What Are Follicles and Why Are They Important for Fertility?

Reviewed By: Dr. Shruthi Mantri, fertility specialist at Ferty9 Fertility Center, L. B. Nagar

As a couple, if you are planning your first step towards IVF, getting a personalized session with your gynecologist is always beneficial. The doctor can help you learn about the fertility process and the methods to improve your chances of pregnancy. Once the procedure has started, it is important to take care of everything that is going on inside the body. One of them is follicular study.

In this article, we will help you understand the definition of follicles, follicular scans, their importance, and their success rate.

What Are Follicles?

Follicles are minute sacs that are full of fluid and are found in ovaries. They contain oocytes (immature eggs) and are responsible for secreting hormones. These hormones influence menstrual cycle stages in a woman. Every follicle can release a fertile egg. Their size plays a key role in determining fertility and its treatment.

Stage 1: This is where the follicle starts to mature and is all set to be released at the time of ovulation. The germinal cells surround the ovarian follicle to form various layers called primary follicles.
Stage 2: This is when this follicle will get more mature, and the granular cells will create more layers around it.
Stage 3: Two more layers are formed around the follicle (internal and external). It will have a fluid-filled space now (antrum).
Stage 4: This is the final stage, at which the oocyte is mature and can be released during ovulation. It supports embryo implantation after the sperm fertilizes it.

Now that we are clear on what is follicle in the ovary, let’s get an understanding of the scanning procedure.

What Are Follicular Scans?

A follicular study scan is a basic monitoring procedure where the follicles in an ovary are studied. Also termed follicular tracking ovarian monitoring, this process is imperative for fertility treatment and assessment. Conducted through several TVS (Transvaginal) Scans, it tracks the growth of ovarian follicles during the menstrual cycle. A reproductive specialist or sonographer is responsible for conducting the follicular monitoring. The process is as follows:

Baseline Scan: This ovulation study is initiated within the 3 days of the menstrual cycle. It gives the ovaries baseline measurement and the quantity of resting follicles. The scan provides information about the uterus’ baseline status and the antral follicular count.
Serial Scan: An ultrasound is conducted every 2 to 3 days during the menstrual cycle. It helps track the follicle growth.
Rupture Scan: This last scan is used to confirm that the ovulation is successful. It detects if there is any free fluid and follicle collapse.

Why is follicular Monitoring Done?

Follicular monitoring, or “Follicular study sonography,” is an important part of the IVF journey. It detects if the woman’s body is responsive to the fertility treatment. The doctor gets to learn about the number of eggs and their condition during the ovulation process. This monitoring also confirms the status of the involved hormones. In case the level is undesirable, the current medications are altered to increase the possibility of conception.

The follicular study also helps determine the exact time when ovulation will happen. This helps find out when intercourse is advisable so that the pregnancy chances increase. That’s not it. It is also a useful test to diagnose ovulation-related problems so that the doctor can start the treatment plan.

Follicular Study for Fertility Assessment and Treatment

Follicular monitoring is an important step for fertility diagnosis and treatment. It gives you extensive information about follicle development and growth. The study also helps identify which follicle is dominant and what is the status of the uterine endometrium. Through this, the doctor can take the next steps to manage infertility. It is majorly suggested to women who are unaware of their ovulation period or have had a miscarriage. Here are some of the instances when a test is recommended:

When the woman uses prediction kits but still does not have an idea of her ovulation time.
When the woman is taking medicines to start the ovulation process.

This tracking gives a better idea of how to proceed with the treatment course.

Why Are Follicular Scans Important?

A follicular study scan report is important in the following cases:

If a woman has been actively trying to get pregnant for over a year before the age of 35. This study helps rule out the possibility of ovulation-related difficulties.
If a woman has been trying to get pregnant for 6 months after the age of 35.
If a woman has PCOD and faces irregular ovulation and cycle.
If a woman is on fertility drugs and undergoing anIUI or IVF procedure.

Once you undergo the follicular study, you will get clarity on your status.

What Is the Procedure of Follicular Study?

The procedure is as follows:

Empty your bladder right before the scan.
A technician will check your blood pressure and oxygen level.
The scan must be performed while lying down in the stirrup position.
The sonographer will cover the transducer (an electronic device) with protection and apply a layer of lubricant on it. This will ensure easy insertion of the device into the vagina.
The device will send sound waves to the pelvic organs. They are recorded by the machine and transformed into images.
The resulting images will showcase the follicle size along with other parameters.
Once the procedure is over, the lubricant will be cleaned, and you can wear your clothes.

This is a non-invasive procedure and does not cause any kind of discomfort to the women.

There might be some side effects to the scan. Although they are not physical, going through this process can be emotionally exhausting for the couple. Generally, couples who are suggested this follicular test are already trying for a baby naturally but to no result. When the doctor studies the results of the scan, he can tell you the ovulation timetable which you have to follow. It increases the chances of pregnancy. Sometimes, in this situation, the woman only wants to have intercourse during ovulation. This can impact her partner’s libido.

How Does Follicle Tracking Work?

Follicle tracking is where continuous rounds of ultrasounds are conducted to study the ovulation progress. As the follicles begin to develop from the 9th day of the menstrual cycle, the scans are conducted till they have disappeared.

This marks the initiation of the ovulation window, the optimal time frame for conception. During this period, intercourse is recommended to maximize the chances of sperm and egg meeting for fertilization. This process helps learn what is a good size of follicle for fertilization.

As the doctor tracks the progress, he sees if the follicle size for conceiving is right or not. The endometrium (uterus wall) thickness and blood flow towards the follicle are also measured.

Typically, the accurate follicle size for pregnancy is between 18 and 25 mm, and the endometrial thickness should be over 10 mm.

Some other uses of a follicular scan are as follows:

Diagnosing the follicles which are unable to grow before they rupture.
Detects the follicles which do not grow at all.
Detects follicles that are too dominant to rupture.
Learning about the quality and thickness of the endometrial lining.
Detects other complications like OHSS.
Detects the right time of ovulation to improve the chances of pregnancy.
Detects unruptured follicle
Acts as a guiding force through ovulation-inducing injections or drugs.

Every possibility is closely monitored by the gynecologist to ensure that there are no further complications.

Role of Follicular Study

Role of follicular study depends on several factors, including the age and hormone levels of the patient. According to the studies conducted, this percentage is not static. The variation is because of the other factors affecting the study. However, a younger woman has a higher chance of success as compared to an older woman.

Although a follicle scan might not guarantee a successful pregnancy, it can provide the right insights for the doctor to proceed with the treatment plan.

How Much Time Does it Take to Undergo a Follicular Study?

A follicular study takes approximately 5 minutes, provided you follow the instructions of the sonographer and doctor properly. The preparation before the scan might take a few hours.

Conclusion

A follicular study is an important parameter in understanding the stage of growth and development in the ovaries. Any couple planning a natural pregnancy, IUI, or IVF treatment will benefit from this procedure.

It provides a clear picture of how the woman’s ovary is functioning, the time of ovulation, and how the body is responding to the treatments. So, if parenthood is on your mind, you can consult the best gynecologists at Ferty9. Reach out to us and schedule a scan to kickstart the journey.

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What Are Follicles and Why Are They Important for Fertility?

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