Genuine empty follicle syndrome: role of double trigger and delayed oocyte retrieval (DTDO)

Abstract Objectives The role of air bubbles in bracketing the embryo-containing medium in inner catheter during embryo transfer (ET) has already been established. However, the role of air bubbles in outer catheter (OC) during implantation is yet to be determined. This study aimed to compare the implantation rates between women who have undergone ET with or without ASP (Vitrolife®; Sweden), a medium use for oocyte retrieval and rinsing in OC embryo catheter. The purpose of introducing the ASP medium to the OC was to eliminate air bubbles in that space during implantation. Methods A total of 312 women were randomly divided into two groups with 156 participants each group. In Group A, ASP medium was used during ET, whereas in Group B, no ASP medium was utilized. Positive implantation was defined as serum beta-hCG level >5 mIU/mL taken on the 7th day following ET. Results The average age of the majority of the participants was 30–39 years and had at least 4–5 years of subfertility. The unexplained subfertility was the prominent cause of ET failure in both groups. In most of the participants in both groups, ET was done using fresh embryo cycles with good to excellent embryo grades. After the ASP medium was manipulated in the OC in both groups, the positive implantation rate was not different in both groups (p>0.05). Conclusions The elimination of air bubbles in OC by using the ASP medium during ET did not confer an additional benefit nor exert a negative impact on implantation rate.

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Immature Oocytes in “Apparent Empty Follicle Syndrome”: A Case Report

Case Reports in Medicine ◽

10.1155/2010/367505 ◽

2010 ◽

Vol 2010 ◽

pp. 1-3 ◽

Cited By ~ 6

Author(s):

Teraporn Vutyavanich ◽

Waraporn Piromlertamorn ◽

Jason Ellis

Keyword(s):

Case Report ◽

Germinal Vesicle ◽

Oocyte Retrieval ◽

Cumulus Cells ◽

Optimal Level ◽

Immature Oocytes ◽

Empty Follicle Syndrome ◽

Margin Of Error ◽

Oocyte Aspiration ◽

Delayed Maturation

Empty follicle syndrome (EFS) is a condition in which no oocytes are obtained after an apparently successful ovarian stimulation. Genuine EFS (GEFS) is differentiated from false EFS by an optimal level of human chorionic gonadotropin on the day of oocyte retrieval. Some believe that GEFS does not exist and that it is only a reflection of the margin of error attendant upon the procedure of oocyte aspiration. Others believe that GEFS is caused by dysfunctional folliculogenesis, resulting in early atresia of oocytes. In this report, we present a case of apparent GEFS, in which immature oocytes were identified after filtration of follicular aspirates. Our findings suggest that delayed maturation of oocyte cumulus complexes in response to HCG might be an etiologic mechanism in some cases of GEFS. This creates a situation similar to the aspiration of immature follicles, where germinal vesicle-stage oocytes with dense scanty cumulus cells are often difficult to identify under a dissecting microscope.

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Chronic Niche Inflammation in Endometriosis-Associated Infertility: Current Understanding and Future Therapeutic Strategies

International Journal of Molecular Sciences ◽

10.3390/ijms19082385 ◽

2018 ◽

Vol 19 (8) ◽

pp. 2385 ◽

Cited By ~ 27

Author(s):

Yi-Heng Lin ◽

Ya-Hsin Chen ◽

Heng-Yu Chang ◽

Heng-Kien Au ◽

Chii-Ruey Tzeng ◽

...

Keyword(s):

Stem Cell ◽

Treatment Strategies ◽

Oocyte Retrieval ◽

Reproductive Age ◽

Immunomodulatory Effects ◽

Women Of Reproductive Age ◽

Ovulatory Dysfunction ◽

Potential Applications ◽

Implantation And Pregnancy Rates

Endometriosis is an estrogen-dependent inflammatory disease that affects up to 10% of women of reproductive age and accounts for up to 50% of female infertility cases. It has been highly associated with poorer outcomes of assisted reproductive technology (ART), including decreased oocyte retrieval, lower implantation, and pregnancy rates. A better understanding of the pathogenesis of endometriosis-associated infertility is crucial for improving infertility treatment outcomes. Current theories regarding how endometriosis reduces fertility include anatomical distortion, ovulatory dysfunction, and niche inflammation-associated peritoneal or implantation defects. This review will survey the latest evidence on the role of inflammatory niche in the peritoneal cavity, ovaries, and uterus of endometriosis patients. Nonhormone treatment strategies that target these inflammation processes are also included. Furthermore, mesenchymal stem cell-based therapies are highlighted for potential endometriosis treatment because of their immunomodulatory effects and tropism toward inflamed lesion foci. Potential applications of stem cell therapy in treatment of endometriosis-associated infertility in particular for safety and efficacy are discussed.

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The Role of FSHR SNPs and AMH in Follicular Fluid and Serum in Ovarian Response during COS: A Pilot Study

International Journal of Reproductive Medicine ◽

10.1155/2021/8685158 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Elli Anagnostou ◽

Despina Mavrogianni ◽

Ilectra-Niki Prifti ◽

Evangelia Dimitroulia ◽

Athanasios Protopapas ◽

...

