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Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. Ovulation also occurs in the estrous cycle of other animals, which differs in many fundamental ways to the menstrual cycle.

The process of ovulation is controlled by the hypothalamus of the brain and through the release of hormones secreted in the anterior lobe of the pituitary gland, (LH and FSH). In the follicular (pre-ovulatory) phase of the menstrual cycle, the ovarian follicle will undergo a series of transformations called cumulus expansion, this is stimulated by the secretion of FSH. After this is done, a hole called the stigma will form in the follicle, and the ovum will leave the follicle through this hole. This release of ovum, ovulation is triggered by a spike in the amount of FSH and LH released from the pituitary gland. During the luteal (post-ovulatory) phase, the ovum will travel through the fallopian tubes toward the uterus, implanting there 6-12 days later if fertilized, or degrading in the fallopian tubes within 24 hours if not fertilized.

In humans, the few days near ovulation constitute the fertile phase. The average time of ovulation is the fourteenth day of an average length (twenty-eight day) menstrual cycle. It is normal and common for the day of ovulation to vary from the average, however.

Cycle length alone is not a reliable indicator of the day of ovulation. While in general an earlier ovulation will result in a shorter menstrual cycle, and vice versa, the luteal (post-ovulatory) phase of the menstrual cycle may vary by up to a week between women.

The start of ovulation can be detected by various signs. Because the signs are not readily discernable by people other than the woman herself, humans are said to have a concealed ovulation.

Women near ovulation experience changes in the cervix, in mucus produced by the cervix, and in their basal body temperature. Furthermore, many women also experience secondary fertility signs including Mittelschmerz (pain associated with ovulation) and a heightened sense of smell.[1]

Many women experience heightened sexual desire in the several days immediately before ovulation.[2] One study concluded that women subtly improve their facial attractiveness during ovulation.[3

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For ovulation to be successful, the ovum must be supported by both the corona radiata and cumulus oophorous granulosa cells. The latter undergo a period of proliferation and mucification known as cumulus expansion. Mucification refers to the secretion of a hyaluronic acid-rich cocktail that disperses and suspends the cumulus cell network in a sticky matrix around the ovum. This network stays with the ovum after ovulation and have been shown to be necessary for fertilization.

An increase in cumulus cell number causes a concomitant increase in antrum fluid volume that can swell the follicle to over 20mm in diameter. It forms a pronounced bulge at the surface of the ovary called the blister.

The majority of hormonal contraceptives and conception boosters focus on the ovulatory phase of the menstrual cycle because it is the most important determinant of fertility. Hormone therapy can positively or negatively interfere with ovulation and can give a sense of cycle control to the woman.

Follicle stimulating hormone, gonadotropin releasing hormone (GnRH), and estradiol have been purified in the laboratory. Chemical analogues of estradiol and progesterone have also been synthesized. Recall that GnRH is an upstream inducer of both FSH and LH secretion.

Generally, administered FSH or GnRH can induce ovulation by rapidly accelerating the pace of folliculogenesis, allowing for conception. Estradiol and progesterone, taken in various forms including combined oral contraceptive pills, mimics the hormonal levels of the menstrual cycle and engage in negative feedback of folliculogenesis and ovulation.

Ovulation induction is a promising assisted reproductive technology for patients with polycystic ovary syndrome (PCOS), oligomenorrhea, endometriosis[citation needed] or male factor infertility.[citation needed]

Medications that are commonly prescribed to induce ovulation include Clomid, Gonal-F/Follistim AQ, Metformin, Bravelle, Menopur and Repronex.

All ovulation-inducing medications carry the risk of side effects. A recent study has raised the possibility of a link between ovulation-inducing agents and an increased risk of ovarian carcinoma.


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