At what rate or speed the D Follicle in ovary should grow wren gomadotrophins are used>>

Read Nesfield Grammar first . Read notes of an old dying man about details of grammar of Folliculometry ??  What are the expected follicular   and endometrial measurements & appearances  in the normal  (unstimulated)  cycle  and Ovulation induction cycle  as per day of cycle :-

Follicular  phase day 3 

Ultrasound  for OI(ovulation induction)  is ordinarily performed on the third  to fifth cycle day to provide    a baseline  from which   to  monitor follicular    development  and to rule out  the presence of ovarian  or endometrial pathology antral    follicles    before  day 3 are normally  3-6 mm in diameter  and 4-6  per ovary in number, The presence   of either or more follicles  in the 3-6 mm range on each ovary with none large    signifies the potential development of 10-20 or  more preovulatory follicles when   gonadotropin stimulation      is used. Approximately 25%   of women have this   type of ovary    but without OI (ovulation induction)  will develop   only one or two  preovulatory follicles   due to normal   functioning of the  ovarian   hypothalamic pituitary   feedback       system. the presence   of eight   or more 6-8 mm   follicles  in each ovary    on day 3 or   late in unstimulated  cycles is diagnostic of classical polycystic ovarian disease . Other abnormal    findings at the beginning of the cycle  may include ovarian   cysts large than 10 mm  endometrial hyperplasia   and endometrial   polyps  described   late in this    chapter. The  endometrial    thickness   at the completion  of menstruation   should be  less than  6 mm,

Follicular phase   day 6 : appearance  of the dominant   follicle

The  lead follicle   destined to become  dominant   normally grows  at the rate  of 1 mm a day   during  the first half   of the follicular    phase  of  the cycle   until it  reaches 10 mm and  then  grows at a rate   of 2 mm   per day . The lead   follicle may be 7-8 mm by day 6 . In  gonadotropin OI  (ovulation induction)  cycles US  performed   on day  6 or   after  three days of stimulation will confirm that follicles  are developing  As a general    rule all     follicles  that were   previously  smaller and are 6 mm or larger   on day 6  of  gonadotropin  OI cycles   will be 10 mm or larger  on day  6  of gonadotropin    OI (ovulation induction)  cycles will be 10 mm or larger by day 12-14  when a spontaneous  Lc  surge occurs  or hCG    is administered for IUI or timed  intercourse     . In   spontaneous    cycles only the lead   or dominant   follicle   will ordinarily  continue to  develop and ovulate .

Follicular  phase  day 12 : appearance of  preovulatory  follicle  capable of ovulation

  By day 12 the dominant follicle should be  16-18  mm or larger and capable of ovulation  if an LH surge occurs   or  if hCG   is administered    . In  spontaneous cycles   further enlargement may occur with the follicle   reaching a size of  22-24  mm immediately    before ovulation    An  increase  of 3 or  even 4  mm in 24   hours may occur at this time.  In controlled  ovarian hyperstimulation    cycles stimulated with hMG   or FSH   the follicular size at ovulation   is often  smaller ranging from 16 to 20    mm. it is   at this time that the   decision    is made about whether to proceed with IUI or to withhold IUI   and proscribe intercourse   for 4-5 days if there is an excessive number of preovulatory follicle Any   follicle that has attained  a size of 10 mm   or larger may ovulate  a mature  egg although   most eggs from 10-12mm  follicles    will be  immature    and not ovulate . Follicles    which are 8mm    or larger may have  acquired    FSH   receptors          and if they    fail to ovulate      may continue to grow and  produce   estrogen   resulting in ovarian    hyperstimulation  syndrome .

Follicular   phase  day  12: endometrial  pattern

Endometrial thickness and pattern  on the day of the spontaneous LH surge  on hCG  administration are   intimately associated with implantation    success  or failure Both  wall to  wall  endometrial    thickness   and endometrial  pattern    have been   reported  to be related  to implantation   success  but th former   may be more important    . The endometrial  pattern typically changes   from an entirely  homogenous  hyperechogenic  pattern in the first   few days of the menstrual    period through    an intermediate   stage with a thin   central    line and    echogenecity    similar to the myometrium    to a triple  lien appearance     with a clearly   demarked  center     line and   echogenecity of the outer lines     less than   half that of the myometrium   before   ovulation. After    ovulation   the triple  line pattern becomes obscured by the increasingly  hyperechogenic pattern of the post ovulation luteal    phase   endometrium   Implantation   does not occur  or occurs at a reduced rate per follicle   if the endometrium   lacks a triple line pattern on the day of  hCG   administration   in COH   cycles. Abnormal     patterns seen at this time   include fluid within   the endometrial  cavity which if persistent  is incompatible with implantation    fluid   collection within the fallopian tube  or tubes    and  small polyps  that were   not visible earlier  in the cycle  A homogeneous  pattern may be an indication   of endometrial  or uterine   pathology Multiple    leiomyomata   synechiae diethylstilbestrol anomalies   or adenomyosis were found in 94% of IVF  patients   with a homogenous  endometrial pattern  at the end of the   proliferative phase   in 305  of patients   with triple  line pattern   and endometrial  thickness < 9 mm and in 6%  of patients   with triple  lien pattern  and thickness > 9mm

Follicular phase day 12: endometrial   thickness :

Endometrial thickness measured by TUS correlates    well with   histological endometrial maturation   . In  spontaneous    cycles endometrial   thickness  increases  from a mean   of 4.6 mm during  menstruation  to 12.4  mm the day of the LH surge  . The increase    in thickness   is generally    constant  averaging   less than 1 mm   per day but  it may increase     by 2 mm a day in the late   proliferative   phase   . Endometrial   thickness  from outer   wall to outer   wall at the widest   point > 9 mm  on the day  of LH surge or hCG injection is associated  with a higher pregnancy   rate compared to thickness < 9 mm.

 In spontaneous and OI cycles implantation    rarely occurs when    thickness is less  than 6 mm   when thickness is 6-8 mm the incidence    of biochemical     pregnancies   is increased  and there is a lower ongoing    pregnancy rate than when thickness   is  > 9 mm Endometrial thickness  < 6 mm is found in 2%  of COH   cycles and 9%      of CC cycles   Endometrial thickness < 6 mm is also  found in 9%   of spontaneous ovulatory cycles where  it may be th cause of unexplained   infertility . When   endometrial   thickness is less than 9  mm the deficiency can be   corrected  in many cases by administration of  exogenous estrogen    as described   .

What happens in Luteal phase day 21 ??

Implantation   occurs   approximately  six  days after ovulation    and seven  days after a spontaneous   LH surge or  hCG  injection. The endometrium  by this    time should show  a completely  homogenous   hyperechogenic   pattern  A mixture    of type C post ovulation   pattern and triple line  at the time  of implantation   5-6   days after    ovulation      is associated  with inadequate progesterone    and a lower   pregnancy rate. If luteal insufficiency is  suspected it can be corrected  with administration of exogenous   progesterone   as described   . Endometrial   thickness normally decreases by 0.5 mm the day after   the LH surge   LH  surge but then increases  an average   of 2 mm between  ovulation  day and 5-6  days later. A  decrease  in endometrial thickness  two days    after ovulation compared to before   ovulation   is believed  to be detrimental to   implantation    . Endometrial thickness  can be increased by  administration   of exogenous   estrogen   even at this   late date.