The missing gonadotropin-releasing hormone agonist trigger leading to missing oocytes

Rama S. Kadam, Navroze M. Jassawalla, Priyanka H. Vora, Mehernosh J. Jassawalla


Authors present a case of Genuine EFS in a young woman where no oocytes were retrieved in the first stimulation cycle after single ovulation trigger. However, a repeat stimulation performed with double ovulation trigger yielded enough oocytes.


Empty follicle syndrome, hCG injection, GnRH analogue trigger, Oocyte retrieval

Full Text:



Coulam CB, Bustillo M, Schulman JD. Empty follicle syndrome. J Fertil Steril. 1986;46:1153-5.

Aktas M, Beckers NG, Van Inzen WG. Oocytes in the empty follicles: a controversial syndrome. J Fertil Steril. 2005;84(6):1643-8.

Awonuga A, Govindbhai J, Zierke S. Continuing the debate on empty follicle syndrome: can it be associated with normal bioavailability of β-HCG on the day of oocyte recovery? J Hum Reprod. 1998;13(5):1281-4.

Stevenson TL, Lashen H. Empty follicle syndrome: the reality of a controversial syndrome, a systemic review. J Fertil Steril. 2008;90(3):691-8.

Baum M, Machtinger R, Yerushalmi GM. Recurrence of empty follicle syndrome with stimulated IVF cycles. J Gynecol Endocrinol. 2012;28(4):239-5.

Zegers-Hochschild F, Fernandez E, Machenna A, Faberes C. The EFS: a pharmaceutical industry syndrome. J Hum Reprod. 1995;10:2262-5.

Zreik TG, Gracia-Velasco JA, Vergara TM. EFS: evidence for recurrence. J Hum Repro. 2000;15(5):999-1002.

Beck-Fruchter R, Weiss A, Lavee M, Geslevich Y, Shalev E. Empty follicle syndrome: successful treatment in a recurrent case and review of the literature. J Hum Reprod. 2012;27(5):1357-67.

Onalan G, Pabuccu R, Onalan R. EFS in two sisters with three cycles: case report. J Hum Repro. 2003;18(9):1864-7.

Vujisic S, Stipoljev F, Bauman R. Pericentric inversion of chromosome 2 in a patient with the EFS: case report. J human Reprod. 2005;20(9):2552-5.

Yariz KO, Walsh T, Uzak A, Spiliopoulos M, Duman D, Onalan G, et al. Inherited mutation of the luteinizing hormone/choriogonadotropin receptor (LHCGR) in empty follicle syndrome. Fertil Steril. 2011;96(2):e125-30.

Pennarrubia J, Balasch J, Fabregues F, Creus M, Civico S, Vanrell J. Recurrent EFS successfully treated with recombinant HCG: case report. J Hum Reprod. 1999;14:1703-6.