Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Hebei Center for Quality Control and Management of Human Assisted Reproductive Technology, Shijiazhuang, China.
Front Endocrinol (Lausanne). 2024 Jul 11;15:1424837. doi: 10.3389/fendo.2024.1424837. eCollection 2024.
Empty follicle syndrome (EFS) is a challenging clinical problem. This study aims to identify the risk factors for EFS, to present pregnancy outcomes in both EFS cycle as well as subsequent cycles, and to summarize an effective rescue protocol to improve outcomes.
A retrospective analysis between 2016 and 2020 was conducted at our center. Stricter criteria were applied to diagnose EFS. Logistic regression analysis was used to identify the risk factors for EFS. Further analyses were performed within the EFS cycle to present pregnancy outcomes and to find optimal rescue protocols. Long-term follow-up was conducted until live birth was achieved, covering at least two complete oocyte retrieval cycles.
Among 14,066 patients, 54 (0.38%) were identified as EFS. Patients with polycystic ovary syndrome (PCOS) had a significantly higher risk of developing EFS than non-PCOS ones (aOR = 2.67; 95% CI, 1.47 to 4.83). Within EFS patients, delaying the second oocyte retrieval by 3-6 h significantly improved the rates of obtaining oocyte (97.4% 58.3%, = 0.002), getting embryo available for transfer (92.3% 33.3%, < 0.001), and pregnancy (48.7% 8.3%, = 0.017) compared to other delayed retrieval times. Overall, 31.5% (17/54) and 46.7% (7/15) EFS patients achieved live birth in the EFS cycle and the future cycle, respectively.
PCOS is an independent risk factor for EFS, indicating that longer exposure time to human chorionic gonadotropin (hCG) may be necessary. Delaying the second oocyte retrieval by 3-6 h is an effective rescue protocol for EFS patients to achieve optimal outcomes. EFS in a single cycle does not necessarily indicate future fertility decline, but repeated EFS may result in poor outcomes.
空卵泡综合征（EFS）是一个具有挑战性的临床问题。本研究旨在确定 EFS 的风险因素，展示 EFS 周期及后续周期的妊娠结局，并总结有效的抢救方案以改善结局。
对我院 2016 年至 2020 年的数据进行回顾性分析。采用更为严格的标准诊断 EFS。采用 logistic 回归分析确定 EFS 的风险因素。在 EFS 周期内进一步分析以展示妊娠结局，并寻找最佳的抢救方案。长期随访直至获得活产，至少包括两个完整的取卵周期。
在 14066 名患者中，有 54 名（0.38%）被诊断为 EFS。多囊卵巢综合征（PCOS）患者发生 EFS 的风险明显高于非 PCOS 患者（aOR = 2.67；95%CI，1.47 至 4.83）。在 EFS 患者中，第二次取卵时间延迟 3-6 小时，可显著提高取卵率（97.4%比 58.3%， = 0.002）、获得可移植胚胎率（92.3%比 33.3%， < 0.001）和妊娠率（48.7%比 8.3%， = 0.017）。总的来说，54 例 EFS 患者中有 31.5%（17/54）和 46.7%（7/15）在 EFS 周期和未来周期中获得了活产。
PCOS 是 EFS 的独立危险因素，提示可能需要更长时间暴露于人绒毛膜促性腺激素（hCG）。第二次取卵时间延迟 3-6 小时是 EFS 患者获得最佳结局的有效抢救方案。单个周期的 EFS 不一定预示着未来生育能力下降，但反复发生 EFS 可能导致结局不佳。
