Empty Follicle Syndrome (EFS)

EFS is defined as the complete failure to retrieve oocytes afterovarian s timulation, monitoring of multiple follicular growthand ovarian puncture with follicular aspiration (OPU), despiteapparently normal development of ovarian follicles and appropriatees tradiol production by granulosa cells with incidence۵-۷% in s tudies.Two types of EFS have been described:۱. Genuine empty follicle syndrome (gEFS): which occurs inthe presence of adequate circulating hCG level at the time ofoocyte retrieval. The cause of gEFS is unclear, but specific geneticfactor is probably involved (LH CGR, ZP۱, ZP۲), dysfunctionalfollicle genesis (aging, reduced ovarian reserve, obesity)and biologic abnormality in mature oocyte despite normalHCG: level treatment for gEFS in controversial.۲. False EFS: which is associated with no circulating hCG or alevel below a critical threshold is mos t likely caused by errorswith the trigger shot, wrong drag, timing, defect in the industrialproduction of some hCG batches, rapid clearance, in appropriates torage.Diagnosis of EFS at oocyte retravel۱. Tell- tale sign of EFS is very sparse granulosa cells in thefollicular fluid۲. If after puncturing ۳-۵ follicle (≥۱۴mm) no oocytes are foundis a probability of EFS; after then sensitive urine pregnancy tes tin preformed; if tes t is negative; using rescue trigger and reschedulethe retrieval ۳۶ hours later.