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Hemorrhagic and Ruptured Ovarian Cysts and Acute Complications of Uterine Fibroids
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Youssef Youssef, Mostafa A. Borahay
The exact etiology of cyst rupture is not clear; however, the increased vascularity in the luteal phase may predispose the corpus luteal cyst to rupture [4]. The ovary has an outer cortex rich in primordial follicles and an inner vascular medulla. Under the influence of hormonal changes during the ovarian cycle, the avascular granulosa cells and stromal cells are vascularized. At the time of ovulation, the LH surge leads to Graafian follicle rupture, resulting in mid-cycle pain commonly referred as mittelschmerz pain, thought to be due to release of fluid in the peritoneal cavity. The corpus luteum is formed from the ruptured leading follicle. The stromal cells are luteinized, and the granulosa cell layer becomes vascularized. The vessels within the corpus luteum wall are thin and tend to bleed, forming a hemorrhagic cyst. The ovary is surrounded by a thin connective tissue layer called the tunica albuginea. The ovarian tunica is thin and malleable, which then allows distention of the ovary by growing follicles. As the tunica distends, stretched blood vessels subsequently tear, resulting in an insignificant amount of bleeding. However, bleeding from larger vessels would result in much more substantial pain and would also result in hemoperitoneum [2, 5].
The Ovaries and the Adnexa
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Kuhan Rajah, Dimitrios Mavrelos
As discussed earlier, at the beginning of the menstrual cycle, the ovaries contain a wealth of antral follicles seen on transvaginal ultrasound as simple sac-like pockets that contain anechoic fluid between 2 and 10 mm arranged at the periphery of the ovary. Quantification of these follicles is a direct assessment of a woman's ovarian reserve as the number of antral follicles that emerge will reflect the number of primordial follicles available to start the journey of maturation approximately 180 days earlier [9]. The subpopulation of antral follicles that best correlates with ovarian reserve includes those between 4 and 6 mm [10]. Counting smaller ones is likely to include atretic follicles and therefore be an overestimate. However, to avoid the time-consuming process of measuring each follicle individually, by convention, all follicles measuring 2–10 mm are included in antral follicle counts (AFCs) [11].
The Use of Ovarian Markers
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
Neena Malhotra, Siladitya Bhattacharya
Ovarian reserve is a term used to describe a woman's reproductive potential and is a reflection of her pool of primordial follicles or, more specifically, the number and quality of oocytes in her ovaries (1). Each woman is born with approximately 2 million primordial follicles, but this number drops to 400,000 around menarche as a consequence of follicular atresia (2). Follicle numbers fall further with age, and the rate of decline is faster when women are in their mid-30s. This decline in fertility potential is specific for an individual woman and is influenced by race as well as genetic and environmental factors.
Does Maternal Vitamin D Level Affect the Ovarian Reserve of Female Newborn Infants?
Published in Fetal and Pediatric Pathology, 2022
Ebru Sahin Gulec, Esra Bahar Gur, Secil Kurtulmus, Banu Isbilen Basok, Duygu Cebecik Ozmus, Veli Iyilikci, Ahmet Demir
Besides its well-known effects on calcium metabolism, vitamin D is a steroid hormone that plays a crucial role in many cellular processes such as proliferation and differentiation. It is currently accepted that vitamin D modulates approximately 10% of the entire human genome and has an important role in developmental processes, including the developing fetus during pregnancy [1]. Current literature suggests an association between vitamin D deficiency and adverse pregnancy outcomes such as impaired fetal growth, preeclampsia, and preterm delivery although the exact mechanism of these processes is not yet known [2–4]. The development of the ovaries in the prenatal period is closely related to the reproductive potential in the future reproductive period. The total number of primordial follicles is determined in the second trimester of pregnancy. The germ cell number of the female fetus peaks at about 20 weeks of gestation, followed by a rapid decrease in the oogonial pool, which continues in postnatal life until menopause. Almost 70% of germ cells are in primordial follicles [5]. Reproductive age and reproductive potential in women are determined by the primordial follicle pool in the ovaries and the processes underlying their depletion. The factors controlling this process, especially in the antenatal period, are not known exactly.
Cyclophosphamide, a cancer chemotherapy drug-induced early onset of reproductive senescence and alterations in reproductive performance and their prevention in mice
Published in Drug and Chemical Toxicology, 2022
Vadakkepurath Raj Athira, Thimmappa Shivanandappa, Hanumant Narasinhacharya Yajurvedi
The mammalian ovary contains a stockpile of primordial follicles at the resting stage. Once entering the growing follicular pool, they mature and culminate in ovulation or undergo atresia at any stage of their development and the lost primordial follicles are not replenished (Greenwald and Roy 1994). Therefore the reproductive life span of a female individual depends on primordial follicular reserve from which a set of follicles start growing during each reproductive cycle (Pelosi et al. 2015) and once the reserve is exhausted the individual enters into a phase of reproductive senescence. Cyclophosphamide treatment causes degeneration of all categories of ovarian follicles (Shiromizu et al. 1984, Jarrell et al. 1987, Plowchalk and Mattison 1992, Davis and Heindel 1998, Meirow et al. 1999) in rats and mice, of which primordial follicles are the most vulnerable (Budel et al. 1988. Plowchalk and Mattison 1989, 1991, 1992. Meirow et al. 1999. Oktem and Oktay 2007). The drastic depletion of primordial follicle reserve following CP treatment limits the span of normal fertile period and causes premature reproductive senescence in women, often reported as premature menopause and infertility (Meirow and Nugent 2001). The results of our present study, for the first time, demonstrate possibility of normal reproductive life span despite CP treatment using a mouse model. The results are of great significance in cancer therapy with CP.
Does Exposure of Smart Phones during Pregnancy Affect the Offspring’s Ovarian Reserve? A Rat Model Study
Published in Fetal and Pediatric Pathology, 2021
Pinar Calis, Merve Seymen, Yagmur Soykan, Kevser Delen, Bahriye Sirav Aral, Gulnur Take Kaplanoglu, Deniz Karcaaltincaba
Ovarian tissue samples were parafin embedded for conventional histological diagnosis. Hematoxylin-Eosin staining was performed on 4 μm thick sections. Slides were examined with a Photo-light microscope (DM4000B Image Analyze System, Leica, Microsystems, Heidelberg GmbH, Heidelberg, Germany) and the Leica DFC280 plus camera. Serial cutaways were taken from ovary tissues and follicle count (primordial, primary, secondary and Graafian follicles) were performed for all groups within these sections for all subjects. Primordial follicles consist of a primary oocyte surrounded by a single layer of squamous granulosa cells, primary follicles were distinguished by one layer of cuboidal granulosa cells for unilaminar and two or more layers of cuboidal granulosa cells for multilaminar follicles. Maturating secondary follicle have a primary oocyte surrounded by two or more layers of tall, supporting granulosa cells with small pockets of follicular fluid. Graafian follicles were distinguished by large follicular antra. Atretic follicles contained breakdown products of the ovarian follicles.