“Empty follicle syndrome” after human error: pregnancy obtained after repeated oocyte retrieval in a gonadotropin-releasing hormone antagonist cycle

Abstract

To report a case of empty follicle syndrome (EFS) after human error occurring in hCG administration and discuss the specific management of this event in a GnRH antagonist cycle. Case report. A university hospital. A 27-year-old woman admitted for a first oocyte retrieval resulting in empty follicle syndrome. The cause was the lack of administration of hCG injection 36 hours earlier. Serial measurements of hCG, LH, and P. Because no injection of GnRH antagonist had been given for 2 days, the occurrence of endogenous LH surge was assessed by measurement of serum LH, P, and E(2). In the absence of any spontaneous LH surge, EFS was successfully treated by administering 250 microg of recombinant hCG in the evening of the first failed ovarian puncture and rescheduling the second oocyte retrieval 36 hours later. Four oocytes were retrieved and two resulting embryos were transferred. Pregnancy was obtained and patient gave birth to a healthy male baby at term. Our case is the first report of pregnancy obtained after a successful treatment of EFS in a GnRH antagonist cycle. In contrast to GnRH agonist down-regulated cycles, the management of EFS in GnRH antagonist cycles has to take into account the possible occurrence of spontaneous endogenous LH surge.