Keyword(s):

Follicular Fluid ◽

Oocyte Retrieval ◽

Ovarian Response ◽

Prognostic Indicator ◽

Fsh Receptor ◽

Oocyte Collection ◽

Significant Difference ◽

Fluid Levels

Background. Several studies have investigated on the polymorphism Ser680Asn of FSHR and its use as a predictive indicator of response to an IVF/ICSI protocol. Furthermore, measurement of AMH in serum and follicular fluid is a useful prognostic indicator for the outcome of an assisted reproduction attempt. The purpose of this study is to examine the FSH receptor Ser680Asn polymorphism in combination with AMH levels in both serum and follicular fluid, on the day of oocyte collection. Materials and Methods. A total of 32 women who underwent IVF/ICSI were included. Women were grouped into 2 groups: those who received rFSH (n=11) and those who received hMG (n=21). Serum AMH was measured on day 3 of the cycle, and AMH in the follicular fluid on the day of oocyte retrieval; the same day peripheral blood was collected for the genotyping of Ser680Asn. Results. No statistical significant difference was found between serum AMH and follicular fluid AMH regarding the FSH receptor genotype for the Ser680Asn polymorphism. Regarding the sAMH/ffAMH ratio in the 3 genotypes, the value was lower in Asn/Asn women than Ser/Ser and Ser/Asn, but no statistical difference was obtained. Women who carry the Ser allele have a higher number of follicles, retrieved oocytes, and mature oocytes than women who do not contain the Ser allele. Women withAMH<2.22 ng/mlpresented lower AMH follicular fluid levels and lower serum AMH/follicular fluid AMH ratio in a statistically significant manner. Concerning the genotype for the polymorphism Ser680Asn of FSHR in relation to AMH levels, no statistically significant differences were found. Conclusions. The identification of polymorphisms, such as Ser680Asn of FSHR, along with the determination of endocrine markers in the follicular fluid, such as AMH, could lead at some point, to the personalized therapy setting per woman.

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Empty Zona Pellucida Only Case: A Critical Review of the Literature

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179409 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9409

Author(s):

Charalampos Siristatidis ◽

Despoina Tzanakaki ◽

Mara Simopoulou ◽

Christina Vaitsopoulou ◽

Petroula Tsioulou ◽

...

Keyword(s):

Zona Pellucida ◽

Critical Review ◽

Treatment Options ◽

Specific Treatment ◽

Follicular Development ◽

Oocyte Retrieval ◽

Vitro Fertilization ◽

Preimplantation Embryo Development

The presence of empty zona pellucida (EZP) in oocytes following oocyte retrieval (OR) during an in vitro fertilization (IVF) cycle presents a major clinical and laboratory challenge in assisted reproduction. It has been attributed to several factors such as the ovarian stimulation protocol employed, the damaging of the follicles during oocyte retrieval (OR) mainly through the high aspiration pressure, during the denudation technique, and the degeneration of oolemma within the zona pellucida (ZP) through apoptosis. The role of ZP is pivotal from the early stages of follicular development up to the preimplantation embryo development and embryo hatching. Polymorphisms or alterations on the genes that encode ZP proteins may contribute to EZP. We present a critical review of the published literature hitherto on EZP and available options when encountered with the phenomenon of EZP. Concerning the former, we found that there is rare data on this phenomenon that merits documentation. The latter includes technical, genetic, and pathophysiological perspectives, along with specific treatment options. In conclusion, we identify the lack of a definitive management proposal for couples presenting with this phenomenon, we underline the need for an algorithm, and indicate the questions raised that point towards our goal for a strategy when addressing a previous finding of EZP.

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“Empty follicle syndrome” after human error: pregnancy obtained after repeated oocyte retrieval in a gonadotropin-releasing hormone antagonist cycle

Fertility and Sterility ◽

10.1016/j.fertnstert.2007.08.008 ◽

2008 ◽

Vol 90 (3) ◽

pp. 850.e13-850.e15 ◽

Cited By ~ 11

Author(s):

E SNAIFER ◽

J HUGUES ◽

C PONCELET ◽

C SIFER ◽

M PASQUIER ◽

...

Keyword(s):

Human Error ◽

Oocyte Retrieval ◽

Gonadotropin Releasing Hormone ◽

Releasing Hormone ◽

Empty Follicle Syndrome

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Prevalence of Empty Follicle Syndrome in King Chulalongkorn Memorial Hospital

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.06.12073 ◽

2021 ◽

Vol 104 (6) ◽

pp. 1005-1009

Keyword(s):

Medical Records ◽

Rare Condition ◽

Poor Response ◽

Oocyte Retrieval ◽

Reproductive Technology ◽

Memorial Hospital ◽

Exclusion Criteria ◽

Vitro Fertilization ◽

Empty Follicle Syndrome

Objective: To investigate the prevalence of empty follicle syndrome (EFS), a condition in which no oocytes were retrieved after ovarian stimulation, categorized into genuine EFS (g-EFS) and false EFS (f-EFS), at the King Chulalongkorn Memorial Hospital (KCMH), Thailand. Materials and Methods: A retrospective study was conducted at the infertility clinic of the KCMH. Medical records of the assisted reproductive technology (ART) patients between January 2001 and October 2019 (5,523 patients) were reviewed. Exclusion criteria were the cases where ovulation occurred before oocyte retrieval or the cases with less than four follicles larger than 14 mm diameter on the day of triggering ovulation to minimize the absence of oocyte from the poor response. The patients with EFS, g-EFS, which are EFS with detectable urinary human chorionic gonadotropin (hCG), and f-EFS, which are EFS with undetectable urinary hCG, were identified. Prevalence of EFS was calculated. Results: There were three cases with EFS in the present study, which g-EFS was identified in one case and f-EFS in two cases. The prevalence of EFS was 0.054%, which g-EFS was 0.018% and f-EFS was 0.036%. Conclusion: EFS is a rare condition, particularly the g-EFS. Although EFS is rare, it causes tremendous stress and anxiety to both patients and physicians. Further study in the etiopathogenesis of EFS is required. Keywords: Empty follicle syndrome; Infertility; In vitro fertilization

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