Empty follicle syndrome: successful treatment in a recurrent case and review of the literature

Abstract

Empty follicle syndrome is a condition in which no oocytes are retrieved after an apparently adequate ovarian response to stimulation and meticulous follicular aspiration. It is a rare condition of obscure etiology. A patient with primary infertility who underwent seven assisted reproductive technique cycles is described. In spite of a satisfactory ovarian response, aspiration yielded no oocytes in four cycles and 1-4 low quality oocytes in three cycles. In the index treatment cycle, ovulation was triggered using GnRH agonist 40 h prior to ovum pickup and hCG was added 6 h after the first trigger. Eighteen oocytes were recovered, of which 16 were mature and were inseminated by ICSI. Two embryos were transferred 48 h after aspiration and nine embryos were cryopreserved. The patient conceived and delivered a healthy boy at 38 weeks of gestation. The literature is reviewed and possible etiologies and treatment options of this enigmatic syndrome are suggested.

Comparison of two different dosage of GnRH agonist as ovulation trigger in oocyte donors: a randomized controled trial

“…Progesterone levels in day 6 were also found to be higher in the 0.4mg group. It remains to elucidate if the lower LH levels could cause clinical impairment as an increase in the number of empty follicle syndrome (EFS) cases (Stevenson & Lashen, 2008;Beck-Fruchter et al, 2012).…”

Successful Pregnancy Following Dual Triggering Concept (rhCG + GnRH Agonist) in a Patient Showing Repetitive Inmature Oocytes and Empty Follicle Syndrome: Case Report

“…However, we may assume that in some patients, like our case, this FSH surge may promote an adequate resumption of meiosis or optimize the signaling within cumulus cells preventing the occurrence of EFS and also inducing oocyte maturation until MII stage. Clinical evidence of this statements are provided by medical literature, for example some cases of EFS are solved by changing the trigger agent to GnRH agonist [14,29], furthermore, the retrieval of more mature oocytes after GnRHa triggering observed in IVF cycles supports a possible beneficial effect of the mid-cycle FSH surge on oocyte maturity [7][8][9][10].…”

“…Levran et al (2002) [13] described 8 cases of oocyte maturation arrest and more recently Beck-Fruchter et al (2012) [14] described EFS treatment including a complete review of the literature. However, our group is not aware of any publication showing both anomalies: oocyte maturation and EFS occurring in the same patient as in the case described herein.…”

Controlled Ovarian Stimulation in IVF Cycles

“…54 Son zamanlarda empty follikül sendromu olgusunda önerilen GnRH agonist ve HCG'nin sı-rayla OPU'dan 40 saat ve 34 saat öncesinde uygulanması olarak tanımlanan 'double trigger' tanımlanmıştır. 55 Bu yöntemin iki avantajı vardır: 1-ovulasyon tetiklenmesi ve OPU arasındaki süreyi uzatması, 2-GnRH agonist ile eş zamanlı FSH pikinin sağlanması. 56 Yazarlar bu uygulamanın granulosa hücre fonksiyonlarındaki, oosit mayotik matürasyondaki ve kumulus ekspansiyonundaki bozuklukların üstesinden geleceğini vurgulamış-lardır.…”