Why doesn't the ovarian follicle rupture?

For women, once the follicle matures, the luteinizing hormone reaches its peak, the follicle will rupture, and then the egg will be released. However, for some women, the follicle does not rupture, which will lead to the inability to conceive successfully. There are many reasons for the failure of follicle rupture, the most important of which is endocrine disorders, which will lead to the failure of follicle rupture. In addition, mechanical factors and iatrogenic factors are also common reasons.

Why doesn't the ovarian follicle rupture?

1. Endocrine disorders: is one of the common causes. From follicle recruitment, development, maturation to final ovulation, local and central hormones coordinate with each other, causing the follicle wall to digest a weak point, increasing the pressure inside the follicle and triggering the release of the egg. Endocrine hormone disorders caused by various reasons, such as polycystic ovary syndrome (PCOS), low gonadotropin, hyperprolactinemia and hyperandrogenemia, are prone to LUFS. In addition, prostaglandins in the follicle cause the follicle wall to thin and dissolve when the follicle ruptures, facilitating the discharge of the egg from the follicle. The use of non-steroidal anti-inflammatory drugs (such as indomethacin suppositories) to inhibit the production of prostaglandins in the body may also lead to LUFS.

2. Mechanical factors:

Due to diseases such as chronic pelvic inflammation and endometriosis, the pelvic structure changes, causing the ovaries to be wrapped in chronic inflammatory adhesions, the surface of the follicles to thicken, and the discharge of eggs to be hindered.

3. Iatrogenic factors:

For patients with ovulatory disorders, ovulation-inducing drugs such as clomiphene are used to help follicles grow and mature. These ovulation-inducing cycles are more likely to cause LUFS than natural cycles.

4. Mental and psychological factors:

Infertile women often show symptoms of mental tension, anxiety, and sensitive reactions to the outside world. These psychological fluctuations affect the normal secretion and coordination of hormones in the body, and some patients develop LUFS.

What should I do if the follicle does not rupture?

LUFS is a special type of ovulatory disorder, not an independent disease, and is usually treated causally.

1. Expectant treatment: LUFS occurs accidentally in some patients. For patients with no history of infertility or who discover LUFS for the first time, the lutein cyst sometimes disappears naturally before the next menstruation and does not need to be treated for the time being.

2. Treatment of primary disease: For patients with concurrent diseases such as hyperprolactinemia, PCOS, endometriosis, chronic pelvic inflammatory disease, etc., after a clear diagnosis, medication or surgery will be given to treat the primary disease.

3. Drug-induced follicle rupture: Individualized ovulation induction plan is formulated and optimized. After the follicles mature, high-dose HCG or short-acting GnRH-a is injected alone or in combination.

4. Mechanical treatment: 48 hours after the drug-induced follicle rupture, if the follicle still exists, you can gently and moderately squeeze the follicle by hand under ultrasound guidance. If the follicle still does not rupture, follicle puncture surgery can be performed through the posterior fornix of the vagina under ultrasound guidance to help the egg rupture and be discharged, while also guiding sexual intercourse to try for pregnancy. However, the moderate compression method has limited effect, the puncture method is not cost-effective, and there may be risks such as potential damage and infection, so it is not widely used in clinical practice.

5. Laparoscopic surgery: Laparoscopic surgery is used to improve the pelvic environment and restore normal structure. Moderate ovarian drilling for patients with PCOS can reduce the secretion of androgen, increase feedback to the hypothalamus and pituitary gland, and induce follicle rupture; if combined with severe endometriosis or pelvic adhesions, it can loosen the adhesions.

6. In vitro fertilization: Patients who still fail to conceive or have recurrent LUFS after using the above methods are recommended to consider in vitro fertilization treatment. The eggs are removed through egg retrieval surgery and fertilized with sperm in vitro to solve the fertility problem.

7. Psychotherapy: Relaxing and, if necessary, seeking psychological counseling can help restore normal ovulation.