Empty follicle syndrome revisited: definition, incidence, aetiology, early diagnosis and treatment

Revelli, Alberto; Carosso, Andrea; Grassi, G; Gennarelli, Gianluca; Canosa, Stefano; Benedetto, Chiara

doi:10.1016/j.rbmo.2017.04.012

Cited by 49 publications

(42 citation statements)

References 48 publications

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“…The prevalence of all EFS is estimated to be 0.045% to 3.4% and of genuine EFS to be 0% to 1.1% ( 148 ). Some units will conduct a urine test for hCG (signifying a level of at least 10 to 20 IU/L) or a serum LH level following GnRHa to indicate whether EFS is genuine or false as a result from a problem with administration or absorption ( 149 ).…”

Section: Endocrine Requirements For Oocyte Maturation and Ovulationmentioning

confidence: 99%

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

2018

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Infertility affects one in six of the population and increasingly couples require treatment with assisted reproductive techniques. In vitro fertilization (IVF) treatment is most commonly conducted using exogenous FSH to induce follicular growth and human chorionic gonadotropin (hCG) to induce final oocyte maturation. However, hCG may cause the potentially life-threatening iatrogenic complication “ovarian hyperstimulation syndrome” (OHSS), which can cause considerable morbidity and, rarely, even mortality in otherwise healthy women. The use of GnRH agonists (GnRHas) has been pioneered during the last two decades to provide a safer option to induce final oocyte maturation. More recently, the neuropeptide kisspeptin, a hypothalamic regulator of GnRH release, has been investigated as a novel inductor of oocyte maturation. The hormonal stimulus used to induce oocyte maturation has a major impact on the success (retrieval of oocytes and chance of implantation) and safety (risk of OHSS) of IVF treatment. This review aims to appraise experimental and clinical data of hormonal approaches used to induce final oocyte maturation by hCG, GnRHa, both GnRHa and hCG administered in combination, recombinant LH, or kisspeptin. We also examine evidence for the timing of administration of the inductor of final oocyte maturation in relationship to parameters of follicular growth and the subsequent interval to oocyte retrieval. In summary, we review data on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.

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Section: Endocrine Requirements For Oocyte Maturation and Ovulationmentioning

confidence: 99%

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

2018

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“…Interestingly, Revelli et al suggested that EFS might not be a constant condition. Thus, in a study of 43 patients undergoing a second stimulation after EFS in the first cycle, a total of 37 patients (86%) obtained MII oocytes, although the stimulation protocols were similar, and a hCG trigger was used for the second cycle too (32). This could be caused by cycle-to-cycle variations in oocyte quality.…”

Section: Empty Follicle Syndrome Following Hcg Triggermentioning

confidence: 99%

Gonadotropin-releasing hormone agonist ovulation trigger—beyond OHSS prevention

Castillo

Haahr

Martínez-Moya

et al. 2020

Upsala Journal of Medical Sciences

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In this review the advantages of the gonadotropin-releasing hormone agonist (GnRHa) trigger are discussed beyond those immediately associated with ovarian hyperstimulation syndrome (OHSS) prevention. The GnRHa trigger concept has sparked the development of novel protocols, enriching the assisted reproductive technology (ART) armamentarium for the benefit of present and future patients. Thus, GnRHa trigger already has a pivotal role, not only for the standard in vitro fertilisation (IVF) patient, but also for patient groups like oocyte donors, cancer patients, patients with poor ovarian reserve, and patients with immature oocyte syndrome and empty follicle syndrome. Herein, we discuss the importance of the GnRHa-elicited midcycle FSH surge and the potential improvement in oocyte yield and embryo competence.

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“…However, only in a few cases, there is a complete failure to retrieve oocytes after hCG as well as the GnRHa trigger (1,2). In the case of a GnRHa trigger, failure to retrieve mature oocytes should not always be classified as an Empty Follicle Syndrome (EFS) (3), as the pathophysiology is likely to be different. Based on the available literature, some authors do not support the existence of the EFS, considering the "syndrome" due to errors in the administration of the trigger.…”

Section: Introductionmentioning

confidence: 99%

Self-Detection of the LH Surge in Urine After GnRH Agonist Trigger in IVF—How to Minimize Failure to Retrieve Oocytes

et al. 2020

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Research question: Urine LH testing may be useful to confirm an LH surge after the GnRH agonist (GnRHa) trigger prior to oocyte retrieval in IVF.Design: A prospective cohort study, including oocyte donors undergoing ovarian stimulation, treated with a GnRHa trigger for final oocyte maturation. Urine LH testing was performed at home, 12 h after the GnRHa trigger. In the case of a negative result, serum LH and progesterone measurements were done that same day. Donors with no serum LH peak after trigger were re-scheduled using a dual trigger, with GnRHa and hCG.Results: Three hundred and fifty nine oocyte donors were included in the analysis. Three hundred and fifty six donors had positive urine LH tests, followed by oocyte retrieval. In one case, the LH test was positive, however, no oocytes were retrieved (false positive 1/356). Three LH tests were negative in urine: in one of these three cases, LH was tested again in blood, confirming an LH rise, consistent with an optimal response to the GnRHa trigger; in the other two cases, serum LH was <15 mUI/mL, after which the oocyte retrieval was re-scheduled for 36 h after an being re-triggered, resulting in the retrieval of 19 and 22 MII oocytes, respectively. Considering the cost analysis, it would be a significantly cost-saving strategy, as blood testing would have costed 14,840e vs. only 185.5e in urine LH kits.Conclusions: Urinary testing of the LH surge after GnRHa trigger is easy, safe, reliable, and convenient. In addition, LH urine testing allows identifying donors and patients who could benefit from a rescue hCG trigger after an unsuccessful GnRHa trigger.

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Empty follicle syndrome revisited: definition, incidence, aetiology, early diagnosis and treatment

Cited by 49 publications

References 48 publications

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

Gonadotropin-releasing hormone agonist ovulation trigger—beyond OHSS prevention

Self-Detection of the LH Surge in Urine After GnRH Agonist Trigger in IVF—How to Minimize Failure to Retrieve Oocytes

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