Coulam, C. B., Bustillo, M., & Schulman, J. D. (1986). Empty follicle syndrome. Fertility and Sterility, 46(6), 1153-1155. https://doi.org/10.1016/s0015-0282(16)49898-5
Empty follicles in four IVF patients may represent a new syndrome
Four women had no eggs retrieved from any of 30 follicles across five IVF cycles. In this 1986 case series, the authors suggest the pattern may be a new syndrome and a possible cause of infertility. Three of the four women had endometriosis, and three had low luteal phase progesterone before stimulation.
Key Findings
All 30 follicles aspirated in five IVF cycles in four women yielded no oocytes. One woman had two cycles that produced no eggs.
Only 7 of the follicular aspirates contained granulosa cells.
Three of the four women were undergoing IVF with stage 1 or 2 endometriosis, and the fourth had tubal disease.
A spontaneous LH surge occurred in four of the five cycles. The luteal phase lasted from 5 to 11 days, and in two cycles it was under 10 days.
In the same period, oocytes were recovered from 53% of follicles over 10 mm in 114 transvaginal retrieval attempts and from 49% in 30 laparoscopies.
Interpretation
The report is a short communication on five IVF cycles in four women, with no comparison group. The authors weigh three explanations: a condition present before treatment, an unusual response to the stimulation drugs, or chance. They suggest an underlying ovulatory disorder could account for the finding. They point to low luteal phase progesterone before IVF and short luteal phases in two cycles as consistent with that idea. The report gives no estimate of how often empty follicles occur.
RRM Context
Restorative reproductive medicine treats ovulation as the central event and looks for why it may be failing. Three of these four women reached egg retrieval with low luteal phase progesterone already on record. The IVF cycles produced no eggs and no explanation. Evaluating the cycle first matters because IVF proceeds without establishing why conception fails.
Our editorial summary of this paper, not the article's abstract.
Abstract
Four patients who had no oocytes retrieved during an IVF cycle were studied in an attempt to identify predictors of such an occurrence and suggestions for its cause. All 30 follicles aspirated in five cycles in these four women yielded no oocytes. One patient had two cycles that produced no eggs. The empty follicle syndrome may represent a new syndrome and a cause of infertility.
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