Empty follicle syndrome: evidence for recurrence

Abstract

The empty follicle syndrome (EFS) is a frustrating condition in which no oocytes are retrieved in an IVF cycle. Although this is an infrequent event in IVF patients, the economic consequences as well as the emotional frustration of a cancelled cycle due to the inability to obtain oocytes are enormous. The mechanisms responsible for EFS remain obscure, though many hypotheses have been put forward ranging from dysfunctional folliculogenesis to a drug-related problem. We found that the EFS is a rare event (1.8% of oocyte retrievals) but with profound implications for counselling the couple about their future reproductive performance. The chances of recurrence of EFS increase with the age of the patient (24% recurrence rate for the 35-39 year age group, and 57% for those over 40 years). We postulate that ovarian ageing, through altered folliculogenesis, may be implicated in the aetiology of EFS and its recurrence.

Empty follicle syndrome after GnRHa triggering versus hCG triggering in COS

“…IVF patients under 35 years old with male factor) and some donors may end up as patients in the future, so if both groups are young, it seems legitimate to present the current data. Finally, it seems that no specific protocol is related to the occurrence or recurrence of EFS [6]. In a further effort to identify specific characteristics of EFS cycles, we evaluated cycle features in EFS vs non-EFS.…”

“…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].…”

A Recurrent Missense Mutation in ZP3 Causes Empty Follicle Syndrome and Female Infertility

“…8 Without oocytes for fertilization, these individuals fail to achieve pregnancy after a demanding and expensive medical intervention, resulting in stress to both physicians and the individuals themselves. 9 In this study, we identified a heterozygous missense mutation in ZP3 (MIM: 182889; GenBank: NM_001110354.1) from a large family with multiple women affected by EFS.…”

Recurrent genuine empty follicle syndrome: a rare case report

“…Some cases of EFS were sporadic with good outcome however in 15-30% cases, recurrent EFS can be anticipated. 7 Assessment of serum βhCG next day after the trigger is a potential preventive measure against False EFS. hCG has long been used as a surrogate marker for the LH surge.…”