Comment on the case report about primary ovarian pregnancy after empty follicle syndrome

Abstract

We have read the interesting case report, ‘Primary ovarian pregnancy after the empty follicle syndrome’, where Qublan, Tahat and Al-Masri have evaluated a rare incident. They have put up possible pathological mechanisms explaining this incident. We would like to comment on the paragraph where the authors describe empty follicle syndrome (EFS), the definition and the treatmentmodalities. They suggest the adequate timing of human chorionic gonadotropin (hCG) administration or repeated follicular aspiration might be fundamental in the oocyte recovery and prevention of EFS. In the case report about the retrieval of zona-free immature oocytes in a woman with recurrent EFS, Duru et al. comprehensively evaluated etiological mechanisms for EFS, and the management options are described in detail. Briefly, the authors summarized the treatment methods in the literature as: (i) rescheduling oocyte pick up with the proper timing; (ii) stopping oocyte retrieval after obtaining no oocytes from one ovary and administering a further rescue dose of urinary hCG for rescue oocyte pick up from the other ovary; (iii) using recombinant hCG instead of urinary hCG as the ovulation trigger; and (iv) triggering the endogenous luteinizing hormone surge with gonadotropin releasing hormone (GnRH)-agonist in a GnRH antagonist downregulated cycle. Keeping those mechanisms and the algorithm for prevention and treatment of EFS might be useful to avoid cases of ectopic pregnancies after egg retrieval following controlled ovarian hyperstimulation, like the case published in your journal.