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Hajshafiha M, Behrouzi Lak T, Hajiloo N, Deldar Y, Ghorbani M, Haghollahi F. Evaluation of follicular fluid's Beta-Human chorionic gonadotropin in the follicles of patient undergoing Intracytoplasmic sperm injection: A cross-sectional study. Int J Reprod Biomed 2019; 16. [PMID: 31417985 PMCID: PMC6600285 DOI: 10.18502/ijrm.v16i12.3686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/13/2018] [Accepted: 08/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background The failure to retrieve oocytes from mature ovarian follicles is referred to as empty follicle syndrome. There is no exact explanation to this problem and it cannot be predicted using ultrasound or serum hormonal levels. The underlying mechanism of Empty follicle syndrome remains obscure. Objective In this study, the authors have investigated the relationship between the Beta-Human chorionic gonadotropin ( β HCG) levels in the follicular fluid with or without the oocyte in the follicles of patients undergoing Intracytoplasmic Sperm Injection. Materials and Methods Seventy-three infertile couples underwent standard long protocol induction ovulation for Intracytoplasmic sperm injection. On the day of oocyte retrieval, each patient had two samples; follicular fluid including 2-3 follicles with oocyte and follicular fluid including of 2-3 follicles without oocyte were collected in separate tubes. These follicles had similar shape and size. The Samples were transferred to a laboratory for measuring the β HCG level, after which the β HCG levels were compared to the follicles with and without the oocyte in each patient. Results In this study, the β HCG level of follicular fluid in the follicles containing oocyte was 18.20 (8.35-42.92) IU/L and in the follicles without the oocyte was 13.50 (5.45-25.81) IU/L. Levels of β HCG in the follicular fluids containing the oocyte were higher than without oocytes, This difference was not statistically significant (p = 0.16). Conclusion It seems that the follicular fluid β HCG isn't caused by empty follicle syndrome, and that dysfunctional folliculogenesis may be the cause of this syndrome.
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Affiliation(s)
- Masoumeh Hajshafiha
- Department of Obstetrics and Gynecology, Urmia Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Tahere Behrouzi Lak
- Department of Obstetrics and Gynecology, Urmia Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Nasrin Hajiloo
- Motahary Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Yaghoub Deldar
- Clinical Biochemistry, Urmia University of Medical Sciences, Urmia, Iran
| | - Mina Ghorbani
- Motahary Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Fedyeh Haghollahi
- Vali-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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2
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Sun L, Fang X, Chen Z, Zhang H, Zhang Z, Zhou P, Xue T, Peng X, Zhu Q, Yin M, Liu C, Deng Y, Hu H, Li N. Compound heterozygous ZP1 mutations cause empty follicle syndrome in infertile sisters. Hum Mutat 2019; 40:2001-2006. [PMID: 31292994 DOI: 10.1002/humu.23864] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 11/06/2022]
Abstract
Empty follicle syndrome (EFS) is a condition in which no oocyte is retrieved from mature follicles after proper ovarian stimulation in an in vitro fertilization procedure. Genetic evidence accumulates for the etiology of recurrent EFS without pharmacological or iatrogenic problems. In this study, we present two infertile sisters in a family with EFS after three cycles of standard ovarian stimulation with human chorionic gonadotrophin and/or gonadotropin-releasing hormone agonist therapy. Via whole-exome sequencing and cosegregation test, we identified compound heterozygous mutations in the gene of ZP1 in both of the infertile sisters. Coimmunoprecipitation tests and homology modeling analysis confirmed that both mutated ZP1 disrupt the formation of oocyte zona pellucida by interrupting the interaction among ZP1, ZP2, and ZP3. We thus propose that the specific mutations in ZP1 gene render a causality for the intractable EFS.
