Empty follicle syndrome prevalence and management in oocyte donors (original) (raw)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
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.
Journal of ovarian research, 2014
Recently, the co-administration of GnRH agonist and hCG for final oocyte maturation- 40 and 34 hours prior to OPU, respectively (double trigger) was suggested as the treatment of genuine empty follicle syndrome. In the present study, we aim to evaluate whether the double trigger improves the number of oocytes retrieved in patients with low (<50%) number of oocytes retrieved per number of preovulatory follicles. In this proof of concept cohort historical study, we compared the stimulation characteristics of 8 IVF cycles, which include the double trigger to the patients' previous IVF attempt, triggered with hCG-only. Patients who received the double trigger (study group) had a significantly higher number of oocytes retrieved, number of 2PN, number of embryos transferred and significantly higher proportions of the number of oocytes retrieved to the number of follicles >10 mm and >14 mm in diameter on day of hCG administration, with a tendency toward a higher number of TQE,...
2015
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 in we report two cases of empty follicle syndrome after gonadotropin releasing hormone agonist (GnRHa) triggering for final oocyte maturation due to ovarian hyperstimulation syndrome (OHSS) risk. Neither oocytes nor granulosa cells were recovered in both patients during first oocyte pick up procedure despite developing multiple follicles. The patients were succesfully rescued by retriggering maturation using hCG and only two and one oocytes could be obtained in patient 1 and 2 respectively after 24 hours. The oocytes were mature (MII) and fertilized normally. Fresh transfer of two embryos and frozen thaw transfer of one embryo was applied to patient 1 and patient 2 respectively. Successful pregnancies were achieved in both patients. Management options of EFS in hyperrespo...
Curing' empty follicle syndrome
Human Reproduction, 1997
rescuing the EFS cycle and present evidence, using EFS patients as their own controls, which confirms that EFS is a 1 To whom correspondence should be addressed drug-related problem rather than a clinical dysfunction (Zegers-We report a novel method of rescuing empty follicle Hochschild et al., 1995). syndrome (EFS) and provide evidence that it is a drugrelated problem rather than a clinical dysfunction. In a Materials and methods preliminary study we established that in EFS the serum β-This study involved three women undergoing assisted reproductive human chorionic gonadotrophin (β-HCG) concentrations technology (ART) at Nottingham University Research and Treatment 36 h after HCG administration never exceeded 10 mIU/ Unit in Reproduction (NURTURE). In all cases controlled ovarian ml. β-HCG concentrations were thus used to confirm EFS hyperstimulation was with gonadotrophin-releasing hormone agonist when oocytes were not retrieved from one ovary after (GnRHa), buserelin, 500 mg s.c., daily (Suprefact; Hoechst UK Ltd, controlled ovarian hyperstimulation. The procedure was Hounslow, Middlesex, UK), starting in the mid-luteal phase of the suspended leaving intact all follicles in the second ovary. preceding cycle, and human menopausal gonadotrophin (HMG) 150-After confirmation of EFS, a second HCG from a different 225 IU, i.m. daily (Pergonal; Serono Laboratories Ltd, Welwyn batch was administered and 36 h later mature oocytes were Garden City, UK or Humegon or Normegon; Organon Laboratories retrieved from the intact ovary, suggesting a fault with the Ltd, Cambridge, UK). Ovarian stimulation was monitored by ultra-HCG previously administered. Three patients have been sound and serum oestradiol measurements. When at least three treated in this way. In the first case, four out of five mature follicles were ജ18 mm, i.m. HCG 10 000 IU was administered (Profasi; Serono or Pregnyl; Organon). Transvaginal ultrasound-eggs were fertilized after intracytoplasmic sperm injection guided oocyte retrieval was carried out 36 h post-HCG administration. (ICSI) resulting in the transfer of three top grade (grade In a previous study of EFS cycles (Ndukwe et al., 1996), we described 1) embryos. In the second case all seven mature oocytes a serum β-HCG value of Ͻ10 mIU/ml as predictive (100% predictive fertilized after in-vitro fertilization (IVF) and three grade value) of EFS. Therefore, in all three cases when no oocytes were 1 embryos were transferred resulting in a twin pregnancy, retrieved from any of the follicles in one ovary despite repeated now delivered. In the third case, five out of nine oocytes aspiration and flushing, blood was taken for urgent serum β-HCG were fertilized after ICSI and one out of the three treated estimation. If the value was Ͻ10 mIU/ml, EFS was confirmed and with high insemination concentration IVF fertilized, the procedure was suspended without aspiration of the follicles in resulting in the transfer of three ICSI embryos. the second ovary. An enquiry was conducted on the appropriateness Key words: controlled ovarian hyperstimulation/empty follicle of the storage, timing, administration and expiry dates of the HCG syndrome/human chorionic gonadotrophin/IVF administered. A second HCG, 10 000 IU i.m. from a totally different batch, was then administered and serum β-HCG evaluated 12 and 36 h later. Oocyte retrieval from the ovary whose follicles had been left intact was then carried out 36 h following the second HCG administration. Evaluation of β-HCG was by Microparticle Enzyme
Human Reproduction, 2003
To date, empty follicle syndrome (EFS) has only been reported in GnRH agonist down-regulated IVF cycles. Some cases have been successfully treated by changing the batch, or by repeating the dose of hCG. A case of EFS was observed in both GnRH antagonist and GnRH agonist down-regulated IVF cycles when ®nal oocyte maturation was triggered using urinary hCG (u-hCG). Failure to retrieve oocytes occurred, despite administration of a further dose of u-hCG from a different batch and a delayed repeated oocyte recovery performed in the second GnRH agonist down-regulated cycle. A successful oocyte recovery cycle was achieved after triggering of an endogenous gonadotrophin surge using GnRH agonist in an antagonist down-regulated cycle. Nine oocytes were readily retrieved from 10 follicles, at 36 h after GnRH agonist administration, and eight of these fertilized normally. Two good quality embryos were used for fresh transfer and four were cryopreserved for future use. EFS can occur in GnRH antagonist down-regulated IVF cycles, and can be successfully treated by triggering a natural gonadotrophin surge using GnRH agonist in the absence of any response to previous treatment methods. This represents a novel therapeutic modality for this uncommon but frustrating condition.
