Partial follicular aspiration for salvaging an IVF cycle after improper hCG administration. A case report

Failure of oocyte retrieval during in vitro fertilization (IVF) is considered "empty follicle syndrome." Many theories have been postulated, some related to an underlying ovulatory disorder or premature oocyte atresia. As illustrated in this case and in a review of empty follicle syndrome at our institution, often it is related to improper administration of human chorionic gonadotropin (hCG).

A 40-year-old woman underwent IVF for a 10-year history of unexplained secondary infertility. Two ultrasound-guided oocyte retrievals were performed 34 hours apart due to improper hCG administration prior to the first procedure. The number of oocytes successfully aspirated at the second retrieval, fertilization rate and pregnancy outcome were analyzed. Successful retrieval of 16 oocytes, all mature and fertilized, occurred subsequent to the second oocyte retrieval. No pregnancy was established with the fresh cycle.

This case report supports the premise that an IVF cycle in which improper hCG administration occurs can be salvaged. After partial follicular aspiration, no ovulation or luteinization of the remaining follicles occurred because of continued suppression by the gonadotropin releasing hormone analog. It is critical to consider the possibility of improper hCG administration when facing failure of oocyte retrieval. The procedure should be terminated and hCG readministered, and a second retrieval should be performed 34 hours later.