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Affiliation(s)
- Ling Sun
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiang Fang
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhiheng Chen
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hanwang Zhang
- Center of Reproductive Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhan Zhang
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Pei Zhou
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ting Xue
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaofang Peng
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qianying Zhu
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Minna Yin
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chunlin Liu
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yu Deng
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hao Hu
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Na Li
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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3
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Revelli A, Carosso A, Grassi G, Gennarelli G, Canosa S, Benedetto C. Empty follicle syndrome revisited: definition, incidence, aetiology, early diagnosis and treatment. Reprod Biomed Online 2017; 35:132-138. [PMID: 28596003 DOI: 10.1016/j.rbmo.2017.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 02/06/2023]
Abstract
In this review, the definition, incidence and possible causes of empty follicle syndrome (EFS), including molecular mechanisms that may underlie the syndrome, are discussed, along with prevention and treatment options. EFS is the complete failure to retrieve oocytes after ovarian stimulation, despite apparently normal follicle development and adequate follicular steroidogenesis. Two variants of EFS have been described: the 'genuine' form (gEFS), which occurs in the presence of adequate circulating HCG levels at the time of oocyte aspiration, and the 'false' form (f-EFS), which is associated with circulating HCG below a critical threshold. Heterogeneous HCG concentration thresholds, however, have been used to define gEFS, and to date no standardization exist. The situation is unclear when GnRH-analogues are used for ovulation trigger, as the threshold circulating LH and progesterone levels used to define EFS as 'genuine' are not established. The cause of fEFS has been clearly identified as an error in HCG administration at the time of ovulation trigger; in contrast, the cause of gEFS is still unclear, although some pathogenetic hypotheses have been proposed. Optimal treatment and prognosis of these patients are still poorly understood. Large, systematic multi-centre studies are needed to increase the understanding of EFS.
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Affiliation(s)
- Alberto Revelli
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy.
| | - Andrea Carosso
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
| | - Giuseppina Grassi
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
| | - Gianluca Gennarelli
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
| | - Stefano Canosa
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
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4
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Blazquez A, Guillén JJ, Colomé C, Coll O, Vassena R, Vernaeve V. Empty follicle syndrome prevalence and management in oocyte donors. Hum Reprod 2014; 29:2221-7. [DOI: 10.1093/humrep/deu203] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Kim JH, Jee BC. Empty follicle syndrome. Clin Exp Reprod Med 2012; 39:132-7. [PMID: 23346522 PMCID: PMC3548070 DOI: 10.5653/cerm.2012.39.4.132] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 11/06/2022] Open
Abstract
Empty follicle syndrome (EFS) is a condition in which no oocytes are retrieved after an apparently adequate ovarian response to stimulation and meticulous follicular aspiration. EFS can be classified into 'genuine' and 'false' types according to hCG levels. It is a rare condition of obscure etiology. The existence of genuine EFS has been questioned and is still controversial. The limitation around EFS is that the definition of EFS is obscure. Management of patients with EFS is a challenge to physicians. No single treatment is known to be universally effective. However, patients should be adequately informed regarding the importance of correct hCG administration because improper hCG administration is a common and preventable cause of EFS. EFS is a syndrome that deserves additional study because such investigation could lead to a further understanding of ovarian biology and infertility.
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Affiliation(s)
- Jee Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
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6
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Matorras R, Meabe A, Mendoza R, Prieto B, Ramón O, Mugica J, Aspichueta F, Exposito A. Human chorionic gonadotropin (hCG) plasma levels at oocyte retrieval and IVF outcomes. J Assist Reprod Genet 2012; 29:1067-71. [PMID: 22815004 DOI: 10.1007/s10815-012-9826-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The aim of our study was to ascertain the influence of hCG levels at oocyte pick-up on IVF outcomes, and their relationship with clinical parameters. METHODS A prospective study was performed including 473 women undergoing IVF, aged under 40 years. Blood samples to analyze hCG levels were obtained at the time of follicular aspiration, 36 h after the administration of 250 μg of recombinant hCG. RESULTS Neither the numbers of oocytes obtained or fertilized, nor the pregnancy rate, were correlated with hCG levels. Moreover, hCG values were very similar in women who did and did not become pregnant (123.3 ± 48.7 and 117.5 ± 44.7 mUI/mL). Cases in which no oocytes were recovered after follicular aspiration had similar hCG levels to those in which more than 1 oocyte was obtained. On the other hand, hCG levels were negatively related to body mass index, weight, and age. CONCLUSIONS These data indicate that after the administration of 250 μg of recombinant hCG, hCG levels are not responsible for failure to recover oocytes. Specifically, there was no correlation between plasma hCG levels and the number of oocytes obtained or other markers of IVF outcome. There was, however, an inverse relationship with BMI, body weight and age.
