulation in which the follicles develop but do not rupture and the oocytes are not expelled. In normal women, luteinization of unruptured follicles can occur in 10% of natural menstrual cycles and can also occur during ovulatory cycles. In infertile women, this percentage is significantly higher. It can also be said that it is one of the causes of infertility.
Some women may say, “I have a normal menstrual cycle. The clinical symptoms of this disorder resemble the normal ovulatory cycle, but it is a specific type of anovulatory menstruation.
Why is this a seemingly normal ovulation disorder?
If you examine the clinical manifestations of LUFS, you will see how similar it is to the “normal situation”!
1. A regular menstrual cycle.
2. Basal body temperature can be typically biphasic.
3, regular menstruation with elevated progesterone levels in the luteal phase.
4, cervical mucus or endometrial biopsy, there is a normal secretion phase changes, similar to the normal ovulation cycle.
Seeing these manifestations you are not relieved of which doubts at the beginning of the article.
Why does this happen?
The pathogenesis of LUF is unclear and is generally thought to be related to the following conditions.
1. related to central and local disorders of ovarian secretion.
2. related to inflammation of the pelvis, history of surgery, and endometriosis. Simply put, the adhesions around the ovaries caused by the above factors and the proliferation of nodular tissues around the ovaries are like putting an iron shirt on the ovaries, preventing the follicles from breaking and the eggs from being discharged.
3, related to psychological factors. The patient often says that the ovulation test was normal at the beginning, but the more the more she does not ovulate.
In addition, some ovulation drugs can also cause follicles to grow up without ovulation. This is related to some mechanism of action of the drug.
How do I know if I have this disease?
It’s not really that simple and easy. It’s like proving that “my mother is my mother” and it takes some effort.
Currently, the diagnosis is made by dynamic observation of follicular development by ultrasound, combined with a test for luteinizing hormone (LH) in human urine. In other words, the diagnosis is made when the follicle is not expelled and continues to grow after 2 d of LH peak in the body or 36-48 h of exogenous hCG (chorionic gonadotropin) injection. This has two problems: firstly, the “LH peak” is not easy to find, and secondly, ultrasound can detect follicular rupture, but it is not certain that the oocytes are excluded. Therefore, the diagnosis is not 100% accurate.
Of course, there are other methods, such as examining the ovarian surface under laparoscopy 4-7 days after the predicted ovulation date, if no ovulation hole is found, and examining the estrogen and progesterone levels in the abdominal fluid to make the diagnosis. However, this is still not 100% possible and is somewhat invasive.
So it seems how difficult it is to prove that “my mother is my mother” (I have this disease).
The diagnosis of a disease is not like a judge deciding a case, you have to find out the truth (and most diseases cannot be diagnosed in this way). The good thing is that the disease does not affect treatment after a suspected diagnosis is made.
How can this be avoided?
The pathogenesis of LUFS is unclear, and there are no effective preventive measures.
In view of the above causative factors, I would like to suggest the following for women with this condition
1. Women who are “trying” or “preparing” to conceive should avoid being overly nervous. It is best to consult if you need ovulation monitoring and ovulation promotion, and to do it under the guidance of a professional doctor. The most taboo thing is to get pregnant this month immediately after not using contraception last month; once you are not pregnant, you will immediately have an ultrasound next month to see if you are ovulating. Then take the ultrasound sheet and study it as a couple. Which day should we have intercourse? With such a toss and turn, menstruation may be abnormal, will be normal ovulation?
2. If the patient has been infertile for many years, do not simply focus on whether she is ovulating or not. You should first rule out other factors causing infertility, such as abnormal tubal function.
3. Ultrasound-guided follicular aspiration and laparoscopic surgery can also be used as a treatment, but the indications for surgery should be strictly controlled.
4. If infertility persists after targeted treatment, it is recommended to consider in vitro fertilization. IVF is an effective treatment for LFUS with infertile eggs because it requires vaginal puncture to remove the eggs and fertilize them in vitro for culture.