The Nigerian Journal of General Practice, 17(2), 51, 2019
Relationship of maximum follicular size, age of woman, and reproductive implications in women attending fertility clinic in St. Margaret's Hospital, Lokoja, using Creighton Model FertilityCare™ System and NaProTECHNOLOGY
Some authorities have found that, when the mean follicular diameter is >25 mm, the follicle is considered large, and these authorities are convinced that large follicles are biomarkers to ovarian pathology. Several studies have been carried out to determine the optimal maximum follicular size (MFS) that will be adequate before the use of human chorionic gonadotropin trigger to induce ovulation. None of these studies have considered the woman's age as a factor. An in vitro fertilization-based study has also shown that large leading follicles did not result in higher percentage of matured oocytes, and they even result in a lower live birth rate; however, we note that the ages of the women were not specifically mentioned in connection with the problems of large follicle. Subjects and
Methods
We set out in this study to evaluate the relationship between the MFS and the woman's age both in our control group (fertile women) Group (A) and in the women attending fertility clinic Group (B). Using the Creighton Model Fertility Care System and NaProTECHNOLOGY, it was possible to determine when to start follicular tracking and also determine ultrasound diagnosis of ovulation by recording the MFS and the reduced size.
Results
In both Group A and Group B, we discovered that the MFS reduces as woman's age increases. We also discovered that the average MFS in the Group B was higher for age compared with the Group A (P = 0.0043). There was also an association between these bigger follicles for age and low mid-luteal progesterone. This is probably the first study that describes the association of follicular size and woman's age and its possible link with ovulation defects. Recommendation: We have proposed that this phenomenon of large matured maximum follicle for age could be a contributory factor to infertility and miscarriages. We propose further studies to verify this hypothesis.
Conclusion
Despite the high percentage of complete rupturing of follicles in the AB cycles in the Group (B) there are very high proportion having low mid luteal (P+7) Progesterone. This may be due to pathologies associated with big follicles for woman's age. The E2/Pg ratio study in luteal phase strongly suggested that the women in Group (B) that may have fertility challenge are those in subgroup of AB in Group (B). Therefore matured follicular size should be considered with the woman's age. If the follicles grows bigger away from the range for a woman's age it may be the marker for infertility or reproductive health challenges.
maximum follicular size age NaProTECHNOLOGY infertility, Creighton Model FertilityCare follicular tracking ovulation, large follicle size biomarker ovarian pathology infertility, follicular size age relationship mid-luteal progesterone, NaProTECHNOLOGY ultrasound follicular monitoring ovulation defects, big follicles for age low progesterone fertility clinic, Achebe follicular size age reproductive implications Nigeria, hCG trigger optimal follicular size woman age factor, ovulation defects large follicle low mid-luteal progesterone, Creighton Model ultrasound diagnosis ovulation follicular rupture
DOI 10.4103/njgp.njgp_9_18 10.4103/njgp.njgp_9_18 Achebe et al. 2019, Achebe 2019
Cite this article
Achebe, F. U. (2019). Relationship of maximum follicular size, age of woman, and reproductive implications in women attending fertility clinic in St. Margaret's Hospital, Lokoja, using Creighton Model FertilityCare™ System and NaProTECHNOLOGY. The Nigerian Journal of General Practice, 17(2), 51. https://doi.org/10.4103/njgp.njgp_9_18
Achebe FU. Relationship of maximum follicular size, age of woman, and reproductive implications in women attending fertility clinic in St. Margaret's Hospital, Lokoja, using Creighton Model FertilityCare™ System and NaProTECHNOLOGY. Niger J Gen Pract. 2019;17(2):51. doi:10.4103/njgp.njgp_9_18
Achebe, FrancisUdoka U. "Relationship of maximum follicular size, age of woman, and reproductive implications in women attending fertility clinic in St. Margaret's Hospital, Lokoja, using Creighton Model FertilityCare™ System and NaProTECHNOLOGY." The Nigerian Journal of General Practice, vol. 17, no. 2, 2019, pp. 51.
Klein NA et al., 1996·The Journal of clinical endocrinology and metabolism
Women experience a decline in fertility that precedes the menopause by several years. Previous studies have demonstrated a monotropic rise in FSH associated with reproductive aging: however, the mechanism of this rise and its role in the aging process are poorly understood. The purpose of this study was to characterize ovarian follicular development and ovarian hormone secretion in older reproductive age women. Sixteen women, aged 40-45 yr, with regular ovulatory cycles were studied. The control group consisted of 12 ovulatory women, aged 20-25 yr. Serum obtained by daily blood sampling was analyzed for FSH, LH, estradiol (E), progesterone, and inhibin (Monash polyclonal assay). Follicle growth and ovulation were documented by transvaginal ultrasound. Older women had significantly higher levels of FSH throughout the menstrual cycle. E, progesterone, LH, and inhibin levels did not differ between the two age groups when compared relative to the day of the LH surge. Ultrasound revealed normal growth, size, and collapse of a dominant follicle in all subjects. Older women had significantly shorter follicular phase length associated with an early acute rise in follicular phase E, reflecting accelerated development of a dominant follicle. We conclude that older reproductive age women have accelerated development of a dominant follicle in the presence of the monotropic FSH rise. This is manifested as a shortened follicular phase and elevated follicular phase E. The fact that ovarian steroid and inhibin secretion were similar to those in the younger women suggests that elevated FSH in women of advanced reproductive age may represent a primary neuroendocrine change associated with reproductive aging.
