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Collection of Human Follicular Fluid, Follicle Somatic Cells, and Immature Oocytes from Individuals Undergoing In Vitro Fertilization
Published on: October 24, 2025
Empty follicle syndrome-Still an enigma
Deepika Krishna1, Lavanya Rajashekar, Madhuri Patil
1O.B.G-Infertility, Dr. Patil's Fertility and Endoscopy Clinic, No1, Uma Admiralty, 1 Floor, Banerghatta Road, Bangalore-560 029, Karnataka, India.
Journal of Human Reproductive Sciences
|June 30, 2009
Summary
Empty follicle syndrome (EFS) prevents oocyte retrieval in IVF despite apparent follicle development. Modifying controlled ovarian hyperstimulation protocols can lead to successful outcomes in subsequent cycles.
Area of Science:
- Reproductive Endocrinology
- In Vitro Fertilization
Background:
- Empty follicle syndrome (EFS) is a rare but frustrating cause of failed oocyte retrieval during in vitro fertilization (IVF).
- EFS occurs despite ultrasound and estradiol evidence of multiple developing follicles, with no oocytes retrieved during oocyte retrieval (OR).
Observation:
- The condition is complex and not solely explained by low human chorionic gonadotrophin (hCG) bioavailability.
- Serum beta-human chorionic gonadotrophin (bhCG) levels on the day of OR are not a reliable diagnostic indicator for EFS, except in cases of very low concentration.
Findings:
- A case report details a patient undergoing intracytoplasmic sperm injection (ICSI) for male factor infertility.
- The initial controlled ovarian hyperstimulation (COH) cycle, utilizing a gonadotrophin-releasing hormone (GnRH) agonist long protocol with follicle-stimulating hormone (FSH) and human menopausal gonadotrophin (HMG), resulted in EFS.
- A modified COH protocol in a subsequent cycle led to successful oocyte retrieval.
Implications:
- This case highlights the potential for successful IVF outcomes in patients with EFS through individualized adjustments to COH protocols.
- Further research into the multifactorial causes of EFS and optimized stimulation strategies is warranted.
- Personalized treatment approaches are crucial for managing EFS in assisted reproductive technologies.
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