Monday, July 21, 2014

The difference between follicles and ovarian cysts

  Cyst ? Or follicle ?

A patient just sent me this query

I am 29 and trying to conceive for past 4 years.I have irregular cycles. My doctor prescribed me Injection recagon 100units for 6 days from 12-May-2014. On 11th day of cycle during follicle study I got dominant follicles on both ovaries and doctor prescribed to take orgamed capsules for 14 days This month I didn’t get my periods and HPT is negative and even checked with doctor , it is negative again and she prescribed me regestrone tablets for 10 days I have a clarification . If I got dominant follicles on both ovaries, where the follicles would have gone? As per my assumption it should be either fertilized or I should have started periods . I'm so confused. Please guide me

It’s very common for infertile women to be confused about reproductive basics. They often do not understand the relationship between menstrual cycle and ovulation; or the difference between follicles and eggs; or how follicles are different from cysts.

We need to go back to basics, to make sure there is clarity going forward. Otherwise this poor patient will keep on going round and round in circles, cycle after cycle !

This was my answer.

The reason your periods are irregular is because you Do not ovulate. This is called anovulation. Read more at

 This maybe because you have PCOD ( polycystic ovarian disease). You can read more about this at

 You need the following medical tests.
1.    Blood tests for you for the following reproductive hormones – FSH ( follicle-stimulating hormone),LH ( luteinizing hormone),PRL ( prolactin) , AMH ( anti-Mullerian hormone) and TSH ( thyroid stimulating hormone)
( to check the quality of your eggs). Do this from a reliable lab such as SRL (;
2.     A vaginal ultrasound scan which should check for the following.
a.    Ovarian volume
b.    B. antral follicle count
c.    C. uterus morphology
d.    D. endometrial thickness and texture

Please send me the detailed test results and medical reports . You can scan them in as a single Word file and email them to me. Patients with PCOD will typically have a high AMH level; a high LH:FSH ratio; increased ovarian stroma; and many small cysts arranged around the periphery of the ovary.

 So what’s the difference between a follicle and cyst ?  A cyst is basically a follicle which does not contain an egg.  They both appear as hollow dark spherical objects in the ovary on ultrasound scans.  Since we cannot make out if the structure we see on scanning contains an egg, this creates a lot of confusion in the patient’s minds .

To make matters worse, doctors often loosely refer to the follicles seen on ultrasound scanning as eggs. In reality, eggs are microscopic, and can only be seen in the IVF lab when the follicular fluid is examined under the microscope by the embryologist. While there are many kinds of cysts, the commonest kind we see is called a functional cyst, which looks exactly like a follicle , except that it’s larger.

Thus, when a mature follicle ( which contains an egg) fails to rupture at the time of ovulation, it collects fluid and becomes larger. This is called LUF syndrome. Read more at

A functional cyst ( so called because it is functioning and produces hormones) will often result in the period being delayed, as a result of the hormones it produces. This is why it may cause the period to be delayed. It’s possible to make this diagnosis by doing an ultrasound scan. The period can be induced with medications . These cysts will usually resolve on their own.

Have a query you are scared to ask your doctor because he is too busy ? Please send me your medical details by filling in the form at so I can guide you sensibly!


  1. Anonymous10:31 PM

    Follicles can be equated to ground nut pods, and eggs are the seeds that are present within. Some ground nut pods don't contain seeds, just the pod is present. Like that, if the follicle is without egg then it is called a cyst and a cyst can be differentiated from the follicle via an ultrasound because it is usually bigger than the mature sized follicle. Am I right doctor ?

    1. Excellent analogy - thanks so much !

    2. Anonymous10:59 PM

      The pleasure is mine ! :)

  2. Anonymous8:32 AM

    I want advice from you. On March 2015, I was diagnosed with follicular cyst in my left ovary and right ovary was normal. My uterus size was bulky and LH: FSH ratio was high and TSH high. My gynaecologist prescribed me Ovacare , hyponidd, her face and eltroxin ( i am taking it since last 3 years). After a month , the sonography reports revealed bogh the ovaries and uterus to be normal and no cyst. Gynaecologist asked me to continue the same medicine for second month. In the 3rd month, she gave me Oosure forte, Xoom and syspol, and carpela and eltroxin as usual. 5 th day of my cycle, she did an IV sonography which revealed thay my left is clear and right ovary is PCOD. She asked me to repeat the blood tests. My weight is increasing every month and i am restless. I want to take a second opinion whether I am on right track. Plz help..

