Follicular atresia

Follicular atresia refers to the process in which a follicle fails to develop, thus preventing it from ovulating and releasing an egg.

[2] Ovaries are the site of development and breakdown of ovarian follicles which secrete hormones and oocytes.

[6] It has been observed that this mechanism is important in regulating and maintaining a healthy reproductive system in mammals.

The dramatic decrease in estrogen and progesterone levels that is characteristic of menopause is caused by follicular atresia.

[8] Atresia is a complex, hormonally controlled apoptotic process that depends dominantly on granulosa cell apoptosis.

[11] Anti-Müllerian hormone (AMH) has been studied to be a key regulator in the ovaries in humans that inhibits follicular atresia.

It has been proven that AMH reduces the growth of follicles and its upregulation proposes a potential pathophysiological pathway in PCOS.

[25] POF may present itself with characteristics and symptoms such as loss of menstruation for at least 4 months and also increased serum follicle-stimulating hormone (FSH) concentration (greater than or equal to 40 IU/L).

[26] There may be many causes of POF, ranging from genetic disorders to surgery, radiation therapy, and exposure to environmental toxicants.

Accelerated follicular atresia due to chromosomal and genomic defects accounts for up to one-half of all POF cases.

[27] Some of the short term effects of POF are hot flashes, irregular heart beat/heart palpitations, night sweats, urogenital symptoms, and headaches; some of the more long-term consequences of POF are osteoporosis, infertility, cardiovascular diseases, and possible premature death.

[26] When an ovarian follicle fails to undergo atresia and release an egg, it can grow to form a cyst.

If the cyst lasts for longer than a few months, a physician may recommend surgical removal or testing to determine if it is cancerous.

[35] Polycystic Ovary Syndrome, or PCOS affects 6-12% of women of reproductive age in the United States, and is one of the common causes of female infertility.

[37] Diagnosis of PCOS is based on meeting two of the three clinical criteria based on the Rotterdam Criteria: chronic anovulation (the ovum is not released from the ovary during menstrual cycle), hyperandrogenism (increased levels of androgen hormones, such as testosterone), and large number of ovarian cysts.

Guidelines suggest possible oral contraceptives in combination with metformin (anti-diabetic medication), and/or anti-androgen agents.