Sunday, October 24, 2010

Empty Follicle Syndrome In 40 Year Old Attributed To Age Factor


Hello Doctor,

I am from Cuba but I live in Miami. I am 40 y/o now. I had my first IVF cycle at 39 that failed, back in July. I started 2nd round in Sept.- Oct. but it was just cancelled due to empty follies. It is possible that I have no more eggs in my ovaries?

I have another theory but I am not an expert and I don't know if it is possible to be true. The first step was taking birth control pill. I took them for 21 days. After that I had NO PERIOD. I did have symptoms "as if" my period was there (cramping, pain) but no bleeding. I did an ultrasound but the endometrium was not big enough to shed. At day 7 after the last pill, my Dr. told me to start the stimulation for IVF anyways. There were 6 follies formed but empty. What do you think? Could this (bcp) be the cause for no eggs retrieved? Thank you very much. I am very frustrated. T. from Florida


Hello T. from Florida,

We tend to see a higher incidence of "empty follicle syndrome" with increasing age. This is indeed because there are fewer and fewer eggs left. However, no eggs at the time of retrieval is not related to having used the birth control pill and not having a period. There are other reasons, besides age, where no follicles are retrieved as well.

I have had several cases of EFS in my career (16 years) of doing IVF and in some cases they were in younger women, so the age factor did not apply. Those younger cases I attributed to a lack of adequate HCG triggering. I used to use a generic HCG, and it is possible that either the medication was not stored correctly and lost its efficacy, or it was not injected properly, or it was a bad batch of medicine. For that reason, I switched to Ovidrel, which is what I still use. I have not had a case of EFS in a young woman since. I still do see older women that have no eggs retrieved, however, and that is the age factor. Nothing can be done about the age factor except continuing to try in the hopes that (1) the next cycle will yield some eggs and (2) there will be a good one in the group.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.


  1. Hi Dr,

    My first IVF cycle was converted to iui, because i produced only 2 good eggs, resulted in negative.

    I have PCOS,(33age, BMI 26) so my gyne believes that i'm being resistant to drugs.

    I was put on metformin, 3 times a day. and I'm still continuing.

    On my second cycle Dr changed from Gonal F 150 iu(tried during first attempt- 2 eggs)Puregon 200iu and menopur 75. My scan revealed a good results. i had around 30 eggs, Dr was scared about hyper stimulation.

    But on egg pick up day, Dr retrieved only 7 eggs, out of which only 3 fertilized, resulted in 2 good embryos.

    Even my blood test on HCG trigger day revealed that my estrogen level was around 6000. They said it's almost matches with number of eggs that were retrieved.

    My biggest worry is what is causing empty follicle syndrome? How can i improve my chances of producing healthy eggs?

    Considering my age, this problems seems rare and it really worries me.

    I really appreciate your guidance to my problem.

  2. Hello,

    The fact that you had eggs retrieved rules out "empty follicle syndrome". That is reserved for when no eggs are retrieved. Withou close evaluation of your IVF cycle details, I cannot give you specific detailed recommendations about your cycle and outcome. That being said, with PCO patients especially, all follicles are counted at the time of ultrasound and many of those follicles are small and do not mature in time for retreival. Only the mature or near mature eggs will release from the follicle wall and get aspirated. Of course, there is the possibility of problems of aspiration technique, but I will assume you doctor has a good track record.

    As a result of most of the follicle being inadequate sized, less eggs would have been retrieved.

    PCO is a difficult problem, and even with IVF, presents many challenges. Your doctor needs to balance adequate stimulation with the ovaries propensity to want to over stimulate, leading to hyperstimulation syndrome. In addition, it has been shown that the egg quality decreases in PCO patients, probably because of non-uniform stimulation. You are on the right track in terms of treatment. You have to keep trying. Make sure your doctor/clinic has lots of experience with PCO patients.

    Good Luck.



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