English abstract
Objectives: Empty follicle syndrome (EFS), although rare, is a disappointing condition in
which no oocytes are retrieved from mature follicle after ovulation induction in in vitro
fertilization (IVF) cycles. The aim of this study was to estimate the incidence and factors
associated with EFS. Methods: All cycles resulting in EFS from May 2012 to September
2013 were retrospectively identified at a tertiary referral infertility center. Among the 3,356
cycles performed, 58 (1.7%) women who underwent their first IVF cycle and had no oocyte
retrieval were enrolled in the study. Three different stimulation protocols (long, antagonist,
and miniflare) were mainly used for induction of follicular growth. Data relating to the
age, follicle stimulating hormone (FSH) level, anti-Müllerain hormone (AMH) level,
and the number of ampules and follicles for each patient was obtained. Results: Out of
58 individuals, 10 (17.2%) showed false type and 48 (82.8%) showed genuine EFS. The
most frequent findings in our study were diminished ovarian reserve, low anti-Müllerian
hormone (AMH; ≤0.5 ng/mL), and less than four mature follicles, indicating EFS in 1.7%
of the patients. Conclusion: Low serum AMH levels and a small number of follicles after
ovarian stimulation is the manifestation of diminished ovarian reserve. Thus, we suggest
that EFS could be a manifestation of low ovarian reserve.
