How One Follicle Can Vanish or Produce an Aged Egg During IVF? – Fertility Plus
Fertility Plus shared a post on LinkedIn:
“Spontaneous Intrafollicular Luteinisation: How One Follicle Can Vanish or Produce an Aged Egg During IVF
Dozortsev DI and Diamond MP. Fertility and Sterility. 2022;117(1):40–41.
When a follicle reaches its critical expansion size during IVF stimulation, mechanical pressure on the ovarian cortex — increasingly rigid with age — triggers spontaneous luteinisation of the granulosa cells. This happens without any LH surge. Progesterone rises inside the follicle and spills into the bloodstream, the earliest detectable clinical signal. Because the GnRH pathway is blocked or downregulated during stimulation, the pituitary cannot respond and no corrective surge occurs. The follicle is left to fail on its own terms.
From that point, one of two things happens. The follicle wall ruptures at its weakest point, releasing fluid and the egg into the peritoneal cavity — it disappears on the next scan, a vanishing follicle. Or the wall thickens and seals, forming a nascent luteinised cyst. Inside, gap junctions between the cumulus cells and the egg begin to dissolve. Meiosis resumes — not triggered by LH, but by the breakdown of those cellular connections. The egg starts ageing. By collection day it arrives postmature: zona thickened, ooplasm vacuolated, spindle integrity compromised. It may fertilise and cleave, but it extremely rarely reaches blastocyst and has not been shown to implant.
In both outcomes, only the affected follicle is involved. Adjacent follicles carry no progesterone receptors and continue developing normally.
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