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Folliculometry
Folliculometry is an important diagnostic method for evaluating ovulation and the regularity of the menstrual cycle.
It is a non-invasive and useful method in the assessment of an infertile couple, but also in the infertility treatment process.
What does folliculometry detect and when is it most useful?
Folliculometry is a valuable method in assessing a woman's menstrual cycle, and as such helps a lot in the diagnosis and treatment of infertility and, of course, menstrual cycle disorders.
It is performed in women whose anamnestic data indicate that she does not ovulate (such as the situation in women with PCOS), when we use drugs to induce ovulation, and practically always in the procedure of in vitro fertilization.
For a long time now that the values of certain hormones in the blood have a significant correlation with the folliculometry findings, so we can also assess a woman's hormonal status with great accuracy using ultrasound findings.
The process of folliculometry in the Gyn. Fertility Clinic Milenković?
The examination is performed with a transvaginal probe in the gynecological position.
The doctor measures the number and dimensions of the follicles, along with, of course, an examination of other anatomical details that are important for the occurrence and development of pregnancy.
As the growth of follicles is a dynamic process, folliculometry is also an examination that is repeated, depending on the findings and the reason for doing folliculometry.
Duration: The folliculometry examination takes a few minutes.
Preparation: The examination does not require special preparation.
Number of examinations: In most cases, three to four visits to the Clinic are needed during one cycle.
After the completed series of folliculometry examinations, patients can expect the final conclusion from the doctor.
Information about ultrasound changes during the cycle will help us decide on a certain approach, that is, it will help us choose an adequate strategy, depending on other circumstances.
What is a follicle?
The ovary is a paired organ that has two functions that are inextricably linked. At the base is the growing follicle, in which the egg cell is located.
To put it simply, a follicle is an egg cell surrounded by a group of cells. In the later stages of development, the cells surrounding the egg cell produce fluid, and the follicle can be seen on the ultrasound examination (as a circular structure with a black interior).
The follicle grows, that growing follicle produces estrogen in increasing concentration, until the moment of ovulation, which is defined as the release of the egg cell and follicular fluid near the inner opening of the fallopian tubes.
Ovulation is a prerequisite for pregnancy.
Expert advice: frequently asked questions
Answers by: Nikola Matavulj MD, specialist in gynecology and obstetrics
How many times during the cycle is it necessary to do folliculometry?
In most cases, three to four visits to the Clinic are required.
What if the follicles do not grow properly?
Suboptimal growth can be threefold, depending on whether follicle growth is stimulated or not. In a natural, i.e. spontaneous cycle, it may happen that follicle dominance and ovulation do not occur. Follicle growth can occur without ovulation (this is how a functional, follicular cyst)is formed. In a stimulated cycle, there may be a slower growth, which is most easily solved by correcting the dose of the drug administered, on the contrary, an intense response may occur, and in the end, disproportionate, non-synchronous growth of follicles may occur. The last option of unsatisfactory growth is the most challenging for the clinician.
How long does the entire follicle tracking process take in one cycle?
It lasts as long as the first phase of the cycle, typically around 14 days, for women with a 28-day cycle. It lasts longer if the cycle is longer? Sometimes an additional examination (after the expected ovulation) is advised, depending on the initial reason for folliculometry.
Is folliculometry reliable for determining ovulation?
There is no ideal ovulation test. The only proof of ovulation is pregnancy. Folliculometry has its irreplaceable place in several situations, and can provide enough information for the gynecologist.
What if the follicle doesn't burst and a cyst forms?
Cyst treatment can be in a "wait and observe" approach, or we can puncture the cyst and evacuate its contents.
How accurate are the folliculometry results?
Folliculometry is a biometric measurement. A lot of studies have been done on follicle growth, and there are nomograms, so the whole procedure is standardized and very specific in the context of interpreting the measurements.
Can folliculometry detect multiple ovulations (twin pregnancy)?
Of course, it can reveal the risk for twin (multiple) pregnancies. This is one of the tasks of folliculometry.
Does folliculometry help couples planning insemination?
In the modern treatment of infertility, when we decide to inseminate, folliculometry is an indispensable part of the procedure.
Can folliculometry predict egg cell quality?
Unfortunately, there is no practically available egg cell quality test.
How many follicles are needed for pregnancy?
Physiologically, we need one follicle. In the procedure of treating infertility, through the procedure of controlled ovarian stimulation, it is clear that the more cells we get, the better the chances. This applies to the obtained 15 cells per cycle, the additional number of cells does not change the final outcome measured through the number of live births.
What if the results show the absence of ovulation in several cycles?
Absence of ovulation is one of the reasons for infertility. There are medications that induce ovulation.
Can folliculometry be done after an abortion?
Previous abortion does not change the indications for folliculometry.
What does dominant follicle mean?
The dominant follicle is the one that shows faster growth and stands out from the others in terms of size. It is expected that the dominant follicle will ovulate when the serum estrogen value reaches a critical value, which is a prerequisite for the LH peak, and when the size of the dominant follicle is from 22 to 24 mm (or 18-24 mm, according to some authors and 17-27 mm).
What are the consequences of non-dominant follicles?
Non-dominant follicles help the chosen, dominant follicle in further growth and development. The fate of non-dominant follicles is cell death, so for one follicle to ovulate, the entire cohort of growing follicles seen by ultrasound examination at the beginning of the the cycle will fail. We can save these follicles from the "cell death" in the IVF procedure.