Fertility and Sterility, 2009
Objective: To compare pregnancy rates and the incidence of ovarian hyperstimulation syndrome (OHSS) in donor stimulation cycles where final maturation of oocytes was induced with recombinant hCG or GnRH agonist. Design: Retrospective, cohort study. Setting: Private infertility clinic. Patient(s): A total of 1171 egg donors performing 2077 stimulation cycles. Intervention(s): Controlled ovarian hyperstimulation of egg donors with GnRH antagonist protocol triggered with recombinant hCG (rhCG; 250 mg) or GnRH agonist (triptorelin 0.2 mg) based on the physician's decision. Main Outcome Measure(s): Proportion of mature and fertilized oocytes per donor cycle; clinical, ongoing pregnancy and implantation rate in recipients; and incidence of moderate/severe OHSS in oocyte donors. Result(s): The proportion of mature oocytes was comparable, whereas the difference in the fertilization rate reached statistical significance (65% vs. 69%). No significant differences were observed in the implantation rate or clinical and ongoing pregnancy rates per ET. The incidence of moderate/severe OHSS was 1.26% (13/ 1031; 95% confidence interval [CI], 0.74-2.15) and 0% (0/1046; 95% CI, 0.00-0.37) in the rhCG and GnRH agonist groups, respectively. Conclusion(s): Recipient outcome was not significantly different when using oocytes from GnRH antagonisttreated donor cycles triggered with hCG or GnRH agonist. However, GnRH agonist triggering was associated with a lower incidence of moderate/severe OHSS in egg donors. (Fertil Steril Ò 2009;91:365-71.
Triggering final follicular maturation- hCG, GnRH-agonist or both, when and to whom?
Journal of Ovarian Research, 2015
Controlled ovarian hyperstimulation (COH) which combines GnRH antagonist co-treatment and GnRH-agonist (GnRHa) trigger has become a common tool aiming to eliminate severe early OHSS and to support the concept of an OHSS-free clinic. However, due to the reported significantly reduced clinical, efforts have been made to improve reproductive outcome. One of the suggested optional strategies aiming to improve outcome was the addition of low-dose (1500 IU) HCG bolus, administered, concomitant, 35 h or 5 days after the triggering bolus of GnRHa. All these regimens were demonstrated to rescue the luteal phase, resulting in improved reproductive outcome in patients at risk to develop severe OHSS, compared to GnRHa trigger alone, however, with the questionable ability to eliminate severe OHSS. Moreover, following the observations demonstrating comparable or even better oocyte\embryos quality following GnRHa, compared to hCG trigger, and the different effects of LH and hCG on the downstream signaling of the LH receptor, GnRHa is now offered concomitant to the standard hCG trigger dose to improve oocyte/embryo yield and quality. GnRHa and hCG may be offered either concomitantly, 35-37 h prior to oocyte retrieval (dual trigger), or 40 h and 34 h prior to oocyte retrieval, respectively (double trigger).
Reproductive Biomedicine Online, 2009
The use of gonadotrophin-releasing hormone (GnRH) agonists for triggering ovulation remains controversial. The primary objective of this study was to evaluate the incidence of ovarian hyperstimulation syndrome (OHSS) following GnRH agonist versus recombinant human chorionic gonadotrophin (HCG) as methods for triggering ovulation. A second aim was to compare the clinical outcome and embryo quality according to the two procedures. The cycle characteristics of 100 oocyte donors undergoing ovarian stimulation and IVF outcomes of their 100 oocyte recipients were analysed. Donors were prospectively randomized into two groups on the last day of ovarian stimulation: Group I received a single bolus of 0.2 mg of triptorelin and Group II received 250 lg of recombinant HCG. No differences were observed in the number of oocytes retrieved or in the proportion of metaphase II oocytes between the groups. The OHSS rate was higher in donors that received recombinant HCG (P = 0.003). Moreover, there was no significant difference between IVF parameters and outcome in the two groups. In conclusion, a GnRH agonist effectively triggers the final oocyte maturation in oocyte donors without negatively affecting implantation, pregnancy or miscarriage rates. Moreover, this regime effectively eliminates the risk of OHSS in this group of women.