The Path to Motherhood: Understanding Multifollicular Ovaries (MFO)

The road to motherhood is not always simple or predictable. This journey can be accompanied by various health challenges. However, modern medicine often works wonders, helping fulfill the cherished dream of becoming a parent.

Many patients feel alarmed when they see the unfamiliar abbreviation MFO (Multifollicular Ovaries) in their ultrasound results. In most cases, there is no reason for panic, as multifollicular ovaries are a common occurrence and are considered a physiological characteristic rather than a complex pathology. Let’s take a closer look at when MFO is not a cause for concern and when it warrants closer attention during pregnancy planning.

What are Multifollicular Ovaries?

When discussing reproductive health, it is vital to distinguish between structural characteristics of the body and serious diseases. Normally, at the beginning of a menstrual cycle, several follicles begin to grow in the ovaries, but only one becomes dominant, reaches the necessary size, and releases an egg.

Antral Follicles These are "resting" follicles, measuring 2–8 mm, which are visible on an ultrasound at the start of the cycle. Their count is the primary indicator of a woman’s ovarian reserve. From this group, one dominant follicle is selected each month.

Dominant Follicle This is the follicle chosen by the body to grow actively while suppressing the others. By the middle of the cycle, it reaches a size of 18–24 mm. The egg matures inside this follicle and is released during ovulation once the follicle wall ruptures.

What Does an MFO Diagnosis Mean in Gynecology?

The term Multifollicular Ovaries means that during an ultrasound at the beginning of the cycle, more than 10 antral follicles are visualized simultaneously within the organ’s structure—averaging 5–7 in each ovary. Usually, their size does not exceed 4–9 mm. This condition is not considered a pathology; rather, it is a statement of fact that the ovaries are currently multifollicular, showing numerous small "bubbles."

How MFO Differs from Polycystic Ovary Syndrome (PCOS)

Patients often confuse MFO with PCOS (Polycystic Ovary Syndrome).

• With MFO: The ovaries are not enlarged (or only slightly so), hormone levels remain within the normal range, and ovulation occurs, though it may be irregular or delayed.

• With PCOS: There is a thickening of the organ's capsule, an increased number of small follicles (more than 20), an irregular menstrual cycle, and anovulation. This may also be accompanied by metabolic disorders, such as insulin resistance and hyperandrogenism (elevated male hormones, hirsutism).

While MFO is typically discovered only through ultrasound, PCOS is often accompanied by the distinct clinical symptoms mentioned above.

MFO: Is it Normal or Pathological?

In modern gynecology, this condition is often viewed as a variant of normal. It can occur during the onset of the menstrual cycle in puberty, after discontinuing oral contraceptives, or during periods of temporary stress. If the menstrual cycle remains regular and ovulation is confirmed, there is no cause for premature worry.

Why Are There So Many Follicles in the Ovaries?

A large number of follicles is a biological reserve established at birth, ensuring the reproductive function of the female body for many years. In each cycle, the body initiates the growth of a group of follicles; then, through natural selection, a dominant one is determined, while the others serve as a source of necessary hormones and gradually perish. This surplus ensures egg survival and maintains the hormonal balance.

Primary Causes of Multifollicular Ovaries

Several factors can trigger the growth of multiple follicles:

• Genetic predisposition;

• Puberty;

• Lactation (due to elevated prolactin levels);

• Sudden changes in body weight (both gain and loss).

Hormonal Causes Often, ultrasound signs of MFO are caused by a deficiency in Luteinizing Hormone (LH) or Follicle-Stimulating Hormone (FSH). When the hormonal balance is disrupted, follicles begin to grow en masse, but none receive enough stimulus to reach the dominant stage. Consequently, they all stall at an intermediate phase.

Signs and Symptoms of Multifollicular Ovaries

This condition is often asymptomatic and is discovered incidentally during an ultrasound. However, there are markers to watch for:

• Delayed menstruation (ranging from a few days to months);

• Changes in cycle duration;

• Occasional dull pulling sensations in the lower abdomen.

Ultrasound Signs of MFO An ultrasound specialist describes the sonographic signs of MFO based on the number and arrangement of antral follicles. They are usually distributed evenly throughout the ovarian tissue, unlike polycystic ovaries, where follicles often line up like a "necklace" along the periphery.

Is There Ovulation with Multifollicular Ovaries?

Many mistakenly believe that a high follicle count automatically means an absence of ovulation. An experienced reproductive specialist always recognizes that pregnancy and MFO are perfectly compatible, provided the body maintains the functional ability to grow a high-quality egg.

Modern reproductive medicine views multifollicularity as a trait rather than an insurmountable barrier to pregnancy. Therefore, with a proper medical approach, lifestyle adjustments, and mild stimulation methods, nearly every woman diagnosed with MFO has every chance for successful conception and the birth of a healthy child.

Why Ovulation May Occur Later with MFO The reason lies in the high competition between follicles. When there are too many, the body's resources are distributed unevenly. In some months, ovulation occurs later because it takes longer for a dominant follicle to mature.

Multifollicular Ovaries and Pregnancy

Can you get pregnant with MFO?

If MFO is identified without other medical complications, the answer is yes—pregnancy can occur naturally. However, if conception does not occur within one year (or six months for women over 35) of active unprotected intercourse, it is a signal to consult a specialist.

Interesting fact: With MFO, the chances of a multiple pregnancy (twins/triplets) are slightly higher. This happens if two eggs reach maturity and are fertilized in the same cycle.

Ovulation Induction with MFO

If pregnancy does not occur due to lack of ovulation, a doctor may prescribe stimulating medications. This helps one or two follicles mature to the dominant stage. It is crucial that this process is monitored via ultrasound (folliculometry) to avoid ovarian hyperstimulation syndrome (OHSS).

Medical Management During Pregnancy Planning

When planning a pregnancy with MFO, it may be enough to normalize prolactin levels or adjust thyroid function. Progesterone is often prescribed in the second phase of the cycle to support a potential pregnancy. Often, no specific surgery or intensive treatment is required.

If Pregnancy Still Does Not Occur

Assisted Reproductive Technologies (ART)

In complex cases where conservative methods fail, ART can help. IVF with multifollicular ovaries usually yields good results because these patients typically have a high ovarian reserve.

Possibilities of Motherhood in Complex Cases

In situations where a woman cannot carry a child herself due to uterine pathologies or other systemic diseases, surrogacy becomes an option. Today, this is a highly refined, high-tech method that allows a couple to have their own biological child. In gestational surrogacy, the surrogate mother carries an embryo created from the egg and sperm of the biological parents; she has no genetic link to the child. This method has helped millions of families worldwide become parents.

The FetusPlus platform helps turn the dream of parenthood into reality. Every day, biological parents, surrogate mothers, and donors from many countries register and begin their journey through our service.

Expert Opinion:

Multifollicular ovaries are a variant of a normal ultrasound finding and reflect a morphological feature of the ovarian structure. This image alone is not a cause of infertility and does not prevent pregnancy. However, in some cases, it may accompany endocrine disorders, including PCOS. Therefore, if you experience symptoms, menstrual irregularities, or difficulty conceiving, a consultation with a reproductive endocrinologist is recommended.

This material is for informational purposes only. When planning a pregnancy or choosing treatment methods, be sure to consult with your healthcare provider.