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Affiliation(s)
- R Matorras
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Cruces University Hospital, C/Plaza de Cruces S/N. 48903 Baracaldo, Vizcaya, Spain.
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7
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Beck-Fruchter R, Weiss A, Lavee M, Geslevich Y, Shalev E. Empty follicle syndrome: successful treatment in a recurrent case and review of the literature. Hum Reprod 2012; 27:1357-67. [PMID: 22357773 DOI: 10.1093/humrep/des037] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Empty follicle syndrome is a condition in which no oocytes are retrieved after an apparently adequate ovarian response to stimulation and meticulous follicular aspiration. It is a rare condition of obscure etiology. A patient with primary infertility who underwent seven assisted reproductive technique cycles is described. In spite of a satisfactory ovarian response, aspiration yielded no oocytes in four cycles and 1-4 low quality oocytes in three cycles. In the index treatment cycle, ovulation was triggered using GnRH agonist 40 h prior to ovum pickup and hCG was added 6 h after the first trigger. Eighteen oocytes were recovered, of which 16 were mature and were inseminated by ICSI. Two embryos were transferred 48 h after aspiration and nine embryos were cryopreserved. The patient conceived and delivered a healthy boy at 38 weeks of gestation. The literature is reviewed and possible etiologies and treatment options of this enigmatic syndrome are suggested.
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Affiliation(s)
- R Beck-Fruchter
- Fertility and In-Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel.
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8
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Mesen TB, Yu B, Richter KS, Widra E, DeCherney AH, Segars JH. The prevalence of genuine empty follicle syndrome. Fertil Steril 2012; 96:1375-7. [PMID: 22130102 DOI: 10.1016/j.fertnstert.2011.09.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 09/19/2011] [Accepted: 09/27/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To describe the prevalence of "genuine" empty follicle syndrome (EFS) and "false" EFS at assisted reproductive technology (ART). DESIGN Retrospective cohort. SETTING Large private fertility center. PATIENT(S) A total of 12,359 patients who underwent ART between 2004 and 2009. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The failure to recover an oocyte during oocyte retrieval at ART, with and without a detectable serum β-hCG on the day of retrieval. RESULT(S) Two cases of genuine EFS and nine cases of false EFS were identified in the cohort examined. The prevalence of genuine EFS was 0.016%, and the prevalence of false EFS was 0.072%. Only two out of 11 cases of EFS were considered genuine. CONCLUSION(S) Genuine EFS is a rare occurrence. Because this syndrome tends to recur with dismal pregnancy rates at ART, continued identification and further investigation of the syndrome are needed.
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Affiliation(s)
- Tolga B Mesen
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Program in Reproductive and Adult Endocrinology, Bethesda, Maryland, USA
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9
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Immature oocytes in "apparent empty follicle syndrome": a case report. Case Rep Med 2010; 2010:367505. [PMID: 20368997 PMCID: PMC2847864 DOI: 10.1155/2010/367505] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 03/18/2010] [Indexed: 11/18/2022] Open
Abstract
Empty follicle syndrome (EFS) is a condition in which no oocytes are obtained after an apparently successful ovarian stimulation. Genuine EFS (GEFS) is differentiated from false EFS by an optimal level of human chorionic gonadotropin on the day of oocyte retrieval. Some believe that GEFS does not exist and that it is only a reflection of the margin of error attendant upon the procedure of oocyte aspiration. Others believe that GEFS is caused by dysfunctional folliculogenesis, resulting in early atresia of oocytes. In this report, we present a case of apparent GEFS, in which immature oocytes were identified after filtration of follicular aspirates. Our findings suggest that delayed maturation of oocyte cumulus complexes in response to HCG might be an etiologic mechanism in some cases of GEFS. This creates a situation similar to the aspiration of immature follicles, where germinal vesicle-stage oocytes with dense scanty cumulus cells are often difficult to identify under a dissecting microscope.
