Empty follicle syndrome: frequency and probable causes in Pakistani population

OBJECTIVE To determine the frequency of empty follicle syndrome in in-vitro fertilization-stimulated cycles and to evaluate the causes associated with this phenomenon. METHODS The retrospective study was conducted at the Baqai Institute of Reproduction and Developmental Sciences, Karachi, and comprised data related to period from January 2012 to December 2016. Other than demographic information, laboratory investigations, ultrasound findings and treatment protocols were noted and evaluated. Data was statistically analysed using SPSS 21. RESULTS Of the 1120 cycles studied, empty follicle syndrome was found in 72 (6.4%). The possible leading causes included advanced age in 64 (88.8%) patients, longer duration of infertility in 56 (77.7%), higher baseline follicle stimulating hormone in 56 (77.7%), and lower oestradiol level before human chorionic gonadotrophin injection in 58 (80%). Empty follicles were significantly correlated with age of the patient, years of infertility, serum follicle stimulating hormone level and stimulation length (p<0.05). CONCLUSIONS Empty follicle syndrome is a rare occurrence. Screening of patients for risk factors before considering IVF cycles is mandatory. The patients should be counseled for possible EFS even in first cycle.