The time from recruitment of tertiary stage follicles to ovulation, is normally about two weeks, comprising days 1-14 of an idealized 28-day menstrual cycle. However, it is common for the follicular phase to last much longer, as sometimes no dominant follicle is selected. In this case, more tertiary stage follicles are usually recruited, and the process begins again. One study of women with regular menstrual cycles found that none of them ovulated after the first wave of follicle development: 68% of cycles showed ovulation after the second wave, while 32% of cycles showed ovulation after the third wave.  Fertility awareness sources may refer to multiple waves of follicular development as a split peak because of the characteristic pattern of cervical mucus changes that is sometimes observed.  [ unreliable medical source? ]
If an ovarian cyst continues to grow, does not resolve on its own, appears suspicious on ultrasound, or is causing symptoms, the doctor may recommend surgical removal. Surgery may be recommended more often for postmenopausal women with worrisome cysts, as the risk of ovarian cancer increases with age. An ovarian cyst may be removed surgically by laparoscopy or laparotomy. Laparoscopy involves the removal of the cyst by making several small incisions in the abdomen. The doctor will then use a camera and specialized instruments for removal of the cyst.