Kuyambira kutha msinkhu mpaka kusintha kwa msambo, thumba losunga mazira ndilo malo a nthawi ndi nthawi. Gawo loyamba la msambo uwu, gawo la follicular limafanana ndi kusasitsa kwa ovarian follicle yomwe, pa nthawi ya ovulation, idzatulutsa oocyte yokonzeka kuti idyedwe. Mahomoni awiri, LH ndi FSH, ndi ofunikira pa gawo ili la follicular.

Msungwana aliyense amabadwa ndi, m'mimba mwake, katundu wa mazana angapo otchedwa primordial follicles, iliyonse ili ndi oocyte. Patsiku lililonse la 28 kapena kupitilira apo, kuyambira kutha msinkhu mpaka kutha kwa msambo, dzira la ovary limachitika ndikutulutsidwa kwa oocyte - ovulation - ndi imodzi mwa mazira awiriwo.

Msambowu uli ndi magawo atatu osiyana:

• gawo la follicular;
• ovulation;
• gawo la luteal kapena post-ovulatory phase.

Gawo la follicular limayamba pa tsiku loyamba la msambo ndipo limathera pa nthawi ya ovulation, choncho limatenga pafupifupi masiku 14 (kudutsa masiku 28). Zimafanana ndi gawo la kukhwima kwa follicular, pomwe chiwerengero china cha ma follicles oyambirira chidzatsegulidwa ndikuyamba kusasitsa. Folliculogenesis iyi ili ndi magawo awiri akulu:

• kulembedwa koyambirira kwa ma follicles: chiwerengero china cha ma primordial follicles (pafupifupi zikwi 25 za millimeter m'mimba mwake) chidzakhwima mpaka kufika pa siteji ya tertiary follicles (kapena anthrax);
• kukula kwa antral follicles ku pre-ovulatory follicle: imodzi mwa antral follicles idzachoka ku gululo ndikupitiriza kukhwima, pamene ena amachotsedwa. Chomwe chimatchedwa follicle yayikulu chidzafika pa siteji ya follicle ya pre-ovulatory, kapena De Graaf follicle yomwe, panthawi ya ovulation, imamasula oocyte.

Pa gawo la follicle, mkazi samamva zizindikiro zilizonse, kupatula kuyambika kwa msambo komwe kumawonetsa kuyambika kwa msambo watsopano komanso kuyamba kwa gawo la follicular.

"Ma conductor" a ovarian cycle ndi mahomoni osiyanasiyana opangidwa ndi hypothalamus ndi pituitary gland, tiziwalo timene timatulutsa timadzi timene timakhala pansi pa ubongo.

• hypothalamus imatulutsa neurohormone, GnRH (gonadotropin releasing hormone) yomwe imatchedwanso LH-RH, yomwe imapangitsa kuti pituitary gland;
• poyankha, pituitary gland imatulutsa FSH, kapena follicular stimulating hormone, yomwe idzayambitsa chiwerengero cha ma follicles oyambirira omwe amalowa mu kukula;
• ma follicles awa nawonso amatulutsa estrogen yomwe imakulitsa chiberekero cha uterine kuti ikonzekere chiberekero kuti chilandire dzira lotheka lobadwa;
• akasankhidwa follicle ya pre-ovulatory, kutulutsa kwa estrogen kumawonjezeka kwambiri, zomwe zimapangitsa kuti LH (luteinizing hormone). Pansi pa mphamvu ya LH, kuthamanga kwa madzi mkati mwa follicle kumawonjezeka. The follicle potsirizira pake imasweka ndi kutulutsa oocyte yake. Ndi ovulation.

Popanda gawo la follicular, palibe ovulation. Izi zimatchedwa anovulation (kusakhalapo kwa ovulation) kapena dysovulation (kusokonezeka kwa ovulation), zonsezi zimabweretsa kusapanga kwa oocyte yobereka, motero kusabereka. Zifukwa zingapo zitha kukhala zoyambira:

• vuto la pituitary kapena hypothalamus (hypogonadism ya chiyambi "chapamwamba"), chomwe chimayambitsa kusakhalapo kapena kusakwanira kwa mahomoni. Kuchulukirachulukira kwa prolactin (hyperprolactinemia) ndizomwe zimayambitsa kusokonekera kumeneku. Zitha kukhala chifukwa cha chotupa cha pituitary gland (chotupa chosaopsa cha pituitary gland), kumwa mankhwala ena (mankhwala oletsa kupsinjika maganizo, antidepressants, morphine…) kapena matenda ena onse (kulephera kwaimpso, hyperthyroidism,…). Kupsyinjika kwakukulu, kugwedezeka kwamaganizo, kutaya thupi kwakukulu kungathenso kusokoneza kugwira ntchito moyenera kwa hypathalamic-pituitary axis ndikuyambitsa kutulutsa kwanthawi kochepa;
• Polycystic ovary syndrome (PCOS), kapena ovarian dystrophy, ndizomwe zimayambitsa vuto la ovulation. Chifukwa cha kusokonekera kwa mahomoni, kuchuluka kwa ma follicles osadziwika bwino amaunjikana ndipo palibe imodzi yomwe imafika pakukhwima kwathunthu.
• kusokonezeka kwa ovarian (kapena hypogonadism ya "otsika" chiyambi) kobadwa nako (chifukwa cha chromosomal abnormality, Turner syndrome mwachitsanzo) kapena kupeza (kutsatira chithandizo cha chemotherapy kapena opaleshoni);
• kutha msinkhu, ndi kukalamba msanga kwa oocyte reserve. Ma genetic kapena chitetezo chamthupi chikhoza kukhala chiyambi cha izi.

Pamaso pa kutulutsa m'mimba kapena dysovulation, chithandizo cha kukondoweza kwa ovarian chingaperekedwe kwa wodwalayo. Mankhwalawa amakhala ndi kulimbikitsa kukula kwa follicle imodzi kapena zingapo. Pali ma protocol osiyanasiyana. Ena amagwiritsa ntchito clomiphene citrate, antiestrogen yotengedwa pakamwa yomwe imapangitsa ubongo kuganiza kuti mlingo wa estradiol ndi wochepa kwambiri, zomwe zimapangitsa kuti FSH iwonongeke kuti ipangitse follicles. Ena amagwiritsa ntchito gonadotropins, jekeseni yokonzekera yomwe ili ndi FSH ndi / kapena LH yomwe imathandizira kusasitsa kwa follicles. Pazochitika zonsezi, panthawi yonseyi, wodwalayo amatsatiridwa nthawi zonse ndi kuyang'anitsitsa kuphatikizapo kuyezetsa magazi kuti ayese kuchuluka kwa mahomoni ndi ultrasound kuti athetse chiwerengero ndi kukula kwa follicles. Ma follicles akakonzeka, ovulation imayambitsidwa ndi jekeseni wa HCG.