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Empty Follicle Syndrome
FERTILITY AND STERILITY CopyrightC 1987 The American Fertility Society
Vol. 47, No.6, June 1987 Printed in U.S.A.
Empty Follicle Syndrome To the Editor: Coulam et al. 1 are to be commended for introducing a new syndrome to describe in vitro fertilization (lVF) cycles in which no eggs were found in follicular aspirates, despite the acceptable serum estradiol levels and follicular dimensions. Five cycles were reported in four IVF patients with unexplained infertility. Coulam's findings encouraged us to analyze the data from our IVF center. We reviewed the charts from 43 cycles that spanned a 2-year period. Three empty follicular cycles were found (Table 1). The reported three patients received a combination of clomiphene citrate and human menopausal gonadotropin (hMG) for ovulation induction. The total number of aspirated follicles was 14 (2, 3, and 9, respectively). As shown in Table 1, the empty follicle syndrome need not only be associated with unexplained infertility. In Coulam's article, no mention was made of the aspiration technique. Oocytes frequently are obtained from follicle flushes, even from the cul-de-sac. 2 The physician should be certain that such attempts to find 00cytes have been made before labeling patients as having empty follicles. Also, it is important to make sure that a patient has not ovulated just prior to the procedure. We have observed that
clear cystic structures may persist soon after ovulation. In our three patients, follicle washing was performed and we were fairly certain that the patients had not yet ovulated. Despite the potential problems in uniformly identifying the empty follicle syndrome, Coulam's article provides a fine description of what many of us believe explains certain ovum retrieval failures.
George Bartfai, M.D., Ph.D. Michael Feinman, M.D. David Barad, M.D. Steven G. Kaali, M.D.' Irwin Merkatz, M.D. The Albert Einstein College of Medicine In Vitro Fertilization Center at the Women's Medical Pavilion Dobbs Ferry, New York March 5, 1987 REFERENCES 1. Coulam CB, Bustillo M, Schulman JD: Empty follicle syndrome. Fertil Steril 46:1153, 1986 2. Acosta AA, Chillik C, Lim H: Laparoscopic harvest of eggs. In In Vitro Fertilization, Norfolk, Edited by HW Jones Jr, GS Jones, GD Hodgen, Z Rosenwaks. Baltimore, Williams & Wilkins, 1986, p 55
Table 1. Attempted Laparoscopic Ovum Retrieval with Empty Follicles Patient
Age
1 2
39 30
3
39
Indication
Peak E.
No.of follicles
pglml
1040
Unexplained Unilateral tubal blockage Unexplained
Letters-to-the-editor
Diameter of largest follicle
Follicle aspiration Cycle day No. of follicles
mm
1270 2630
3 9
21 16
15 15
3 9
928
2
16
12
2
Fertility and Sterility
Vol. 47, No.6, June 1987 Printed in U.S.A.
Empty Follicle Syndrome To the Editor: Coulam et al. 1 are to be commended for introducing a new syndrome to describe in vitro fertilization (lVF) cycles in which no eggs were found in follicular aspirates, despite the acceptable serum estradiol levels and follicular dimensions. Five cycles were reported in four IVF patients with unexplained infertility. Coulam's findings encouraged us to analyze the data from our IVF center. We reviewed the charts from 43 cycles that spanned a 2-year period. Three empty follicular cycles were found (Table 1). The reported three patients received a combination of clomiphene citrate and human menopausal gonadotropin (hMG) for ovulation induction. The total number of aspirated follicles was 14 (2, 3, and 9, respectively). As shown in Table 1, the empty follicle syndrome need not only be associated with unexplained infertility. In Coulam's article, no mention was made of the aspiration technique. Oocytes frequently are obtained from follicle flushes, even from the cul-de-sac. 2 The physician should be certain that such attempts to find 00cytes have been made before labeling patients as having empty follicles. Also, it is important to make sure that a patient has not ovulated just prior to the procedure. We have observed that
clear cystic structures may persist soon after ovulation. In our three patients, follicle washing was performed and we were fairly certain that the patients had not yet ovulated. Despite the potential problems in uniformly identifying the empty follicle syndrome, Coulam's article provides a fine description of what many of us believe explains certain ovum retrieval failures.
George Bartfai, M.D., Ph.D. Michael Feinman, M.D. David Barad, M.D. Steven G. Kaali, M.D.' Irwin Merkatz, M.D. The Albert Einstein College of Medicine In Vitro Fertilization Center at the Women's Medical Pavilion Dobbs Ferry, New York March 5, 1987 REFERENCES 1. Coulam CB, Bustillo M, Schulman JD: Empty follicle syndrome. Fertil Steril 46:1153, 1986 2. Acosta AA, Chillik C, Lim H: Laparoscopic harvest of eggs. In In Vitro Fertilization, Norfolk, Edited by HW Jones Jr, GS Jones, GD Hodgen, Z Rosenwaks. Baltimore, Williams & Wilkins, 1986, p 55
Table 1. Attempted Laparoscopic Ovum Retrieval with Empty Follicles Patient
Age
1 2
39 30
3
39
Indication
Peak E.
No.of follicles
pglml
1040
Unexplained Unilateral tubal blockage Unexplained
Letters-to-the-editor
Diameter of largest follicle
Follicle aspiration Cycle day No. of follicles
mm
1270 2630
3 9
21 16
15 15
3 9
928
2
16
12
2
Fertility and Sterility