Empty Follicular Syndrome in IVF procedure -does a second dose of another batch of HCG help to recruit Ovum from another ovary??

 

What do we mean by “Empty Follicle Syndrome?” ..Admittedly, the incidence of this condition is too low.

Definition:  One of the most frustrating experience of the clinician dealing with IVF is that of finding no oocytes retrieved in any of the multitudes of follicles aspirated after controlled ovarian hyperstimulation (COH). The clinician in a desperate attempt to retrieve the oocytes repeatedly flushes and aspirates the follicle in vain.

 

Can we precinct this in IVF settings?? This is known as empty follicle syndrome (EFS). It cannot be predicted either sonologically or by estrogen estimation. The estrogen values most often correspond to values obtained normally when retrieving the same number of oocytes as the existing follicles in other women.

 

In which settings this phenomenon is common?? This situation may be true in some cases of women who have A) unexplained infertility or it may reflect B) dysfunctional ovulation induction. But this has been questioned by some workers who have managed to retrieve oocytes from the second ovary when the cohort of follicles from the first ovary yield no oocytes by stopping the procedure of ovum pick up and the patient given a repeat injection of 10,000 IU of HCG from a separate batch of the drug.

 

What is the way out then?? Successful oocyte retrieval from the remaining ovary has been carried out 36 hours after the second HCG administration. The result obtained are not bad in this procedure   

 

Explanation:-  Since HCG is eliminated by the liver, rapid clearance of the molecule by the liver may explain the non-availability of the drug to the oocytes. But this is ruled out when a different batch of HCG produced and adequate serum concentration and at the same time gave satisfactorily clinical result.

   Since inadequate exposure of preovulatory follicle to HCG has been found to be the cause in some cases some have  suggested  that S.BETA-HCG estimated 12 hours post HCG administration would prognosticate the situation of EFS so that a rescue measure may be taken as mentioned above changing the batch of HCG administered.

 

Does second dose of HCG cause any harm?? Ans: No.  It looks as though repeating the dose of HCG 24 hours does not seem to cause any harm to the oocytes. The argument against routine estimation of beta-HCG 18 hours post HCG as a part of the protocol is that the incidence of this condition is too low to be cost effective.

 So the sensible alternative would be to become cautious when the embryologist repeatedly draws a blank after scrutiny of each sample of the follicles on the contralateral side and ask for an urgent evaluation of serum BETA HCG. If the level of HCG<10 mlU/ml one must repeat injection of HCG 10,000 IU from an entirely different batch of the drug and take up follicular aspiration 36 hours later

COH followed by inj. HCG 10,000 units IM 1^st OPU resulting in EFS.