    1. What's your AMH level ?
      Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at

  3. Anonymous12:10 PM

    Hi,i have missed my period for three months i went to a gyna and some blood tests were done on me and they told me i had hormonal imbalance,they did and ultrasound which they told me that my right ovary had cysts(4).I didn't have pain at all but when i was asked if i had pain on my right side that's when i started feeling some cramps,i have egg white discharge which is actually a lot.Could it be that they made a wrong diagnosis?Can i still ovulate with my left ovary/

    1. I need more information to be able to provide you with intelligent advise.
      What kind of cysts were these ?
      The reason you missed your periods is because you did not ovulate. This is called anovulation.


      You may need to induce a period with meds.


      Please do a vaginal ultrasound scan . This should check for the following.

      A. Ovarian volume
      B. antral follicle count
      C. uterus morphology
      D. endometrial thickness and texture
      Please send me the detailed test results and medical reports . You can scan them in as a single Word file and email them to me.

      Please find a digital ultrasound scanner for your next scan .
      They will burn the images as a jpeg file on a CD or flash drive.
      I want the raw images as jpeg files please - not scanned in copies of the paper printout – too much loss of resolution with this !

      Based on the scan results, we can prescribe meds to induce a period

  4. Anonymous6:12 PM

    Hello doctor I am having polycystic ovarian disease I'm taking metformin 1000 milligram morning and night this month I took Clomid first 5 days after period and also I am taking ovacare forte and a folic acid is it possible I will ovulate this month

    1. You can read more about how we treat PCOD at

      Do a complete workup before starting treatment haphazardly.

      You need to do ALL the following simple medical tests:

      semen analysis for your husband ( to check his sperm count and motility).

      blood tests for you for the following reproductive hormones - FSH ( follicle-stimulating hormone),LH ( luteinising hormone),PRL ( prolactin) , AMH ( antiMullerian hormone) and TSH ( thyroid stimulating hormone) on Day 3 of your cycle, ( to check the quality of your eggs). Do this from a reliable lab such as SRL ( Day 1 = Day the period starts.

      HSG ( hysterosalpingogram, X-ray of the uterus and tubes, on Day 8 of your cycle ( to confirm
      your fallopian tubes are open);

      The vaginal ultrasound scan on Day 10-11 should check for the following. a. ovarian volume b. antral follicle count c. uterus morphology d. endometrial thickness and texture

      Please send me ALL the detailed test results and medical reports . You can scan them in as a single doc or pdf file and email them to me.

      Please send me all the results together, rather than piecemeal, so I can interpret them intelligently

      Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

      You can talk to some of our patients by email at

      We look forward to helping you to have a baby !


      Dr Aniruddha Malpani, MD
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India

      Clinic Mobile: 9867441589

      Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

      Helping you to build your family !

      You can add a google review for us at

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      Watch our infertility cartoon film at

      Read our book, How to Have a Baby - A Guide for the Infertile Couple,
      online at !

      Read my blog about improving the doctor-patient
      relationship at

  5. I have irregular periods and have been diagnosed with PCOD 2 years back. I have been following homeopathic treatment for the same and have comparatively regular menstrual cycles. Last week i was diagnosed with appendicitis in ultra sonography and I am considering laparoscopy for removing my appendix. My latest ultrasound report also mentioned on tiny follicles in both my ovaries and PCOD as well. While surfing for laparoscopy i did found out that PCOD can also be resolved with it. I am 22 years old so should i consider getting a laparoscopy surgery done for both appendix and PCOD at the same time?

    1. Dear Shreya,

      Yes, you can do a laparoscopic ovarian drilling, but only if your ovaries are large and have increased stroma !

      You can read about this at

  6. Anonymous6:03 AM

    What would the difference be between appearance wise on ultrasound of a follicle, and an ovarian cyst?

    1. They look exactly the same, except that a cyst is larger than a follicle

  7. Anonymous12:26 PM

    Hello...I have been married for more than 2 years...have not conceived yet...have normal AMH, FSH, LH, TSH levels...normal ultrasound...have tried induction twice...ovulatedon day 11 when follicle size was about 24mm, still no HSG reports say patent tubes with prompt spillage but suspected peritubal adhesions...I am totally confused...I have tried every my doctor wants me to go for laproscopy...I dont know what to decide...Can you kindly suggest something?


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