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Human Reproduction, Vol. 18, No. 10, 2079-2081, October 2003
© 2003 European Society of Human Reproduction and Embryology

Successful treatment of empty follicle syndrome by triggering endogenous LH surge using GnRH agonist in an antagonist down-regulated IVF cycle

F. Lok1,3, J. Pritchard1 and H. Lashen2

1 Assisted Conception Unit, Tree Root Walk, Sheffield and 2 Obstetrics and Gynaecology, University of Sheffield, Sheffield, UK

3 To whom correspondence should be addressed at: Assisted Conception Unit, Level 1 Jessop Wing, Tree Root Walk,Sheffield S10 2SF, UK. e-mail: dflok@yahoo.com

To date, empty follicle syndrome (EFS) has only been reported in GnRH agonist down-regulated IVF cycles. Some cases have been successfully treated by changing the batch, or by repeating the dose of hCG. A case of EFS was observed in both GnRH antagonist and GnRH agonist down-regulated IVF cycles when final oocyte maturation was triggered using urinary hCG (u-hCG). Failure to retrieve oocytes occurred, despite administration of a further dose of u-hCG from a different batch and a delayed repeated oocyte recovery performed in the second GnRH agonist down-regulated cycle. A successful oocyte recovery cycle was achieved after triggering of an endogenous gonadotrophin surge using GnRH agonist in an antagonist down-regulated cycle. Nine oocytes were readily retrieved from 10 follicles, at 36 h after GnRH agonist administration, and eight of these fertilized normally. Two good quality embryos were used for fresh transfer and four were cryopreserved for future use. EFS can occur in GnRH antagonist down-regulated IVF cycles, and can be successfully treated by triggering a natural gonadotrophin surge using GnRH agonist in the absence of any response to previous treatment methods. This represents a novel therapeutic modality for this uncommon but frustrating condition.

Key words: empty follicle syndrome/GnRH agonist/GnRH antagonist/IVF/oocyte retrieval


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