What to do if the follicle is enlarged and does not rupture

The follicle is very important for women and is a special existence. When the follicle grows to maturity, it will rupture, and then the egg will be discharged. If the female follicle does not rupture, the female egg will be blocked in the follicle and cannot be discharged. In this way, it cannot combine with the male sperm, and the girl cannot get pregnant. So what should I do if the follicle does not rupture?

Some scholars have confirmed the existence of luteinized unruptured follicle syndrome (LUF syndrome). It refers to the failure of mature follicles to rupture due to various reasons, so the egg cannot be discharged, but the patient still has regular menstrual cycles and normal corpus luteum function, that is, although a corpus luteum is formed, no egg is discharged. The function of this corpus luteum is the same as that of the corpus luteum after normal ovulation, and it can synthesize and secrete estrogen and progesterone. Therefore, general examination methods, such as basal body temperature measurement, cervical mucus examination, endometrial biopsy and peripheral serum estrogen and progesterone level measurement, cannot confirm anovulation, but may mistakenly indicate ovulation.

With the development and improvement of various diagnostic technologies, especially in recent years, in the process of using laparoscopy to observe ovulation and B-type ultrasound to monitor follicle development, it has been found that the incidence of luteinized unruptured follicle syndrome is not low. According to foreign reports, in a group of 102 women with unexplained infertility, laparoscopy was performed 3-5 days after ovulation, and 30 cases had no post-ovulation blood body formation (referring to a vascularized structure seen on the ovaries during laparoscopy 2-5 days after the basal body temperature rises). However, this syndrome does not necessarily occur in every cycle. It may occur occasionally in a certain cycle, or it may occur repeatedly in the same patient, which means that it may be one of the causes of unexplained infertility. How often it occurs is not yet clear.

So why doesn't this mature follicle rupture? It turns out that ovulation is a very complex physiological process, and every link in the reproductive endocrine axis must remain normal, otherwise it will cause long-term or temporary anovulation. In particular, the hormonal environment of the mature follicle itself is very important for ovulation. If the ratio of estrogen to androgen in the follicular fluid is unbalanced, the follicle may become atretic. It is now clear that in amenorrhea, anovulation is caused by hyperprolactinemia, confirming that prolactin plays an important role in ovulation. Serum secretin levels will increase when you are in a state of tension and stress. Infertile women can be said to be in a state of long-term tension, because they have to measure their basal body temperature every day and choose the time to have sex every month. The fear of not getting pregnant and the outside world's contempt and ridicule will invisibly give them a lot of mental pressure, which may cause high prolactin without ovulation. Therefore, some people believe that this syndrome is the factor of so-called psychological infertility. In addition, the level of prostaglandins in the follicles and the action of proteases are also very important. If their levels are insufficient, it will also cause anovulation. In short, there are still many unknowns about the etiology and pathogenesis of this syndrome, and in-depth research on the ovulation mechanism of human eggs and their development and maturation is needed. If it is possible to prevent artificial follicles from rupturing in normal people, then it would be possible to find a contraceptive method that most closely approximates the physiological state.

Currently, it is quite difficult to diagnose this syndrome in general hospitals. Its diagnosis must first rule out infertility caused by various factors, directly observe under laparoscopy or take peritoneal fluid to measure hormone levels, or use B-type ultrasound to observe follicular development and ovulation. Its treatment is also relatively difficult. Currently, the method of using human menopausal gonadotropin and chorionic gonadotropin to induce ovulation has achieved certain therapeutic effects. Since this syndrome is related to mental factors, the patient's psychiatric treatment cannot be ignored.