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Many IVF specialists do not know how to deal with Empty Follicle Syndrome (EFS). This is a guide for IVF doctors dealing with EFS.
Vaginal egg collection is a very routine procedure in an IVF clinic. The procedure is over in about 20 minutes, and good doctors will usually get one egg from each mature follicle. However, one of the dreaded complications which can mar a vaginal egg collection is called the empty follicle syndrome.
What are empty follicles?
The doctor starts puncturing the follicles, and is dismayed when the embryologist does not get any eggs whatsoever in the follicles. The procedure in the OR seems to be technically straightforward. The follicles collapse when aspirated and there is free flow of follicular fluid into the test tubes. However, when the embryologist scans the follicular fluid under his microscope, he does not find any eggs as all !
An uncommon occurrence
This is unexpected and uncommon; and many doctors are completely stumped as to what to do when this happens, because they have not dealt with this condition earlier. This is actually a medical emergency, but is often managed badly.
Because many doctors don't know how to deal with this problem, they tend to just continue with the procedure blindly, and suck out the follicular fluid from all the follicles. After completing the procedure, they then leave the theater. When the embryologist then reports that he cannot find any eggs, they tell the patient - Sorry, we did not get any eggs at all.
Patients are stunned into disbelief and don't know how to respond. The doctor may offer the use of donor eggs at this time - and often patients are bulldozed into agreeing, in order to salvage a bad situation.
Actually, this is a sign of poor medical management. So how should a doctor manage this crisis ?
Remember that 99% of the time, empty follicle syndrome occurs because the patient has not taken the hCG injection properly . This could occur for multiple reasons:
How do we manage empty follicle syndrome in our clinic?
A better chance
At the time of the second egg retrieval , which is planned 36 hours after the second hCG shot , we expect to see intact follicles ; and expect to retrieve eggs from each of these follicles. In order to document the diagnosis , we repeat the blood hCG level again , and expect this to be more than 100 mIU/ml.
Using this protocol , it is possible to salvage the situation, and give the patient a very good chance at getting pregnant !
Read more- Emergencies and Complications in IVF