Empty follicle syndrome due to human errors: its occurrence in an in-vitro fertilization programme

Abstract

We report five cases in which no oocytes were retrieved after standard ovarian stimulation for in-vitro fertilization (IVF), and in which it was found that mistakes had been made at the time of human chorionic gonadotrophin (HCG) administration. In all five cases, oocyte retrieval was achieved after injecting HCG, when necessary, and reprogramming aspiration 24-36 h later. A mean of 7+/-3.2 MII oocytes were recovered per patient and 3.2+/-0.8 embryos were transferred. Three clinical pregnancies were obtained, and four healthy infants were born. In our programme, these were the only cases of empty follicle syndrome (EFS) that appeared over a total of 1118 cycles, and were all explained by human error in the administration of HCG. Our experience shows that human error could be considered a significant factor in the aetiology of empty follicle syndrome, and that EFS may be in part avoided by taking simple preventive measures.

Gonadotropin-releasing hormone agonist triggering is effective, even at a low dose, for final oocyte maturation in ART cycles: Case series

“…The incidence of EFS has been reported as 0.6%-3.5% in GnRHa trigger cycles, which is similar to that reported (0.1%-3.1%) after an hCG trigger (12,19,(25)(26)(27)(28)(29). Therefore, EFS is not an inherent and exclusive problem to the GnRHa trigger (25) but could be related to human error, abnormalities in the in vivo biological activity of some batches of commercially available GnRHa, hypothalamic dysfunction, or GnRH receptor mutations (23,26,(28)(29)(30). Elucidating the relationship between lower doses of GnRHa and EFS will require further studies including a larger number of patients.…”

Empty follicle syndrome after GnRHa triggering versus hCG triggering in COS

“…The available literature describes two subtypes of EFS; the so called genuine EFSpresumably related to intrinsic ovarian factors -and false EFS, mainly related to pharmacological problems or human administration error. Several hypotheses as to the background of EFS after hCG triggering of final oocyte maturation in gonadotropin stimulated cycles have been proposed: early oocyte atresia due to a dysfunctional folliculogenesis in the presence of an apparently normal hormonal response [4], a biological abnormality in the supply of mature oocytes to be retrieved despite normal bioavailability of hCG [5], genetic factors such as LH/hCG receptor mutations [6, REF 22 from Yariz 2011], abnormalities in the in vivo biological activity of some batches of commercially available hCG or GnRHa [7], rapid clearance of hCG by the liver [7], pharmacological problems [5,8,9] and human error [5,7,10] -in particular inappropriate timing of the triggering bolus of hCG [8]. Moreover, advanced ovarian ageing is considered a risk factor for EFS recurrence, probably due to altered folliculogenesis [6].…”

“Empty follicle syndrome” after human error: pregnancy obtained after repeated oocyte retrieval in a gonadotropin-releasing hormone antagonist cycle

“…This is a very frustrating and uncommon event that has been reported to occur in 0.2%-7% of cases (2,3). It seems that the risk of recurrence increases with the age of the patient (4).…”