What is premature ovarian failure? Premature ovarian failure is defined as the onset of amenorrhea, perimenopausal syndrome or menopausal symptoms, hypoestrogenemia and hypergonadotropic hypogonadism before the age of 40 years, and depleted ovarian reserve. The diagnostic criteria are: 1. Age <40 years. 2, Duration of amenorrhea ≥ 6 months. 3. Two (more than 1 month apart) blood FSH > 40mIU/ml. Patients with premature ovarian failure have lost their fertility and have obvious symptoms of menopause. I believe that all women are afraid of premature ovarian failure. The number of follicles in women is fixed at birth, no more new follicles after birth, about 400-500 follicles in a lifetime, so worry that originally only one follicle per month, after entering ovulation promotion is not the later follicles are discharged early, will not this ovarian premature failure? In fact, it is not, so today we will discuss this issue. 1, first of all the process of follicle development is the resting follicle, early growth follicle (secondary follicle —- pre sinus follicle – early sinus follicle —- selection follicle), sinus follicle growth period, mature follicle. 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. When the sinus follicle formation reaches 2 mm 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. The FSH-dependent follicles continue to develop and take about 25 days to grow from 2mm to 18mm in diameter, the latter 15 days being equivalent to the follicular phase of the menstrual cycle. 2. There is a very important stage in the process of follicular maturation which is the recruitment process, just like the well-known huge number of sperm, but the final fertilization can only be one out of millions. The recruitment of sinus follicles occurs between the 1st and 4th day of menstruation. In a normal young woman, there are about 20-30 follicles that enter the recruitment phase, 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 cannot eventually become a mature follicle. Where do the immature follicles go? This brings us to follicular atresia. Atresia is actually a process that begins at 7 weeks of a woman’s fetal gestation, when the oocyte is annihilated, which is in accordance with the laws of nature. The follicles that enter a cycle are all in one batch, but the natural cycle eventually matures only one in most of the population, and the rest do not match well to the FSH level and enter the atretic stage accordingly. In other words, the ovulation promotion process only pulls the follicles that should have been in atresia back into the growth queue using the medication, but not all subsequent follicles. Will the medication used affect subsequent follicles? As mentioned above the resting follicles are non-gonadotropin dependent, i.e. they can be said to be in a sleepy phase and do not respond. In contrast, the start of secondary follicles to follicular maturation generally involves a period of 3 months. The main causes of premature ovarian failure: 1. chromosomal abnormalities, especially of the X chromosome, such as Turner syndrome (X chromosome deletion), fragile X syndrome; 2. drugs toxic to the ovaries such as chemotherapy, pelvic radiotherapy, ovarian-related surgical treatment, autoimmune diseases, etc.; 3. Despite this, a significant proportion of premature ovarian failure is of unknown origin, as the person is a whole. Psychological factors can also affect ovarian function, such as high-intensity workload, anxiety and depression and other stressful psychology, excessive staying up late can affect ovarian function, and currently because of the change in social rhythm, this aspect causes premature ovarian failure in the increase. So I hope you adjust your mindset, arrange your life and work rationally, and have a positive and healthy way to improve your quality of life.