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10
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Hirshfeld-Cytron J, Kim HH. Empty follicle syndrome in the setting of dramatic weight loss after bariatric surgery: case report and review of available literature. Fertil Steril 2008; 90:1199.e21-3. [DOI: 10.1016/j.fertnstert.2007.08.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 08/27/2007] [Accepted: 08/27/2007] [Indexed: 10/22/2022]
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11
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Empty follicle syndrome: the reality of a controversial syndrome, a systematic review. Fertil Steril 2007; 90:691-8. [PMID: 18023430 DOI: 10.1016/j.fertnstert.2007.07.1312] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 07/09/2007] [Accepted: 07/16/2007] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine all case reports and studies of empty follicle syndrome (EFS) that have been published since the condition was first reported, in an attempt to identify trends or common features that may expose possible risk or causative factors. DESIGN Systematic review of all available literature obtained from PubMed, Ovid, and Embase. SETTING Academic unit. PATIENT(S) Review of all published case reports and case studies. INTERVENTION(S) All original work was assessed and labeled as "genuine" or "false" EFS according to set definitions. MAIN OUTCOME MEASURE(S) Genuine and false EFS. We defined genuine EFS as a failure to retrieve oocytes from mature ovarian follicles after ovarian stimulation for IVF after apparently normal follicular development and steroidogenesis in the presence of optimal beta-hCG levels on the day of oocyte retrieval. False EFS included all cases in which this definition cannot apply and often in which human error or a pharmaceutical inaccuracy has occurred. RESULT(S) By classifying all cases of EFS as "genuine" or "false" according to stated definitions, it was evident that a much greater proportion of cases of reported EFS, 67%, occurred as a result of human error and that "genuine empty follicle syndrome" is an even rarer event than previously presumed. CONCLUSION(S) Our report highlights the value of classifying cases of EFS as "genuine" or "false" and shows that more epidemiological data are required of "genuine" EFS cases to develop a clearer picture of the possible etiology.
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12
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Stefanis P, Das S, Barsoum-Derias E, Kingsland C, Lewis-Jones I, Gazvani R. Relationship between serum human chorionic gonadotrophin levels and body mass index in women undergoing in vitro fertilisation cycles. Eur J Obstet Gynecol Reprod Biol 2006; 132:204-8. [PMID: 17011694 DOI: 10.1016/j.ejogrb.2006.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 05/20/2006] [Accepted: 08/30/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To ascertain if serum concentrations following injection of human chorionic gonadotropin (hCG) influenced the outcome of in vitro fertilisation (IVF) treatment and correlated to body mass index (BMI). STUDY DESIGN A prospective study conducted with the participation of 149 women undergoing IVF and/or intracytoplasmic sperm injection (ICSI) treatment at the regional IVF Unit in Liverpool, UK. The BMI of each individual was calculated and serum hCG concentrations were measured at 12 and 36 h following a subcutaneously (SC) injection of 5000 IU hCG. The main outcome measures were fertilisation rate and biochemical pregnancy rate. RESULTS No correlation was found between serum hCG levels at 12 and 36 h with the number of oocytes retrieved or the number of oocytes fertilised. Furthermore, there was no correlation between BMI and hCG levels at 12 and 36 h following administration (Pearson's correlation coefficient: -0.23, -0.24, respectively). CONCLUSION Our results suggest that the serum concentrations of hCG do not influence IVF outcome and that the serum levels of hCG achieved following administration do not correlate with the individual's BMI. Serum hCG concentration also does not correlate with number of oocytes collected or fertilisation rate.
