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To learn more about follicular atresia and its role in fertility, we spoke with Dr Tripti Raheja, Director – Obstetrics & Gynaecology at The CK Birla Hospital®, Delhi.
What Is Follicular Atresia?
Follicular atresia is the natural degeneration of ovarian follicles that do not reach the stage of releasing an egg.Usually, one becomes the dominant follicle and continues to mature. It may eventually release an egg during ovulation. The other follicles generally stop growing and undergo atresia.
“Follicular atresia is a normal biological process, not a disease. It helps the ovaries naturally regulate the number of follicles available for future reproductive cycles.”
- Dr. Tripti Raheja, Director – Obstetrics & Gynaecology, The CK Birla Hospital®, Delhi
Why Does Follicular Atresia Happen?
Follicular atresia can happen for several natural reasons:- Limited egg supply: Women are born with a fixed number of eggs
- Natural follicle loss: Many follicles stop developing before ovulation
- Hormonal changes: FSH helps regulate follicle growth
- Dominant follicle: Usually, one follicle continues towards ovulation
- Follicle breakdown: The remaining follicles naturally degenerate and are absorbed
How Does Follicular Atresia Affect Ovarian Reserve?
Follicular atresia contributes to the natural decline in ovarian reserve as follicles are gradually lost throughout life. This means fewer follicles may be available for future ovulation as age increases. However, a lower ovarian reserve does not automatically mean infertility, as fertility also depends on egg quality, ovulation, age and sperm health.Does Follicular Atresia Cause Infertility?
Follicular atresia is a normal ovarian process and does not directly cause infertility. However, excessive follicle loss may reduce ovarian reserve. With age, egg quantity and quality also decline, which can affect the chances of conception. A lower ovarian reserve does not mean pregnancy is impossible.What Is the Connection Between Follicular Atresia and AMH?
AMH is produced by small developing follicles and is commonly used to estimate ovarian reserve. As the number of growing follicles decreases, AMH levels may also fall. However, AMH cannot predict pregnancy on its own and should be considered alongside age, antral follicle count and other fertility factors.Can Follicular Atresia Be Seen on an Ultrasound?
Follicular atresia itself usually cannot be directly observed on a routine ultrasound. However, ultrasound can show the number of small antral follicles present in the ovaries.Antral follicle count (AFC) is often used as part of an ovarian reserve assessment. It can help doctors estimate how many follicles are available at a given time.
The number can vary between cycles and may also be affected by factors such as hormonal contraception and the timing of the scan. Therefore, ultrasound findings are generally interpreted alongside other fertility information rather than in isolation.
Can Follicular Atresia Be Prevented?
Follicular atresia is a natural process and cannot be completely prevented. However, you can support overall reproductive health by:- Avoid smoking to support reproductive health
- Maintain a healthy weight and balanced diet
- Stay physically active with regular exercise
- Limit excessive alcohol intake
- Get adequate sleep and manage stress
When Should You See a Fertility Specialist?
Consider seeing a fertility specialist if:- You have been trying to conceive without success
- Your periods are irregular or absent
- You have been told your ovarian reserve is low
- You are planning to delay pregnancy for several years
- You want to understand your fertility options and ovarian reserve
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FAQs on What Is Follicular Atresia and How Does It Affect Fertility?
- At what stage does follicular atresia occur?
Follicular atresia can occur at different stages of follicle development. A follicle may stop growing before becoming dominant or before reaching maturity. Most follicles never release an egg, and their gradual disappearance is a normal part of ovarian activity. - Does every follicle undergo atresia?
Most ovarian follicles eventually undergo atresia rather than reaching ovulation. During a menstrual cycle, only a small number are selected for development, and usually one becomes dominant. The others naturally stop growing and are gradually removed by the body. - Is follicular atresia linked to menopause?
Follicular atresia contributes to the gradual reduction of the ovarian follicle pool throughout life. When the reserve becomes very low, reproductive function eventually declines and menopause occurs. However, atresia itself is not the same as menopause.