Ovulation, folliculogenesis and ovarian reserve

Infertility - Ovulation, folliculogenesis and ovarian reserve

Diagnostic tests

Ovulation monitoring and folliculogenesis

Each time a woman menstruates, she should generally produce a single oocyte (the female sex cell) which is "ovulated" (released) through ovulation after it has reached maturity. This happens via the process of folliculogenesis thanks to the coordinated action of three hormones: FSH (follicle-stimulating hormone), which stimulates the growth of follicles, particularly at the beginning of the cycle; LH (luteinising hormone), which helps stimulate follicular growth and triggers ovulation; and oestradiol, which helps regulate the activity of the other two hormones.

Ovulation can be verified by recording the basal body temperature on a daily basis, observing the changes in body temperature that occur during the different phases of the cycle: this method is very simple but equally unreliable, because measurements are often inaccurate.

Folliculogenesis can be monitored by measuring the hormones involved in this process: FSH, LH and oestrogen.

It is also a good idea to check hormones such as prolactin, the thyroid hormones and androgens, as these can affect the ovulation mechanism and cause infertility and female sterility.

Evaluation of ovarian reserve

This examination is carried out between the second and fifth day of the menstrual cycle and assesses ovarian volume as well as the antral follicle count in each ovary.

This transvaginal pelvic ultrasound, together with an evaluation of the levels of the three hormones mentioned above (follicle-stimulating, produced by the pituitary gland; Inhibin B and anti-Müllerian hormone or AMH, both produced by the ovaries), allows for an estimation of the ovarian reserve.

Normally, levels of Inhibin B and AMH decrease as a woman approaches the menopause, while levels of FSH rise.

Gathering all this information allows us to estimate the ovarian response to pharmacological stimulation with gonadotropins during assisted conception treatments.

Anatomical tests

The fallopian tubes are a fundamental organ for female fertility. Their proper functioning is essential in order to transport and nourish the sex cells and the embryo, so it is vital that they are intact and functional.

Issues affecting the fallopian tubes are often alterations caused by endometriosis or acute and/or chronic pelvic infections (due to sexually transmitted diseases not treated promptly, or to surgery).

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