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Affiliation(s)
- Petros Stefanis
- The Hewitt Centre for Reproductive Medicine, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK
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13
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Aktas M, Beckers NG, van Inzen WG, Verhoeff A, de Jong D. Oocytes in the empty follicle: a controversial syndrome. Fertil Steril 2005; 84:1643-8. [PMID: 16359958 DOI: 10.1016/j.fertnstert.2005.05.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Revised: 05/27/2005] [Accepted: 05/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the prevalence and etiology of the empty follicle syndrome (EFS). DESIGN Observational longitudinal study. SETTING Tertiary fertility centers. PATIENT(S) All patients beginning in vitro fertilization (IVF) treatment from December 2002 to November 2004 were included. Couples undergoing IVF with donor oocytes or participating in an experimental IVF study were excluded from analysis. INTERVENTION(S) Identification of EFS cycles. Comparing ovarian hyperstimulation strategy, follicle count, and timing of human chorionic gonadotropin (hCG) for final oocyte maturation of the EFS cycles with normal IVF cycles. MAIN OUTCOME MEASURE(S) Number of follicles punctured, number of oocytes recovered, previous and future IVF attempts, and serum hormone levels. RESULT(S) Twenty-five of a total of 1,849 patients were identified with an EFS cycle. Reasons for occurrence of EFS cycles were mistiming of hCG for final oocyte maturation, premature ovulation, and poor ovarian response. None of the affected patients had experienced EFS cycles in earlier IVF attempts nor were there any recurrence in subsequent treatments. CONCLUSION(S) Accurate timing of induction of final oocyte maturation, properly scheduled ovarian hyperstimulation, instruction of patients and doctors, and full workup for IVF are essential for the successful recovery of oocytes. Occurrence of EFS in IVF can normally be attributed to a failure of at least one of these factors and probably rarely or never occurs otherwise.
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Affiliation(s)
- Mustafa Aktas
- Department of Obstetrics and Gynecology, Erasmus MC/Daniel den Hoed, University Medical Center, Rotterdam, The Netherlands
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14
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Vujisic S, Stipoljev F, Bauman R, Dmitrovic R, Jezek D. Pericentric inversion of chromosome 2 in a patient with the empty follicle syndrome: Case report. Hum Reprod 2005; 20:2552-5. [PMID: 15905290 DOI: 10.1093/humrep/dei083] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The empty follicle syndrome (EFS) is defined as a lack of retrieved oocytes from follicles, at the time of repeated aspiration and flushing, following ovulation induction. The actual mechanism responsible for the EFS is still unknown. The aim of this study was to offer more information regarding the possible connection of this syndrome with pericentric inversion of chromosome 2. We give a case report of a patient who had multiple failed IVF attempts, due to the absence of oocyte and granulosa cells in the follicular fluid, following oocyte retrieval in both stimulated and natural cycles. Chromosomal analysis showed the presence of a pericentric inversion of chromosome 2: 46,XX,inv(2)(p11q21) in the female partner karyotype, while the male partner had a normal karyotype. Our case showed possible genetic factor influence in the aetiology of EFS.
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Affiliation(s)
- Sanja Vujisic
- Clinical Laboratory for Human Reproduction, Department of Obstetrics and Gynaecology Medical School, University of Zagreb, Sveti Duh Hospital, Croatia.
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15
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Younis JS, Skournik A, Radin O, Haddad S, Bar-Ami S, Ben-Ami M. Poor oocyte retrieval is a manifestation of low ovarian reserve. Fertil Steril 2005; 83:504-7. [PMID: 15705406 DOI: 10.1016/j.fertnstert.2004.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2003] [Revised: 09/29/2004] [Accepted: 09/29/2004] [Indexed: 11/19/2022]
Abstract
Women with complete absence of oocytes during retrieval, as well as those with less than the 10th percentile of the expected number of oocytes retrieved, have clear manifestations of low ovarian reserve. It seems that this occurrence is a gradual biological phenomenon related to the basic pathophysiology of ovarian aging.
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Affiliation(s)
- Johnny S Younis
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center, Tiberias, Israel.
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16
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Bustillo M. Unsuccessful oocyte retrieval: technical artefact or genuine 'empty follicle syndrome'? Reprod Biomed Online 2004; 8:59-67. [PMID: 14759289 DOI: 10.1016/s1472-6483(10)60498-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Unsuccessful oocyte retrieval after apparently successful ovarian stimulation (also referred to as 'empty follicle syndrome') occurs in 1-7% of women undergoing assisted reproductive techniques. A literature review was performed, as individual studies have reached differing conclusions on the aetiology and treatment or management of the phenomenon. The aetiology is not clear, but probably multifactorial, and occurs in natural and stimulated cycles. In many cases, technical problems such as errors in human chorionic gonadotrophin (HCG) administration or defects in HCG batches can be identified, but this is not sufficient to account for all reported cases. The term empty follicle syndrome is inappropriate in cases in which such procedural factors can be identified. In many patients, however, unsuccessful oocyte retrieval appears to be due to an underlying ovarian dysfunction, and some may have a genuine empty follicle syndrome. Appropriate measures, such as monitoring of serum beta-HCG, should be taken to minimize the risk of unsuccessful oocyte retrieval. This review discusses the potential causes of unsuccessful oocyte retrieval, its clinical implications, and potential solutions to this clinical problem.
