Published: 2016-12-27

Recurrent genuine empty follicle syndrome: a rare case report

Akshaya Kumar Mahapatro, Kundavi Shankar, Thankam Varma


Failure to aspirate oocytes from follicles after Controlled ovarian stimulation with apparently normal growing follicles with normal steroidgenesis after meticulous follicular aspiration is called Empty follicular syndrome (EFS). EFS are mainly two types, Genuine EFS & False EFS. Here we report a case of 24 yrs female presenting with primary subfertility with normal ovarian reserve, husband having normal semen analysis, planned for In vitro fertilization for failed Intra uterine insemination (IUI) & underwent two cycles of oocytes retrieval after controlled ovarian stimulation. We couldn’t retrieve any oocytes in spite of adequate serum βhCG level in both the cycles. Karyotyping of the patient was normal (46 XX). In this patient we were not able to find out any cause for recurrent genuine empty follicle syndrome. So we advised the couple to opt for oocyte donation program.


Oocyte, Controlled ovarian stimulation, EFS, βhCG, Karyotyping

Full Text:



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

Aktas M, Beckers NG, Van inzenWG. Oocytesin the emptyfollicles: a controversial syndrome. fertilsteril. 2005;84(6):1643-8.

Awonuga A, Govindbhai J, Zierke S. Continuing the debate on Empty follicle syndrome: can it be associated with normal bioavailability of β-HCG on the day of oocyte recovery? Hum reprod. 1998;13(5):1281-4.

Stevenson TL, Lashen H. Empty follicle syndrome: the reality of a controversial syndrome, a systemic review. Fertil steril. 2008;90(3):691-8.

Baum M, Machtinger R, Yerushalmi GM. Recurrence of empty follicle syndrome with stimulated IVF cycles. Gynecol Endocrinol. 2012;28(4):239-5.

Ben-shlomo I, Schiff E, Levran D, Ben-RaFael Z. Failure of oocyte retrieval during IVF :a sporadic event rather than a syndrome. Fertil Steril. 1991;55:324-7.

Zreik TG, Gracia-Velasco JA, Vergara TM. EFS: evidence for recurrence. Hum reprods. 2000;15(5):999-1002.

Zegers-Hochschild F, Fernandez E, Machenna A, Faberes C. The EFS: A pharmaceutical industry syndrome. Hum reprods. 1995;10:2262-5.

Onalan G, Pabuccu R, Onalan R. EFS in two sisters with three cycles: case report. Hum Rerod. 2003;18(9):1864-7.

Vujisic S, Stipoljev F, Bauman R. Pericentric inversion of chromosome 2 in a patient with the EFS: case report. human reprod. 2005;20(9):2552-5.

Yariz KO, Walsh T, Uzak A. Inherited mutation of the LH/choriogonadotropin receptor (LHCGR) in EFS. Fertil Steril. 2011;96(2):e125-30.

Griesinger G, Diedrich K, Devroey P, Kolibianakis EM. GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis. Hum Reprod Update. 2006;12:159-68.

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;17:510-24.

Lamb JD, Shen S, McCulloch C, Jalalian L, Cedars MI, Rosen MP. Follicle-stimulating hormone administered at the time of human chorionic gonadotropin trigger improves oocyte developmental competence in in vitro fertilization cycles: a randomized, double-blind, placebo-controlled trial.Fertil Steril. 2011;95:1655-60.

Pennarrubia J, Balasch J, Fabregues F, Creus M, Civico S, Vanrell J. Recurrent EFS successfully treated with recombinant HCG: case report. Hum Reprod. 1999;14:1703-6.

NdukweG, Thornton S, Fishel S, Dowell K, Aloum M, Green S. Curing EFS. HumReprod. 1997;12:21-3.