Cycle Across the Lifespan · Cycle and General Health
Bouchard TP et al., 2026·Journal of ovarian research·
Open Access
Reproductive hormones of the fertile window are often referenced to women in regular cycles, but this may not be representative of the hormonal profiles of women in different circumstances like polycystic ovarian syndrome, the postpartum period, and the perimenopause transition. This observational cohort study sought to identify the variability in the reproductive hormones in various clinical circumstances and to establish potential thresholds for each category based on hormone measurements with the Mira urinary hormone monitor. A total of 57 women (ages 22-51) in various circumstances (regular cycles, polycystic ovarian syndrome, postpartum and perimenopause) tracked Mira urine hormone measurements (estrone-3-glucuronide, luteinizing hormone, pregnanediol glucuronide), contributing 444 cycles of data. Using additive mixed models, hormone values were stratified by the four different reproductive categories. The perimenopause and polycystic ovarian syndrome groups demonstrated relative hypoestrogenic states, while the perimenopause group showed low luteal pregnanediol glucuronide and the polycystic ovarian syndrome/polyendocrine metabolic ovarian syndrome (PCOS/PMOS) group showed high luteal pregnanediol glucuronide. The perimenopause group had significantly higher luteinizing hormone values throughout the whole cycle. The fertile window hormone thresholds vary depending on a woman's specific reproductive category. Women in different circumstances should not necessarily use the same hormonal thresholds for the fertile window and ovulation. A larger dataset with ultrasound correlation to ovulation is required to delineate the fertile window with more precision. Hormone differences across the menstrual cycle could be used for targeted treatments in polycystic ovarian syndrome and perimenopause women.
Early-life nutritional deprivation may influence lifelong health, but its role in the broader process of reproductive aging remains underexplored. Guided by the Developmental Origins of Health and Disease framework, this study investigates the impacts of fetal/infant and adolescent exposure to famine on age at natural menopause, a key indicator of reproductive aging. The study sample comprised 4256 women from the China Health and Retirement Longitudinal Study. Participants were categorized into fetal/infant (1959-1962 births) or adolescent (1942-1946 births) famine-exposed cohorts and non-exposed controls. Multivariable linear and logistic regression models were used to assess associations between famine exposure and age at natural menopause or early menopause, adjusting for sociodemographic, economic, and behavioral covariates. Famine exposure was associated with an earlier age at natural menopause: 1.16 years earlier for fetal/infant exposure (β = -0.12, p = 0.002), and 0.72 years earlier for adolescent exposure (β = -0.07, p = 0.014); it was also associated with increased odds of early menopause (odds ratio [OR] = 1.05, 95 % confidence interval [CI] 1.01-1.10). No significant association with premature menopause was observed. Nutritional deprivation during critical developmental windows-particularly adolescence-has distinct, long-term effects on the trajectory of reproductive aging. These observational findings, which cannot establish causality, underscore the importance of early-life nutrition in shaping female reproductive health and are consistent with the Developmental Origins of Health and Disease framework in reproductive health.
Cycle Across the Lifespan · Cycle and General Health
Background Reproductive hormones of the fertile window are often referenced to women in regular cycles, but this may not be representative of the hormonal profiles of women in different circumstances like polycystic ovarian syndrome, the postpartum period, and the perimenopause transition. This observational cohort study sought to identify the variability in the hormones of the fertile window in various reproductive categories and to establish potential thresholds for each category based on hormone measurements with the Mira urinary hormone monitor. Results A total of 57 women (ages 22–51) in various circumstances (regular cycles, polycystic ovarian syndrome, postpartum and perimenopause) tracked Mira urine hormone measurements (estrone-3-glucuronide, luteinizing hormone, pregnanediol glucuronide), contributing 444 cycles of data. Using additive mixed models, hormone values were stratified by the four different reproductive categories. The perimenopause and polycystic ovararian syndrome groups demonstrated relative hypoestrogenic states, while the perimenopause group showed low luteal pregnanediol glucuronide and the polycystic ovarian syndrome group showed high luteal pregnanediol glucuronide. The perimenopause group had higher luteinizing hormone values throughout the whole cycle. Conclusion The fertile window hormone thresholds vary depending on a woman’s specific reproductive category. Women in different circumstances should not necessarily use the same hormonal thresholds for the fertile window and ovulation. A larger dataset with ultrasound correlation to ovulation is required to delineate the fertile window with more precision. Hormone differences across the menstrual cycle could be used for targeted treatments in polycystic ovarian syndrome and perimenopause women.