How to prevent and treat luteinized follicles

Follicular luteinization refers to the follicles maturing but not rupturing, and the soft cells are not discharged but luteinized in situ. The occurrence of these problems will directly affect female conception and cause female infertility, so it is important to pay attention to prevention, treatment and treatment.

1. Luteinized unruptured follicle syndrome refers to the phenomenon that the follicle matures but does not rupture, the oocyte is not discharged but luteinized in situ, forming a corpus luteum and secreting progesterone, and a series of changes similar to the ovulation cycle occur in the effector organs of the body. The main clinical features are regular menstrual cycles, similar ovulation performance but persistent infertility. It is a special type of anovulatory menstruation and one of the important causes of infertility. In 1975, Jewelewicz first proposed the situation of luteinizing follicles without rupture and named it LUFS. Treatment methods vary from person to person, and are often based on inducing ovulation. The most commonly used method is hormone supplementation. If the follicles fail to rupture after several months of using ovulation-inducing drugs, in vitro fertilization may be necessary. The cause of LUFS is still unclear. Most people believe that it is related to central regulatory disorders, local disorders, and mental and psychological factors. The incidence rate varies from report to report, but most believe that it occurs in about 5% to 10% of natural menstrual cycles and about 30% to 40% of drug-induced ovulation cycles. According to dynamic B-ultrasound monitoring, it can be divided into three types: small follicle type, follicle retention type and continuous enlargement type.

2. Prevention and treatment

1. Luteinization of follicles is mostly found in the systematic monitoring of follicular development and ovulation in infertile patients, and LUF does not occur in every menstrual cycle. Therefore, its prevention and treatment is only of clinical significance for infertility. Since LUF does not occur in every cycle, the authors believe that it is more appropriate to treat after LUF occurs in two consecutive menstrual cycles.

2. There is no mature experience in the prevention and treatment of LUF, and the therapeutic effect is less than ideal. Most people advocate using HCG (10,000-15,000 IU) to stimulate ovulation when the follicles reach maturity as monitored by ultrasound. It has been reported that luteinized follicles are divided into two types, mature and precocious. When the follicle reaches the size of a mature follicle (average diameter 18-24mm), and estradiol > 734pmol/L and progesterone < 7.95nmol/L, it is considered to be in the maturation stage. When the follicles have not reached the size of mature follicles and progesterone is >7.95nmol/L, it is precocious. For the mature type, it is recommended to use HCG or: HCG and HMG injection at the same time to stimulate ovulation and achieve certain results. For precocious puberty, larger amounts of estrogen or GnRH-A can be used to inhibit follicle development, and then HMG can be used to induce follicle growth. For those with small (not reaching the size of mature follicles) and luteinized follicles, it is recommended to use chlorsucralose or HMG to promote follicle development, and then use HCG to stimulate ovulation when the follicles are mature.

3. The prevention and treatment of luteinized follicles is only for infertile people, because luteinized follicles is not a persistent disease. When taking the medicine, it cannot be predicted that LUF will occur in this cycle. It can be seen that the purpose of taking the medicine is to prevent LuF from occurring again in this cycle and affecting conception. In fact, if ovulation occurs after taking the medicine, it may be the effect of treatment or it may be natural ovulation, so the efficacy of LUF is more difficult to judge accurately.

4. Clinically, patients taking clomiphene often develop luteinized unruptured follicle syndrome. In order to prevent the occurrence of this phenomenon, human chorionic gonadotropin is often used for treatment. In addition, patients with endometriosis or women with hyperprolactinemia often have this type of occurrence, and treating the primary disease and using bromocriptine can help improve it.