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Abstract

We report a case of a recurrent empty follicle syndrome. The patient was admitted to our intracytoplasmic injection program because of her partner's azoospermia. Ovarian stimulation was accomplished using gonadotrophin therapy after treatment with oral contraceptive pills followed by gonadotrophin-releasing hormone agonist. Thirty-six hours after the administration of HCG (human chorionic gonadotrophins), transvaginal oocyte retrieval yielded no oocytes despite the aspiration and flushing of all available follicles. Two years later, a second treatment cycle was started using the same pituitary desensitisation and ovarian stimulation regimens. HCG from a different batch with respect to that used in the first treatment cycle was administered. Aspiration and repeated flushing of all follicles of one ovary failed to yield any identifiable oocyte. The beta-HCG and progesterone serum concentrations on the day of retrieval were 181 mIU/mL and 3.79 ng/mL, respectively. New oocyte retrieval was planned 6 h after the first attempt for aspiration of follicles. Again, no ova were obtained at this second trial despite the aspiration of the all follicles. As to our knowledge this is the first report of recurrent EFS (empty follicle syndrome) and managed without repeating the HCG injection on the day of unsuccessful oocyte retrieval.

GnRH agonist triggering affects the kinetics of embryo development: a comparative study

“…Decleer et al reported a greater number of excellent oocytes and cryopreserved embryos after dual triggering, compared with hCG only [ 28 ]. A recent paper recommended prolonging the time interval between ovulation triggering with a GnRHa and oocyte pick-up to overcome any existing impairment in granulosa cell function, oocyte meiotic maturation, or cumulus expansion for patients with abnormal follicular maturation [ 29 ]. We did not evaluate the effects of a dual trigger on oocyte development.…”

Empty follicle syndrome

“…Uygur et al [42] suggested prolonging the interval between ovulation triggering and OPU. However, the strategy regarding prolonging the interval between triggering and OPU has little evidence to be generally recommended.…”

Unraveling the Puzzle: Oocyte Maturation Abnormalities (OMAS)

“…In the study of Zreik et al, they reported that the incidence of EFS was 1.8% and the recurrence rate was 24% in 34–39-year-old patients and 57% in women over 40 years of age [ 29 ]. Early follicular atresia or apoptosis was first mentioned by Uygur et al as the cause of EFS [ 30 ]. Vutyavanich et al obtained immature oocytes from the filtrate of IVF follicular fluid in a case of EFS [ 31 ].…”