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Affiliation(s)
- María Bustillo
- South Florida Institute for Reproductive Medicine, 7300 SW 62nd Place, 4th Floor, Miami, Florida, USA.
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17
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Milki AA, Mooney SB. Failure to recover oocytes during IVF: case reports and suggestions for management. J Assist Reprod Genet 2001; 18:352-3. [PMID: 11495414 PMCID: PMC3455849 DOI: 10.1023/a:1016636822361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A A Milki
- Department of Gynecology and Obstetrics, Stanford University School of Medicine, California 94305-5317, USA
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Brett S, Yong PY, Thong KJ. Ovarian hyperstimulation after the sole use of a gonadotrophin-releasing hormone agonist (Nafarelin) as a complication of in vitro fertilisation treatment. J Assist Reprod Genet 2001; 18:353-6. [PMID: 11495415 PMCID: PMC3455846 DOI: 10.1023/a:1016680504614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Brett
- Assisted Conception Unit, Simpsons Memorial Maternity Pavilion, Royal Infirmary of Edinburgh, Scotland, United Kingdom
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Papier S, Lipowicz R, De Vincentiis S, Nodar F, Olmedo SB, Acosta A. Pregnancy obtained by the transfer of frozen-thawed embryos originating from a rescued empty follicle syndrome cycle. Fertil Steril 2000; 74:603-4. [PMID: 10973665 DOI: 10.1016/s0015-0282(00)00706-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Papier
- Center for Studies in Gynecology and Reproduction, Buenos Aires, Argentina
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Peñarrubia J, Balasch J, Fábregues F, Creus M, Cívico S, Vanrell JA. Recurrent empty follicle syndrome successfully treated with recombinant human chorionic gonadotrophin. Hum Reprod 1999; 14:1703-6. [PMID: 10402371 DOI: 10.1093/humrep/14.7.1703] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report a case of a patient with polycystic ovary syndrome and primary infertility who was admitted to our in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) programme because of her partner's severe oligozoospermia and asthenozoospermia. Ovarian stimulation was accomplished in the three treatment cycles using gonadotrophin therapy after a dual approach with ovarian suppression using oral contraceptive pills followed by gonadotrophin-releasing hormone agonist therapy. Oocyte retrieval was unsuccessful in the first two treated cycles despite the fact that human chorionic gonadotrophin (HCG) from three different batches was used. In the third treatment cycle, recombinant HCG was used and five oocytes were retrieved. This is the first report of recurrent empty follicle syndrome despite the use of different batches of commercially available urinary HCG, and of its successful treatment using recombinant HCG.
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Affiliation(s)
- J Peñarrubia
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, Barcelona, Spain
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Evbuomwan IO, Fenwick JD, Shiels R, Herbert M, Murdoch AP. Severe ovarian hyperstimulation syndrome following salvage of empty follicle syndrome. Hum Reprod 1999; 14:1707-9. [PMID: 10402372 DOI: 10.1093/humrep/14.7.1707] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We report a case of severe ovarian hyperstimulation syndrome (OHSS) following a rescue of empty follicle syndrome (EFS). This suggests that the risk of developing OHSS remains unaltered even in the presence of EFS. The case supports the possibility of obtaining oocytes that fertilize and cleave normally after a second dose of human chorionic gonadotrophin (HCG) and a repeat oocyte retrieval. It supports the suggestion that the follicles are not necessarily empty in EFS. It demonstrates further that OHSS cannot be prevented by aspiration of follicular fluid and patients with large numbers of follicles and EFS must be warned of this potential complication.
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Affiliation(s)
- I O Evbuomwan
- Centre for Reproductive Medicine, RVI Trust, Newcastle upon Tyne, NE1 4LP, UK
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