Does the empty follicle syndrome occur in cases of low number of maturing follicles in assisted reproduction?

Abstract

The pathophysiology of the genuine empty follicle syndrome (EFS) is still debated. Ovarian aging has been contested as a cause of this condition. Our aim was to investigate the occurrence of the genuine EFS in cases of a low number of mature follicles in a prospective manner. Ninety-five infertile women were recruited and evaluated following conventional controlled ovarian stimulation (COS) with ≤ six follicles of ≥14 mm diameter on the day of hCG administration. Enrolled women were 37.5 ± 5.2 years of age with basal FSH level of 9.1 ± 3.7 mIU/L, antral follicle count (AFC) of 6.9 ± 4.6, and number of ≥14 mm follicles (on the day of hCG) of 3.4 ± 1.5. Among the 95 women, four were complicated by the genuine EFS (4.2%) with features of the depleted ovarian reserve. Comparison between these four cases and the 91 controls revealed significant differences between age, AFC, number of ≥14 mm follicles, and serum E₂ level corresponding to 41.8 ± 1.7 versus 37.4 ± 5.2 years, 1.7 ± 0.6 versus 7.1 ± 4.5, 2.0 ± 0.8 versus 3.4 ± 1.5 follicles, and 356 ± 200 versus 975 ± 557 pg/mL, respectively. Post hoc analysis revealed that 56 among the 95 women fulfilled the Bologna criteria for poor ovarian response and all four cases matched the definition of the genuine EFS raising its incidence to 7.1% in this group. A logistic regression analysis showed that AFC was a significant factor in the development of the genuine EFS. We conclude that the genuine EFS complicates infertile women characterized by a low number of mature follicles. Our findings suggest that the mechanism behind this occurrence is associated with a more exhausted ovarian reserve.

摘要

真正的空卵泡综合征（EFS）的病理生理学仍然存在争议。卵巢衰老一直被认为是造成这种状况的原因。我们的目的是以前瞻性的方式研究在少数成熟卵泡的情况下真正EFS的发生情况。招募了95名不孕妇女, 对常规卵巢控制促排卵刺激（COS）下, 直径≥14mm的卵泡数≤6个, 注射hCG的当日进行评估。入组女性为37.5±5.2岁, 基础FSH水平为9.1±3.7 mIU / L, 窦卵泡计数（AFC）为6.9±4.6, ≥14mm卵泡数（hCG当天）为3.4±1.5。在95名女性中, 有4名患者因真正的EFS（4.2％）并发症, 其卵巢储备功能减弱。这四个病例和91个对照之间的年龄、AFC、≥14mm卵泡数和血清E2水平之间比较存在显着差异, 结果分别为： 年龄为41.8±1.7 vs 37.4±5.2岁, AFC为 1.7±0.6 vs 7.1±4.5, ≥14mm卵泡数为2.0±0.8 vs 3.4±1.5个卵泡, 血清E2水平分别为356±200 vs 975±557pg / mL。事后分析显示, 95名女性中有56名符合博洛尼亚卵巢反应不佳的标准, 所有4名患者均符合真正的EFS定义, 将其发病率提高至7.1％。logistic回归分析表明, AFC是真正EFS发展的重要因素。我们得出结论, 真正的EFS合并不孕妇女的特征是成熟卵泡数量少。我们的研究结果提示, 这种情况背后的机制与卵巢储备耗竭有关。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Assisted reproduction
• empty follicle syndrome
• low ovarian reserve
• ovarian aging
• poor ovarian response

Ethical approval

The performance of this study was approved by the Baruch Padeh Medical Center IRB committee in Poriya.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.