Is the occurrence of the empty follicle syndrome a predictor that a subsequent stimulated cycle will be an unfavourable one?

Abstract

Several hypotheses have been advanced to explain empty follicle syndrome (EFS) but it remains a controversial topic. This paper reports experience with three IVF cycles in which no oocytes were collected. In all cases, an additional IVF cycle was performed. The ovarian stimulation protocol, ultrasound and hormonal surveillance methods, human chorionic gonadotrophin timing and oocyte retrieval technique were similar in all patients. The assessment of additional cycles demonstrated a poor response in terms of oocyte quality, since the number of mature oocytes was low despite the high number of oocytes collected. Thus, the data suggest that in these patients, EFS should be considered as a borderline form of poor response to ovarian stimulation. If this is confirmed, EFS should be a recurrent event and an empty cycle could be a good predictor that a subsequent stimulated cycle will be an unfavourable.

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

“…2 It has been proposed that GEFS is caused by dysfunctional folliculogenesis, ovarian aging, or genetic factors including pericentric inversion of chromosome 2 and LHCGR (MIM: 152790) mutations. [3][4][5][6][7] A retrospective study of 12,359 individuals who underwent assisted reproductive technology (ART) revealed that the prevalence of GEFS was about 0.016%. 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.…”

Empty follicle syndrome

“…Several reports suggest that a significant part of genuine EFS is associated with ovarian ageing [4,8,20-22]. Ovarian ageing is characterized by poorly functioning GC [23].…”

“…On the other hand, some suggest the occurrence of EFS would indicate a poor outcome in subsequent cycles. Lorusso et al [20] reported in their case series that poor quality oocytes were obtained after an EFS cycle and suggested that the empty cycle could be a predictor that a subsequent stimulated cycle will be an unfavorable one. Later, Coskun et al [9] also reported poor outcomes after genuine EFS.…”

Failure of intrauterine insemination as rescue treatment in low responders with adequate HCG timing with no oocytes retrieved

“…A number of investigators have related failure to obtain oocytes to ovarian ageing (Ben-Shlomo et al, 1991;Lorusso et al, 2005). This is characterized by the following: poorly functional granulosa cells and oocytes unable to achieve maturity (Ben-Shlomo et al, 1991); underlying ovarian dysfunction resulting in impaired follicular maturation or ovulation (Bustillo, 2004); an error in folliculogenesis or premature apoptosis of the oocytes that still continued follicular growth (Desai et al, 2009); strong attachment of cumulus cell complexes to the follicular wall; dysfunctional ovulation induction (Khalaf et al, 2000); a borderline form of poor response to ovarian stimulation (Lorusso et al, 2005); or a genetic defect (Yariz et al, 2011). In our opinion, the different ostradiol-follicle ratios found could reflect poor oocyte quality.…”