Service de Médecine de la Reproduction, Hôpital Jean Verdier, 93143 Bondy, Université Paris XIII
Empty follicle syndrome is a very frustrating and uncommon event which has been reported to occur in 0.2 to 7 % of cycles with ovarian punction. It cannot be predicted by the pattern of ovarian response to stimulation. Consequently, the diagnosis of EFS is usually retrospective. Many causes have been advocated, but the most frequent causes are commonly linked to human errors or to a pharmacological problem of in vivo hCG bioavailability. Most of the cases of EFS reported so far occurred in GnRH agonist down-regulated cycles. Here, we report a case of EFS occurring in a GnRH antagonist cycle due to a human error in the administration of recombinant hCG, which was treated by a second injection and oocyte retrieval 36 heures later, and resulted in pregnancy. We discuss here about the specific management of this event in relation to the use of GnRH antagonists or GnRH agonists. 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. Our case is the first report of pregnancy obtained after a successful treatment of EFS in a GnRH antagonist cycle.