Why don’t grown follicles rupture? In some women, the follicles grow quite well, but the eggs are not released and the follicles become luteinized. This is a type of ovulation disorder called luteinized unruptured follicle syndrome (LUFS.) LUF is actually more difficult to diagnose and cannot be based on an occasional unruptured follicle. If a persistent follicle doesn’t rupture, there is most likely a cause, and there are a few tricks you can try. If the follicle just won’t rupture, then do IVF to get the egg out. Why do grown follicles not rupture? When the follicle matures, the egg is not expelled from the follicle, a phenomenon called luteinized unruptured follicle syndrome (LUFS). The clinical picture is that after the follicle has matured and after the peak luteinizing hormone (LH) has appeared or 36 to 48 h after chorionic gonadotropin (HCG) injection, the ultrasound shows that the follicle is still there and has not collapsed or disappeared. LUFS is a type of non-ovulation. Patients with LUFS also have normal menstrual cycles and changes in cervical mucus, giving the illusion of ovulation. The follicles still secrete progesterone after luteinization, and the basal body temperature remains elevated during the second half of menstruation, so it is less easy to detect without ultrasound monitoring. The incidence of LUFS is about 10% in those who are monitored for ovulation, with an elevated incidence of about 25-40% in the infertile population. Diagnosing LUF by ultrasound monitoring alone, which reveals that the follicle is still present, is not accurate enough. This is because sometimes the follicular fluid is not released after ovulation and the follicle remains full, which can be mistaken for a lack of ovulation. In fact, it is difficult to diagnose LUF clinically. What causes mature follicles not to rupture? 1, endocrine factors: is one of the common causes. From follicle recruitment, development, maturation to eventual ovulation, the hormones localized in the follicle are coordinated with those of the pituitary gland and hypothalamus, prompting the follicle wall to digest a weak point and the pressure inside the follicle to increase, triggering the egg to be discharged. Abnormal pituitary secretion of LH peaks, decreased progesterone levels, and abnormal signaling of factors such as prostaglandins within the follicle can lead to LUFS. (1) Abnormal LH peak secretion and reduced progesterone level: Before normal ovulation, when the estrogen in the blood exceeds 200pg/ml, it will stimulate the superior leaders, the hypothalamus and pituitary gland, to release a large amount of LH and send out the instruction of ovulation. If there is insufficient estrogen, poor LH secretion, and defective ovulation signals received by the follicle, all of them will cause low progesterone secretion during the luteal phase, which will further lead to LH secretion disorders in the next cycle. Thus in patients with clinical PCOS, hypogonadotropic hypoprolactinemia, hyperprolactinemia, and hyperandrogenemia are prone to LUFS. (2) Prostaglandins (PGs) and some hydrolytic enzymes play an important role in the process of ovulation by causing the follicular wall to thin, dissolve, and rupture, and the egg to be expelled from the follicle. The use of non-steroidal anti-inflammatory drugs (such as anti-inflammatory pain suppositories, etc.), endometriosis, or insufficient progesterone secretion may inhibit the production of PG in the body, leading to the occurrence of LUFS. 2.Mechanical factors: Due to chronic pelvic inflammation and endometriosis and other diseases, the pelvic structure is caused by changes in the pelvic cavity, so that the ovaries are surrounded by chronic inflammation adhesion package, the follicular surface is thickened, which prevents the discharge of the eggs. 3.Altered expression and mutation of related genes: It was found that mice lacking a certain gene (nrip1) showed inability to discharge oocytes. Certain gene mutations cause defects in the follicular wall, which prevents the egg from contracting and being expelled. Medical factors: For patients with ovulation disorders, clinicians may apply ovulation stimulants to help the follicles grow and mature. Clomiphene (CC) and human menopausal gonadotropin (HMG), these two types of ovulation drugs are more likely to cause ovulation disorders than natural cycles. 5, mental psychological factors: relaxation of the mind is conducive to the normal operation of the hypothalamus – pituitary – ovarian axis (H-P-O axis). Infertile women are often characterized by mental tension and anxiety, sensitive to external reactions. These psychological fluctuations affect prolactin secretion and the normal functioning of the H-P-O axis, and LUFS occurs in some patients. If LUFS occurs, how is it treated? LUFS is a special type of ovulation disorder, not an independent disease, there is no specific treatment, mostly using allopathic treatment. Expectation therapy: Some patients experience LUF by chance. For patients with no history of infertility or those who discover LUFS for the first time, sometimes lutein cysts can disappear naturally before the next menstrual period, so they can be left untreated for the time being. 2.Primary disease treatment: For patients with combined hyperprolactinemia, PCOS, endometriosis, chronic pelvic inflammatory disease, etc., after clear diagnosis, medication or surgery will be given to treat the primary disease. 3.Drugs to promote follicle rupture: For patients with PCOS and other ovulation disorders, appropriate ovulation promotion will be carried out, and after the follicles have matured, high-dose HCG injections will be given. Ultrasound-guided follicular puncture: If the follicle has not collapsed or disappeared after 48h after HCG injection, ultrasound-guided follicular puncture can be used to help the egg rupture and discharge. However, the effect of this method is very limited, and there may be potential damage and infection and other risks, cost-effective, and is no longer used in our center. 5. Laparoscopic surgery: Laparoscopic surgery improves the pelvic environment and restores the normal structure. Ovarian perforation in patients with PCOS can reduce the secretion of androgens, increase the feedback to the hypothalamus and pituitary gland, and induce follicular rupture; if combined with severe endometriosis or pelvic adhesions, the adhesions can be loosened, but the therapeutic effect is limited. 6.Ovulation promoting drugs: If LUF is caused by clomiphene, it can be changed to letrozole to promote ovulation, which can increase the chance of follicle ovulation, and HCG can be given to induce ovulation. 7.In vitro fertilization (IVF): For patients who are still infertile or have recurrent LUFS, it is recommended to consider IVF treatment, in which the eggs are retrieved through egg retrieval and inseminated with sperms to solve the fertility problem. Psychotherapy: Relaxation, health education and psychological counseling can help restore normal ovulation.