Mothers-to-be are instinctively afraid when they hear the words premature ovarian failure.
There is a rumor circulating on the internet that “a woman has a limited number of follicles in her life, and ovulation promotion will encourage too many follicles to develop and ovulate early, causing premature ovarian failure.”
Many patients are wary of ovulation promotion when they hear such statements.
So today, let’s find out if ovulation promotion can cause premature follicular failure.
What is premature ovarian failure?
Premature ovarian failure is the phenomenon of amenorrhea before the age of 40 due to ovarian failure.
It is characterized by primary or secondary amenorrhea accompanied by elevated blood gonadotropin levels and decreased estrogen levels, and is accompanied by a range of low estrogen symptoms of varying degrees such as hot flashes and sweating, facial flushing, and low libido.
The diagnostic criteria are.
1. Age < 40 years. < div="">
2, Duration of amenorrhea ≥ 6 months.
3, Two times (more than 1 month apart) blood FSH>40mIU/ml.
Developmental process of follicles
1, Early growing follicles (secondary follicles —- anterior sinus follicles – early sinus follicles —- selective follicles)
Resting follicles are non-gonadotropin dependent and are influenced by genetic factors and local regulatory factors. It is only at the secondary follicle stage that they become hyposensitive to gonadotropins and gradually develop into sinus follicles, a process that takes 60 days and begins to become gonadotropin-dependent.
2. Sinus follicle growth phase
When the sinus follicle reaches 2mm in diameter, this is the small follicle that we can see through ultrasound. After that, the granulosa cells increase significantly and their sensitivity to FSH increases further, and the FSH-dependent follicles continue to develop, taking about 25 days to grow from 2mm to 18mm in diameter, the last 15 days being equivalent to the follicular phase of the menstrual cycle.
3. Mature follicles
Follicular recruitment process
The recruitment of the sinus follicle occurs between days 1-4 of menstruation. In a normal young woman, there are about 20-30 follicles in the recruitment stage, which are called follicular clusters.
Some follicles are sensitive to low FSH and some are not, so the sensitive follicles move on to the next stage of growth.
Ovulation stimulation, by increasing the dose of FSH, allows some of the non-sensitive follicles to enter the sensitive category and grow further to reach the standard of mature follicles, so usually more follicles can be obtained with ovulation stimulation than with a natural cycle.
Of course, the process of ovulation promotion is also a process of further recruitment, and if the developing follicle does not follow the development of the dominant follicle, then it still does not eventually become a mature follicle.
Where do all the follicles go?
Adult women have one batch of follicles per cycle, but only one of them eventually matures in the majority of the population, and the rest do not match well to the FSH level and enter the atretic stage accordingly.
Therefore, the ovulation promotion process only pulls the follicles that should have been in atresia back into the growth queue with the use of medication, rather than bringing forward all subsequent follicles.
The real causes of premature ovarian failure
1. Genetic factors
X chromosome abnormalities have been recognized as the main cause of POF, and with the progress of molecular biology, researchers have found more and more candidate genes related to POF on autosomes.
2, immune factors
Researchers have found that 9% to 40% of patients with premature ovarian failure are combined with autoimmune diseases of other endocrine glands or systems, such as autoimmune thyroiditis, systemic lupus erythematosus, myasthenia gravis, hypoparathyroidism, rheumatoid arthritis, idiopathic thrombocytopenic purpura, and diabetes mellitus.
Patients with premature ovarian failure often have a combination of 2 or more autoimmune diseases. Of all autoimmune diseases accompanying POF, thyroid disease is the most common cause, and thyroid disease can be detected in 12% to 33% of patients with premature follicular failure.
In 18% of patients with premature ovarian failure, thyroid disease is inherited in the family, and the second most common is polyglandular autoimmune disease.
Principles of ovulation promotion use.
Outpatient ovulation promotion is a relatively economical and important means of treating infertility with the following clinical indications.
1, menstrual disorders, including polycystic ovary syndrome, where endocrine regulation is basically normal.
2, follicular development abnormalities with insignificant ovulation symptoms
3, follicular growth and endometrial thickening that are not synchronized
4, unexplained non-pregnancy for more than one year, having had normal ovulation monitored by natural cycles
5. those with reasons for needing to get pregnant as soon as possible; 6. those that the clinician feels are necessary.