1. Dr SIVARAJ S
DEPT OF PHYSIOLOGY
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
NEW DELHI
20/03/2013

2.  The mechanisms that trigger initiation of
follicular growth are still not completely
understood
 Thought to involve bidirectional
communication between germ and somatic
cells through gap junctions
 Paracrine factors : cytokines and growth
factors (insulin-like growth factor [IGF],
epidermal and fibroblast growth factors, and
interleukin-1).
Lange endocrine physiology 2ed

3.  FSH and insulin-like-growth factor (IGF)
enhance each other's ability to
stimulate follicle cell function
 Access of IGF II to their receptors is
regulated by IGF binding proteins and specific
proteases ascribed a role in DF development
Son WY et al. 2011

4.  Serum AMH level correlates with ovarian
follicle number
 AMH levels decline as the size of the follicle
increases
 In patients with polycystic ovary syndrome
(PCOS), AMH levels are elevated,
 Potential relevance in PCOS diagnosis and
management
 A useful clinical marker for the assessment of
ovarian reserve
Broekmans FJ et al.2008

5. Aromatase and Estradiol
Estradiol by DF
Granulosa cell proliferation in
non DF
DF= Dominant follicle
FSH in blood

6.  Healthy blood supply
 Accumulation of follicular fluid
 Increased density of FSH receptors on its
granulosa cells
 Accumulation of atretogenic androgens,such
as DHT in the non DF

7.  As the DF grows vascularization of the theca
layer increases
 More efficient delivery of cholesterol to theca
cells and better exposure to circulating
gonadotropins