(Monday, July 21, 2014)

The Difference Between Follicles & Ovarian Cysts
Cyst ? Or follicle ?

A patient just sent me this query

I am 29 and trying to conceive for past 4 years. I have irregular cycles. My doctor prescribed me Injection recagon 100units for 6 days from 12-May-2014. On 11th day of cycle during follicle study I got dominant follicles on both ovaries and doctor prescribed to take orgamed capsules for 14 days This month I didn’t get my periods and HPT is negative and even checked with doctor, it is negative again and she prescribed me registration tablets for 10 days I have a clarification. If I got dominant follicles on both ovaries, where the follicles would have gone? As per my assumption it should be either fertilized or I should have stated periods. I'm so confused. Please guide me.

It’s very common for infertile women to be confused about reproductive basics. They often do not understand the relationship between menstrual cycle and ovulation; or the difference between follicles and eggs; or how the follicles are different from cysts.

We need to go back to basics, to make sure there is clarity going forward. Otherwise, this poor patient will keep on going round and round in circles, cycle after cycle!

This was my answer.

The reason your periods are irregular is because you, Do not ovulate. This is called Anovulation read more here.

This may be because you have PCOD (polycystic ovarian disease) You can read more here.

You need the following medical tests.

1. Blood tests for you for the following reproductive hormones – To check the quality of your eggs. Do this from a reliable lab such as SRL (www.srl.in)
  • FSH (follicle-stimulating hormone)
  • LH (luteinizing hormone)
  • PRL (prolactin)
  • AMH (anti-Mullerian hormone)
  • TSH (thyroid stimulating hormone)
2. A vaginal ultrasound scan which should check for the following.
  • Ovarian volume
  • Antral follicle count
  • Uterus morphology
  • Endometrial thickness and texture

Please send me the detailed test results and medical reports. You can scan them in as a single Word file and email them to me. Patients with PCOD will typically have a high AMH level; a high LH: FSH ratio; increased ovarian stroma; and many small cysts arranged around the periphery of the ovary.

So what’s the difference between a follicle and a cyst? A cyst is basically a follicle, which does not contain an egg. They both appear as hollow dark spherical objects in the ovary on ultrasound scans. Since we cannot make out if the structure we see about scanning contains an egg, this creates a lot of confusion in the patient’s minds.

To make matters worse, doctors often loosely refer to the follicles seen on ultrasound scanning as eggs. In reality, eggs are microscopic, and can only be seen in the IVF lab when the follicular fluid is examined under the microscope by the embryologist. While there are many kinds of cysts, the commonest kind we see is called a functional cyst, which looks exactly like a follicle, except that it’s larger.

Thus, when a mature follicle (which contains an egg) failed to rupture at the time of ovulation, it collects fluid and becomes larger. This is called LUF syndrome Read more here.

A functional cyst (so called because it is functioning and produces hormones) will often result in the period being delayed, as a result of the hormones it produces. This is why it may cause the period to be delayed. It’s possible to make this diagnosis by doing an ultrasound scan. The period can be induced by medications. These cysts will usually resolve on their own.

Have a query you are scared to ask your doctor because he is too busy?

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