Biomechanical properties of ovarian tissue and their impact on the activation of follicular growth: a narrative review.

Follicular recruitment is tightly regulated to ensure long-term balance between the pools of dormant and growing follicles. While the growth of secondary to antral follicles is well understood, the initiation of folliculogenesis remains elusive. Several processes have been described, and a new approach is mechanotransduction. The aim of this review is to present the latest findings on the biomechanical properties of the ovary, and their role during the initiation of folliculogenesis. A search of PubMed using keywords related to the biomechanical properties of ovarian tissue and ovarian mechanobiology identified 114 manuscripts, and 74 were included in this review. The investigation of mechanical properties of the ovary has revealed the existence of an elastic modulus gradient from the cortex to the medulla, which is essential for balancing the preservation of a pool of quiescent follicles and supporting folliculogenesis. Growing follicles subjected to different mechanical environments respond through mechanotransduction, leading to the activation or inhibition of folliculogenesis. The application of findings on ovarian mechanoreactivity revealed that stretching cortical tissue fragments may activate in-vitro folliculogenesis. Although these results require confirmation by larger studies, a comprehensive understanding of normal and pathological ovarian biomechanical functions offers new possibilities for managing patient infertility.