Empty follicle syndrome (EFS) has been defined as a condition in which no oocytes are retrieved from mature ovarian follicles with apparently normal follicular development and estradiol levels, after Controlled ovarian hyper stimulation (COH) for an assisted reproductive technology (ART) cycle, despite repeated aspiration and flushing.
No oocytes are retrieved even after many ultrasounds & estradiol levels which show many potential follicles, Empty follicle syndrome is a frustrating situation at times.
Risk Factors of Empty follicle syndrome:
- The risk factor for Empty follicle syndrome increases with age.
- About 24% of patients between the age of 35 to 39 years of age & 57% for those > 40 years of age.
- It has also 20% chances of recurrence & the risk of recurrence increases with advancing age of the patient.
Causes of Empty follicle syndrome:
- Inappropriate timing of hCG
- PCOS
- Dysfunctional folliculogenesis, in which oocyte atresia occurs with normal hormonal response
- Genetic factors
- Advanced ovarian ageing through altered folliculogenesis
Types of empty follicle syndrome:
Empty follicle syndrome can be classified into 2 types
- Genuine Empty follicle syndrome (GEFS)
- False Empty follicle syndrome (FEFS)
1. Genuine Empty follicle syndrome (GEFS):
- Genuine Empty follicle syndrome is defined as failure to retrieve oocytes from mature follicles apparently after Controlled Ovarian stimulation for IVF.
- It may be due to dysfunctional folliculogenesis, the oocytes fail to retrieve even with normal follicular development & steroidogenesis in presence of optimal beta human choriogonadotrophin (bhCG) levels on the oocyte retrieval
2. False Empty follicle syndrome (FEFS):
- False Empty follicle syndrome (FEFS) is defined as failure to retrieve oocytes in presence of low beta human choriogonadotrophin hormone (bhCH) level on the day of oocyte retrieval
- It is basically due to human errors or pharmaceutical reasons
Discussion on Empty follicle syndrome (FEFS) :
- The egg undergoes “ripening” to prepare for fertilization by LH surge which precedes spontaneous ovulation also hCG & various fertility drugs are given to induce ovulation.
- Enzymes are released at the same time , that loosen the cells (cumulus oophorus) that surround and bind the egg to the inner wall of the follicle. This is necessary to enable the egg to come free at ovulation and/or at the time of egg retrieval.
- The problem is that with poorly developed eggs, the latter mechanism often fails, leaving such eggs tightly “stuck” to the follicle wall and unable to come free, often in spite of vigorous attempts to flush them loose.
- That is why the more difficult it is to successfully aspirate an egg at egg retrieval, the more likely it is that such an egg is chromosomally abnormal and incapable of developing into a normal pregnancy
- EFS do not represent a permanent pathophysiological condition and most cases occur only sporadically.
- The ovarian follicles of patients with so-called EFS may not actually be devoid of viable oocytes. The problem seems to be that of inadequate preovulatory follicular changes arising from either poor bioavailability of LH or hCG or too short an interval between the onset of these changes and follicular aspiration.
- EFS do not predict a reduced fertility potential in future cycles. Nevertheless, whatever the cause of EFS, such patients should be counseled regarding its possibility of recurrence and future poor prognosis.
Treatment for Empty follicle syndrome (FEFS)
The right treatment for empty follicle syndrome will be non-hormonal that will gently stimulate the follicular maturation, to release health eggs for natural conceiving without any side effects. All this criterias are fulfilled only by the Homeopathic treatment of empty follicle syndrome through HART treatment protocol.
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