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Ovarian follicles: what they are and what they indicate about female fertility

Home > Blog > Fertility

By Dr. Victoria Verdú (Licensed Gynaecologist No. 282847366).

Imagen de una maqueta de un útero con folículos ováricos

What are ovarian follicles?

Ovarian follicles are small structures within the ovary that contain an oocyte (an immature egg) surrounded by cells that nourish it and help it mature.

We can imagine them as microscopic “sacs” where eggs develop. Each follicle includes: the oocyte (the future female reproductive cell); granulosa cells, which nourish it; theca cells, which produce hormones; and follicular fluid when the follicle matures.

The number, size, and development of these follicles are key parameters for achieving pregnancy, both naturally and through assisted reproductive techniques.

They are small fluid-filled structures located in the ovaries that contain an immature oocyte inside. Each of these follicles acts as a kind of “capsule” that protects and nourishes the egg while it matures.

Women are born with all the oocytes they will have throughout their lives. During the reproductive years, many of these oocytes begin their development, but only a small proportion will complete the maturation process. In fact, during each menstrual cycle several follicles begin to grow under hormonal influence, although usually only one reaches the ovulatory stage.

How many follicles are there in each ovary?

This depends on each woman and her age. To count them, a transvaginal ultrasound is performed at the beginning of the menstrual cycle to observe the so-called antral follicles—small fluid-filled sacs that contain immature eggs and serve as an indicator of ovarian reserve. As a general reference:


This count is not interpreted in isolation, but together with other hormonal tests and the patient’s age.

Micrograph of the human ovary showing Graafian follicle containing secondary oocytes.Micrograph of the human ovary showing Graafian follicle containing secondary oocytes.

How do follicles develop?

Follicular development is a complex process that occurs in several stages:


During the first days of the menstrual cycle, several follicles begin to develop in the ovaries. As the days pass, one of them usually becomes dominant and is known as the dominant follicle, which will ultimately release the oocyte during ovulation, while the remaining follicles undergo atresia and are reabsorbed.

Throughout this process, the follicle gradually increases in size. At the beginning they usually measure between 2 and 10 millimeters, but as the cycle progresses the dominant follicle may reach between 18 and 24 millimeters before the release of the oocyte (ovulation).

In assisted reproduction treatments, the situation is different. Instead of a single follicle maturing, specialists use hormonal medication to stimulate the growth of several follicles at the same time (all those recruited by the ovary for that cycle), with the aim of obtaining multiple oocytes in a single cycle and thereby increasing the chances of treatment success.

A key indicator of reproductive health

The study of ovarian follicles provides very important information about ovarian function and a woman’s reproductive capacity at the time of evaluation. Medical specialists use several parameters to guide fertility treatments, including the number of available follicles, their development during the cycle, and their response to hormonal stimulation.

For this reason, follow-up ultrasounds and follicle counts are an essential part of reproductive evaluation and make it possible to tailor treatments to each patient’s characteristics. In assisted reproduction, every case is unique and there is no universal formula for achieving a positive result. That is why personalization and a detailed assessment of each case are key to the entire process.

Authors

Authors and medical review

Author
Dr. Victoria Verdú

Dr Victoria Verdú Merino is a gynaecologist specialising in assisted reproduction and reproductive medicine at IVF-Life Madrid, with more than 25 years of experience in the diagnosis and treatment of infertility. Her clinical practice focuses on in vitro fertilisation (IVF), low ovarian reserve, recurrent implantation failure, recurrent miscarriage and reproductive immunology. She is a member of SEF, SEGO and ESHRE.

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