DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160410

Empty follicle syndrome after GnRH agonist trigger, rescued with HCG in a donor oocyte with successful pregnancy outcome: a case report

Akshaya Kumar Mahapatro, Kundavi Shankar, Thankam Varma

Abstract


Empty follicle syndrome (EFS) is a rare condition characterized by failure to obtain oocytes despite repeated meticulous aspiration from normally growing ovarian follicles during in vitro fertilization (IVF) cycles. Here we report a case of empty follicle syndrome in donor oocyte cycle after gonadotropin releasing hormone agonist (GnRHa) triggering for final oocyte maturation. Her estradiol on the day of trigger was 4564.3 IU/L. No oocytes were collected from the right ovary and the procedure was abandoned. The patient was successfully rescued by retriggering with 10,000 units of Inj. hCG and 5 oocytes were collected after 35 hours of retriggering. All oocytes were mature (MII) and fertilized by recipient’s husband sperm. Recipient cycle was prepared by hormone therapy, and underwent day 3 fresh embryo transfer. Successful pregnancy was achieved and a term female child was delivered at 37 weeks by lower segment caesarean section. Management options of EFS in hyper responder patients triggered with GnRH agonist may be a risk factor for empty follicle syndrome & retriggering with Rescue hCG might help in oocyte retrieval in a donor. 

Keywords


Empty follicle syndrome, GnRH agonist, Ovarian hyperstimulation syndrome, HCG, Oocyte pick up

Full Text:

PDF

References


Coulam CB, Bustillo M, Schulman JD. Empty follicle syndrome. Fertil steril. 1986;46:1153-5.

Stevenson TL, Lashen H. Empty follicle syn¬drome: the reality of a controversial syndrome, a systematic review. Fertil Steril. 2008;90:691-8.

Kim JH, Jee BC. Empty follicle syndrome. Clin Exp Reprod Med. 2012;39(4):132-7.

Mesen TB, Yu B, Richter KS, Widra E, DeCherney AH, Segars JH. The prevalence of genuine empty follicle syndrome. Fertil Steril. 2011;96:1375-57.

Reichman DE, Greenwood E, Meyer L, Kligman I, Rosenwaks Z. Can in vitrofertilization cycles be salvaged by repeat administration of intramuscular human chorionic gonadotropin the day after failed injection? Fertil Steril. 2012;98:671-4.

Humaidan P, Kol S, Papanikolaou E. The Copenhagen GnRH Agonist Triggering Workshop Group. GnRH agonist for triggering of final oocyte maturation: time for a change of practice? Hum Reprod Update. 2011;17:510-4.

Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician. Fertil Steril. 2010;94(2):389-400.

Honnma H, Hashiba Y, Asada Y, Endo T. Failure of triggeringoocyte maturation with a GnRH agonist in polycystic ovary syndrome: two case reports. Eur J Obstet Gynecol Reprod Biol. 2011;157(2):239-40.

Reichman DE, Hornstein MD, Jackson KV, Racowsky C. Empty follicle syndrome does repeat administration of hCG really work? Fertil Steril. 2010;94:375-77.

Zegers-Hochschild F, Fernandez E, Mackenna A, Fabres C, Altieri E, Lopez T. The empty follicle syndrome: a pharmaceutical industry syndrome. Hum Reprod. 1995;10:2262-5.

Castillo JC, Garcia-Velasco J, Humaidan P. Empty follicle syndrome after GnRHa triggering versus hCG triggering in COS. J Assist Reprod Genet. 2012;29:249-53.

Gonen Y, Balakier H, Powell W, Casper RF. Use of gonadotropin releasing hormone agonist to trigger follicular maturation for in vitro fertilization. J Clin Endocrinol Metab. 1990;71:918-22.

Itskovitz J, Boldes R, Levron J, Erlik Y, Kahana L, Brandes JM. Induction of preovulatory luteinizing hormone surge and prevention of ovarian hyperstimulation syndrome by gonadotropin releasing hormone agonist. Fertil Steril. 1991;56:213-20.

Kummer NE, Feinn RS, Griffin DW, Nulsen JC, Benadiva CA, Engmann LL. Predicting successful induction of oocyte maturation after gonadotropin releasing hormone agonist (GnRHa) trigger. Hum Reprod. 2013;28:152-9.

Quintans CJ, Donaldson MJ, Blanco LA, Pasqualini RS. Empty follicle syndrome due to human errors: its occurrence in an in-vitro fertilization programme. Hum Reprod. 1998;13:2703-5.

Anna Blazquez, Juan Jose´ Guille´n, Clara Colome´, Oriol Coll, Rita Vassena, Valerie Vernaeve. Empty follicle syndrome prevalence and management in oocyte donors. Human Reproduction. 2014;29:2221-7.