In some women with infertility, the follicles grow well each cycle, but the eggs repeatedly fail to expel and eventually the follicles become luteinized, a condition that medically we call luteinized follicular failure to rupture syndrome (LUFS). If the follicle does not rupture consistently, it is important to correct it, otherwise the fertility problem will not be solved. Today, let’s talk about this topic specifically. What is non-rupture of the follicle? Once the follicle has developed, 48 hours after peak luteinizing hormone (LH) or chorionic gonadotropin (HCG) injection, ultrasound shows that the follicle is still present, has not collapsed or disappeared and the egg has not been expelled from the follicle, this is LUFS. these patients also have a normal menstrual cycle and changes in cervical mucus, giving the illusion of ovulation. The follicles still secrete progesterone after luteinization and the basal body temperature remains elevated in the second half of the menstrual cycle, which is less likely to be detected without ultrasound monitoring. The incidence of LUFS is about 10% in those monitored for ovulation and about 25-40% in those who are infertile. Why do mature follicles not rupture? 1. Endocrine disorders: is one of the common causes. From follicle recruitment, development, maturation to final ovulation, the local and central hormones coordinate with each other, prompting the follicle wall to digest a weak point and the pressure inside the follicle to increase, triggering the egg to be discharged. Various causes of endocrine hormonal disorders such as polycystic ovary syndrome (PCOS), hypogonadotropic, hyperprolactinemia and hyperandrogenemia predispose to LUFS. in addition, intrafollicular prostaglandins promote thinning and dissolution of the follicular wall during follicular rupture, facilitating egg expulsion from the follicle. The use of non-steroidal anti-inflammatory drugs (such as anti-inflammatory pain suppositories) to inhibit the production of prostaglandins in the body can also lead to LUFS. 2. Mechanical factors: Chronic pelvic inflammatory disease and endometriosis cause structural changes in the pelvis, resulting in chronic inflammatory adhesions around the ovaries and thickening of the follicular surface, which hinders the discharge of the eggs. 3. Medical factors: For patients with ovulation disorders, ovulation-promoting drugs such as clomiphene are applied to help follicles grow and mature. These ovulation-promoting cycles are more likely to cause LUFS than natural cycles. 4. Psychosomatic factors: Infertile women often show mental tension and anxiety and sensitivity to external reactions. These psychological fluctuations affect the normal secretion and coordination of hormones in the body and LUFS occurs in some patients. What should I do if my follicles do not rupture? LUFS is a specific type of ovulation disorder, not an independent disease, and is mostly treated with allopathic treatment. 1. Expectant therapy: LUFS occurs incidentally in some patients. For patients without a history of infertility or in patients with LUFS found for the first time, sometimes the flavin cysts can disappear naturally before the next menstrual period and can be left untreated for the time being. 2. Treatment of primary disease: For patients with combined hyperprolactinemia, PCOS, endometriosis, chronic pelvic inflammatory disease, etc., medication or surgery should be given to treat the primary disease after clear diagnosis. 3, pharmacological follicle rupture: individualize and optimize the ovulation promotion protocol, and give high-dose HCG or short-acting GnRH-a injections alone or in combination when the follicles are developed and mature. 4.Mechanical treatment: 48 hours after follicle rupture by medication, if the follicle still exists, the follicle can be gently and moderately squeezed by hand under ultrasound guidance. If the follicle still does not rupture, follicular puncture can be performed under ultrasound guidance via the posterior vaginal fornix to help the egg to rupture and expel, as well as to guide sexual intercourse to try for pregnancy. However, the moderate squeezing method has limited effect, the puncture is not cost-effective, and may have risks such as potential injury and infection, so it is not much used clinically. 5.Laparoscopic surgery: laparoscopic surgery is performed to improve the pelvic environment and restore the normal structure. In patients with combined PCOS, moderate ovarian perforation can reduce androgen secretion, increase feedback to hypothalamus and pituitary gland, and induce follicle rupture; if combined with severe endometriosis or pelvic adhesions, adhesions can be loosened. 6. IVF: Patients who are still infertile or have recurrent LUFS using the above methods are advised to consider IVF treatment, in which the eggs are removed and fertilized with sperm outside the body through egg retrieval surgery to solve fertility problems. 7. Psychotherapy: Relaxation and psychological counseling if necessary can help restore normal ovulation.