A new model for ovarian follicular development during the human menstrual cycle.

OBJECTIVE To evaluate changes in ovarian follicle dynamics during the human menstrual cycle to test the hypothesis that folliculogenesis occurs in a wave-like fashion. DESIGN Prospective longitudinal study. SETTING Healthy volunteers in an academic research environment. PATIENT(S) Fifty healthy women of reproductive age (range 19-43 years) with a history of regular menstrual cycles not taking medications known to interfere with reproductive function were evaluated. INTERVENTION(S) Transvaginal ultrasonography was performed daily for one interovulatory interval (IOI). MAIN OUTCOME MEASURE(S) Changes in the diameter and number of follicles > or =5 mm were evaluated. RESULT(S) Sixty-eight percent of women exhibited two waves of follicle development during the IOI and 32% exhibited three waves. Waves were characterized by an increase and subsequent decrease in the number of follicles > or =5 mm occurring in association with the growth of > or =2 follicles to > or =6 mm. A day effect and day by wave interaction were detected in the mean diameter of the largest three follicles and the number of follicles > or =5 mm. CONCLUSION(S) The follicular wave phenomenon in women provides a new model for ovarian function during the menstrual cycle and will improve our understanding of the ovarian response to fertility and hormonal contraceptive regimens.