I remember I read somewhere that there are 11000 follicles. When a girl is born, there is no more multiplication of oocytes. After birth follicles sit dormant. When female goes into her reproductive age, follicles start to grow and mature (one by one). Only 400 of them mature.

Yeah, it should be like this. Calculate. Average cycle is 28 days. So there are around 12 cycles a year. Women start to menstruate at 13-15 years old. The menopause is around 45-55 years. Total is 30-40 years

Multiply everything together. It should be around 400.

By way, an interesting thought.

All those discussion about abortion and Stem Cell research. Somewhere in nineteen century baby was considered baby when it was born. The church even struggled to admit anything like existence of cells etc. Rare baby actually survived beyond first year. Heck, hypothesis that human been consists of small cells was actually admitted widely not so long ago. Maybe hundred years ago. Then, all that research happened. People learned how fetus is created and how it grows. Now public idea is that fertilized oocyte is already baby.

Have you seen any oocyte under microscope? Even a human hair near an oocyte looks like a skyscraper near a real human. Now, if public perception had shifted this way in several decades, shouldn't we punish all women for that they recklessly loose 400 potential babies during lifetime. Isn't it a crime?

Then, maybe we should punish every man for losing millions of sperms - also potential babies. Where did this idea come from that fertilized oocyte is baby and non-fertilized oocyte is not? Shouldn't we move boundary a little bit earlier? Need to think about that.

Anyway.

Ovarian follicle (follicle means small bubble in Latin) usually mature, rupture and release oocyte that was in this follicle. Sometime rupture delays. Then ovulation delayes. (Ovulation is rupture and release of oocyte. Oocyte is cell that eventually becomes fetus after sperm gives genetic material).

Normal cycle is divided into follicular phase (when follicle grows) and luteal phase. Luteum means yellow in Latin.

When follicle ruptures (by way rupture means burst or tearing), oocyte goes out.

The cavity that left behind (remember it was small bubble) is filled with blood and special cells, producing hormones. These special cells grow in quantity and fill that cavity. These cells produce hormones that help fertilized oocyte to attach and to grow in uterus. Because they grow in quantity, they create a yellowish body in ovary. It is literally yellowish. The name is Corpus Luteum (corpus=body, luteum = yellow).

This is normal cycle.

As we said, follicle sometime doesn’t rupture (there is a bunch of reasons). A physician should sort out several different conditions. This is an abnormal cycle. If follicle does not rupture it becomes follicular cyst. Cyst also means bubble in Latin. There are actually plenty of different kinds of bubbles in medical Latin. Big ones and small ones. Normal and abnormal.

OK, cyst did not rupture. Then what happens?

Well. If cyst doesn't rupture, it usually resolves. That fluid inside cyst is reabsorbed and cyst collapses.

However, if cyst ruptures, it causes acute pain. The pain comes from irritation of peritoneum (lining of peritoneal cavity) with blood and cyst content.

Why it is not painful when a regular follicle ruptures and releases oocyte? Probably, a regular follicle is too small. In addition it doesn't cause much bleeding.

In contrast cyst is a really big bubble (sometime 5-10 cm in diameter). If it ruptures, it instantaneously release bunch of special fluid. Plus, there is significant bleeding because there are a lot of blood vessels around to feed.

Significant is of course relative.

For example, take 5-10-20 ml of blood from a patient vein in a hospital daily. He complains about pain from needle mostly.

But if you get same 10 ml of blood into peritoneum... Wow. You will cry. There are plenty of nerve endings. Peritoneum is too touchy-feely. Tender.

Besides, cyst has high concentration of prostaglandins. Prostaglandins, in their turn, are mediators of inflammation. They should cause significant pain directly and indirectly.

From other hand bleeding could be really significant. Then it becomes really dangerous.

A physician also should not miss an ectopic pregnancy. Doctor will order a pregnancy test for that. If an ectopic pregnancy starts to bleed, this is really really worrisome. It seems like your blood did not left your body. However blood is in abdominal cavity. It left blood vessels. It is internal bleeding. You die quickly.

Aleksandr Kavokin MD/PhD,

http://www.kavokin.com

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