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By: Dr Mnaju B nair, Mnaipal Hospital, Bangalore
11 November 2012
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This is about a 30 year old lady with primary infertility of 5 years duration who had been having history of irregular cycles once in two months and was diagnosed  to have polycystic ovaries outside our institution.After evaluation her baseline hormones were normal, S AMH 2.7 ng/ml and USS done AFC 5-6 in each ovary.Husband semen analysis revealed severe oligoasthenoteratospermia.In view of male factor she was counselled for ICSI-ET.


1ST IVF cycle : Antagonsit protocol- Recagon 225 IU- 12 days of stimulation- E2 on Day of HCG- 2800 PG/ML- REC hcg 250 mcg GIVEN- NO EGGS RETRIEVED- Serum Beta HCG- 108- Diagnosed as True empty follicular syndrome


2nd IVF cycle- Antagonist protocol- Gonal F 300 IU ,10 days of stimulation- E2 on day of HCG- 1991 pg/ml- Rec HCG 500 mcg given- no eggs retrieved

We would like to know if there is alternative for this patient apart from egg donation.Is there any other tests which can be recommended to find out the cause of this problem

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Case discussion
Dr.Y.Ravindranath said on 26 January 2013

"Dear Dr.
Did you check whether the patient has Hyperinsulinimia or high androgen levels ? Generally ,in such instances, we do give metformin for couple of months and then stimulate with a starting dose of 150 IU Rec. FSH. and then start Antagonist as the follicle reaches 1.2/ 1.4 cm size It seems she has responding to your protocols as E2 levels were good. Please try with step up Rec.FSH and monitor. All the best.
If you need more information, can reach my mobile 99724 33845-
Dr.Ravindranath, Senior Embryologist"


imad aboujaoude

imad aboujaoude said on 24 November 2012

"there is a new protocol that you can try recently published in human reproduction 2012 Volume 27,, Issue 5Pp. 1357-1367. Empty follicle syndrome: successful treatment in a recurrent case and review of the literature R. Beck-Fruchter1,*,"


Dr manju nair

Thank You
Dr manju nair said on 03 December 2012

"Thanks a lot, read the article , i think we will try giving GnRh Agonist trigger 40 hours before and also Rec HCG 34 hour prior to OPU, hopefully we will get eggs this time."


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