Menstrual regularity but not pregnant, "false ovulation" every month? Be sure to be wary of this disease!

"False ovulation": unruptured follicle flavinization syndrome

What we call false ovulation, scientifically called Luteinized Unruptured Follicle Syndrome (LUFS), refers to the follicle maturation but not rupture, the egg cells are not excreted and in situ flavinylation, forming a luteum and secreting progesterone, and causing a series of changes similar to the ovulation cycle in the effect organs of the body.

To put it simply, the follicles have also matured, and there are corresponding sign changes such as bipolar body temperature, ovulation dipsticks can measure the LH peak, there is a transparent brushed white belt, and the intima is converted into a secretory period to have a normal menstrual period.

but! This mature follicle is not excreted, it is "false ovulation"!

It is one of the important causes of infertility, and the incidence of LUFS in infertile women can reach 30%.

Why "false ovulation"?

The mechanism of LUFS is currently unclear, and the possible causes are as follows:

1. Central endocrine disorders

Ovulation is a complex process of synergy between multiple hormones, and central endocrine disorders can directly affect the growth and development of follicles and the occurrence of ovulation.

Studies have shown that the ovulation process is stimulated by the peak secretion of LH/FSH, mainly by LH. When the central endocrine disorder is caused by various causes, the level of LH peak secretion is not enough, the amount of LH secretion is not up to the value or the LH peak appears prematurely, which cannot stimulate the biochemical and histological changes that cause the follicle wall to be digested and ruptured, but it can lead to the re-initiation of meiosis and the "false ovulation" phenomenon of follicle failure and progesterone secretion.

2. Local disorders of the ovaries

Endometriosis, pelvic inflammatory disease, pelvic surgery, etc. can cause pelvic adhesions, excessive fibrosis and thickening of the ovarian cortex, resulting in follicles that cannot be ruptured and discharged after maturity, but endogenous LH can promote follicular cytovinization.

This shows normal menstrual cycle changes.

3. Mental and psychological factors

It is also believed that it is related to mental and psychological factors, long-term infertile women are in a state of tension and constant stress, resulting in repeated small spikes in blood prolactin levels and affecting ovulation. Therefore, for couples who can't find out the specific cause of infertility and are very anxious, doctors will always recommend that they go out for a vacation, relax their spirits, and maybe relax their mentality during the vacation, and they will get pregnant, such examples are really not in the minority.

How do I diagnose if it's "false ovulation"?

It is mainly judged by clinical manifestations and related examinations.

1. Clinical manifestations

Infertility is a common symptom and is often mistaken for "unexplained" infertility.

May be accompanied by pelvic endometriosis or chronic pelvic inflammatory disease.

There are often no abnormalities in the menstrual cycle and menstrual flow.

Occasionally, there is a slightly shorter luteal phase or a low progesterone level, but there is no specificity.

Clinical methods of ovulation monitoring, such as basal body temperature (BBT), cervical mucus (CMS), and progesterone measurement, are all suggested as "ovulatory" menstruation.

2. Relevant inspections

B ultrasound continuous detection: from the 8th to 9th day of menstruation, daily vaginal B ultrasound continuous observation to understand the development dynamics of follicles, if there is a dominant follicle formation, up to the standard of mature follicles (the maximum diameter of the follicle > 18mm clear and transparent, clear boundaries, etc.), and no ovulation performance, that is, the follicle continues not to disappear or shrink significantly (follicle retention type), or continue to enlarge (30 ~ 45mm, the follicle continues to grow large), uterine rectal depression without free fluid, can be considered as an unruptured follicle flavinization (LUF) cycle, This is currently the most commonly used method.

Laparoscopy: laparoscopy is further confirmed when unruptured follicle flavinification is suspected. Signs of ovulation are thought to persist for 1.5 days after ovulation, and there is a luteal body forming on the ovary but no ovulation holes. Because it is invasive, it is less clinically useful.

Endocrine test: indicated in cases where serum LH peak measurement is low or appears prematurely.

It is really "false ovulation", how to treat it?

Because its formation mechanism is not very clear, it is currently symptomatic treatment.

1. Treatment of primary disease

Active management of local mechanical factors that cause LUFS, such as endometriosis, chronic pelvic inflammatory disease, pelvic adhesions, etc.

Women who are overly nervous and anxious should be given psychiatric counseling to help restore normal ovulation. Therefore, women who are trying to conceive must pay attention to adjusting their psychology and not giving themselves too much pressure or anxiety.

2. Drugs promote follicle rupture

After the mature follicles reach the standard (the maximum diameter of the follicles > 18 mm clear and transparent, the boundaries are clear, etc.), intramuscular injection of HCG5000-10000 units can be used to promote the rupture and discharge of the follicles, and the rupture of the follicles can be observed after 48 hours of medication.

After 2-3 cycles of medication, there is still no ovulation, and other methods can be switched.

3. Mechanical therapy

Moderate squeezing of follicles: Follicles do not rupture after 48 h HCG injections and can be gently squeezed by hand under ultrasound guidance. If it is still not ruptured, the follicles can be punctured vaginally under the B ultrasound vagina in combination with guided sexual life.

Assisted reproductive technology: Women who cannot successfully ovulate by other methods can choose embryo transfer (IVF-ET), that is, after super-ovulation induction, egg retrieval is performed under the B ultrasound vagina, and then after sperm-egg binding in vitro, the embryo is transferred into the uterine cavity.

It is worth noting that many normal women may also occasionally appear follicular flavinylation, but it does not belong to LUFS, it can only be flavinylated unruptured follicles, without the word "sign" it is possible to monitor ovulation in the following months, no longer appear flavinyl unruptured follicles, there will be a chance of natural pregnancy.

Therefore, the occasional appearance of flavinated unruptured follicles is not a serious problem, and there is no need to carry mental baggage.

I wish everyone a good pregnancy soon!