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


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. 


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

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