a Reproductive Medicine Unit, Department of Obstetrics and Gynecology , Poriya Medical Center , Tiberias , Israel.
b Department of Evolutionary and Environmental Biology , University of Haifa , Haifa , Israel.
Gynecol Endocrinol. 2019 Apr;35(4):305-308. doi: 10.1080/09513590.2018.1519793. Epub 2018 Oct 10.
The pathophysiology of the genuine empty follicle syndrome (EFS) is still debated. Ovarian aging has been contested as a cause of this condition. Our aim was to investigate the occurrence of the genuine EFS in cases of a low number of mature follicles in a prospective manner. Ninety-five infertile women were recruited and evaluated following conventional controlled ovarian stimulation (COS) with ≤ six follicles of ≥14 mm diameter on the day of hCG administration. Enrolled women were 37.5 ± 5.2 years of age with basal FSH level of 9.1 ± 3.7 mIU/L, antral follicle count (AFC) of 6.9 ± 4.6, and number of ≥14 mm follicles (on the day of hCG) of 3.4 ± 1.5. Among the 95 women, four were complicated by the genuine EFS (4.2%) with features of the depleted ovarian reserve. Comparison between these four cases and the 91 controls revealed significant differences between age, AFC, number of ≥14 mm follicles, and serum E level corresponding to 41.8 ± 1.7 versus 37.4 ± 5.2 years, 1.7 ± 0.6 versus 7.1 ± 4.5, 2.0 ± 0.8 versus 3.4 ± 1.5 follicles, and 356 ± 200 versus 975 ± 557 pg/mL, respectively. Post hoc analysis revealed that 56 among the 95 women fulfilled the Bologna criteria for poor ovarian response and all four cases matched the definition of the genuine EFS raising its incidence to 7.1% in this group. A logistic regression analysis showed that AFC was a significant factor in the development of the genuine EFS. We conclude that the genuine EFS complicates infertile women characterized by a low number of mature follicles. Our findings suggest that the mechanism behind this occurrence is associated with a more exhausted ovarian reserve.
真正的空卵泡综合征（EFS）的病理生理学仍存在争议。卵巢衰老已被认为是这种情况的原因之一。我们的目的是前瞻性地研究在促排卵后仅获得少量成熟卵泡的情况下真正的 EFS 的发生情况。95 名不孕妇女符合以下标准入选并接受评估：在 hCG 给药日，直径≥14mm 的卵泡数≤6 个。纳入的女性年龄为 37.5±5.2 岁，基础 FSH 水平为 9.1±3.7 mIU/L，窦卵泡计数（AFC）为 6.9±4.6，直径≥14mm 的卵泡数（hCG 给药日）为 3.4±1.5。在 95 名妇女中，有 4 名患有真正的 EFS（4.2%），表现为卵巢储备功能耗竭。将这 4 例与 91 例对照比较，结果显示年龄、AFC、直径≥14mm 的卵泡数和血清 E2 水平存在显著差异，分别为 41.8±1.7 岁与 37.4±5.2 岁，1.7±0.6 个与 7.1±4.5 个，2.0±0.8 个与 3.4±1.5 个，356±200 pg/mL 与 975±557 pg/mL。事后分析显示，95 名妇女中有 56 名符合卵巢反应不良的博洛尼亚标准，而这 4 例均符合真正的 EFS 定义，其发生率为 7.1%。逻辑回归分析显示，AFC 是真正的 EFS 发生的一个显著因素。我们得出结论，真正的 EFS 使具有少量成熟卵泡的不孕妇女复杂化。我们的发现表明，这种情况发生的机制与卵巢储备功能衰竭更严重有关。
