A borderline form of empty follicle syndrome treated with a double-trigger of gonadotropinreleasing hormone agonist and human chorionic gonadotropin: A case report

Abstract

Rationale: The borderline form of empty follicle syndrome (EFS) is a phenomenon where only a few mature or immature oocytes are retrieved despite adequate response to controlled ovarian hyperstimulation (COH). It is a rare phenomenon with an unclear underlying mechanism, and there is currently no effective treatment. Patient concerns: The patient received 3 assisted reproductive technology cycles, and although her follicular development and estrogen levels were normal during COH, the outcome with respect to the oocytes obtained was unsatisfactory. Diagnoses: Borderline form of EFS. Interventions: In the context of undergoing GnRH-antagonist protocol, we implemented a double-trigger with human chorionic gonadotropin (hCG) after 6hours of gonadotropin-releasing hormone agonist (GnRH-a) administration. Outcomes: Eleven oocytes were obtained (M I×3, M IItimes;8 ), which underwent in vitro fertilization (IVF). After 18hours, 7 oocytes showed normal fertilization, with 2 embryos formed 72hours later (embryo rating, 6C IItimes;1, 9C II times;1); the embryos were then frozen. Lessons: Oocyte maturation and ovulation are time-dependent processes, and that different patients require different lengths/ intervals of time for treatment. Therefore, the borderline form of EFS, in general, may be treatable, and our novel trigger method provides a new treatment option for such patients in the future.