One of the most valuable currencies on the Trying To Conceive journey is HOPE! Hope makes a woman track her cycle, day in, day out, in the hope that magic would happen. Hope makes a man submit himself to the privacy-invading procedures of surgical sperm removal. Hope makes a couple hops on the IVF bandwagon.
Hope makes them add ICSI, PGD, etc.. They include the intralipids, endometrial scratch and every other add-on; all hinged on the hope that baby will come out of all these goings-on. So, you can imagine how many hopes have been dashed, how many dreams have been aborted amongst the millions of folks walking this path, and in reality, how many more hopes are hanging in the atmosphere around us, calling forth babies and wishing them into being.
Going back to basics, it is only hope, and an unguaranteed promise of a baby, that will make a woman inject herself, or willingly have a nurse inject her with loads of hormones, to suppress, stimulate, trigger all sorts of reactions in her body.
And that hope is severally dashed when you’re dealing with Empty Follicle Syndrome (EFS). A syndrome defined as an uncommon, but frustrating, complication of assisted reproductive technology, with failure to obtain any oocytes after an adequate ovarian response to stimulation has been established.
When Essah started her IVF procedure, everything was proceeding like text book-perfect. Her body was responding to the stimulation drugs, the scans showed some juicy follicles and it was thought her body was primed for egg collection. The trigger was administered and she went in for her egg collection.
Seventeen follicles were collected but under the microscope of the embryologists, there were no eggs. Surprise! Surprise!! No one expected that. It wasn’t part of the drill. The doctor had talked about a lot of things that could go wrong, and how they would mitigate them, but empty follicles? Hmmm, no one mentioned that bit.
Immediately, her doctor suggested she used donor eggs, so the cycle wouldn’t go to waste, but she was too much in shock from dealing with the news that the follicles she had been rejoicing over on the ultrasound screen, were flukes. The suggestion of donors just added insult to her already open wound. She did nothing about it and that was how that cycle went.
Later, Essah sat down with her doctor to find out what could have caused it. Her doctor was truthful; she hadn’t seen a case like that in her practice and was stumped as to the reason it happened, given everything in the cycle had been perfect up until that moment.
After a few more months of detoxing and rest, Essah was back at her doctor’s, ready for another cycle with fingers crossed that there wouldn’t be a repeat of the last empty follicles saga.
Unfortunately, it happened again, and somehow, it was more painful, given they had made some modifications to her drugs. It was during the third cycle that Essah got some viable oocytes, which fertilised and even grew to blastocysts before they were transferred. This cycle resulted in a life birth.
Currently, Essah has no frozen embryos, her baby is one, the baby craving is kicking in again, and a fresh cycle doesn’t appeal to her, courtesy of her history and I don’t blame her.
Like stated earlier, empty follicle syndrome is not a regular occurrence in IVF (thank God for small mercies), thus many doctors are completely stumped as to what to do when it happens, because they have not dealt with this condition earlier, or suggest donor eggs, just to salvage the situation.
What is standard is that doctors will usually get at least one egg from each mature follicle.
This condition is however not without a remedy, as a 2015 study discovered that the Empty Follicle Syndrome is often caused by an improper administration of the hCG injection. In fact, the study categorically stated that, it was a not a pathological issue, so the case of Essah is sort of a one-off situation. Even though it happened to her twice, before the third cycle got her some much needed oocytes.
According to the study, the risk of EFS is quite small, as it is drug-related and can be avoided. The researchers shared how a pregnancy was achieved in a woman who was administered a dual trigger, with the combination of GnRH agonist and human chorionic gonadotropin, and it yielded 11 oocytes, which led to the transfer of 3 blastocysts, resulting in one baby.
Apparently, changing the treatment protocol with dual trigger brought about a successful outcome for this woman.
Given it is a preventable situation, these are some of the things that could have happened;
The patient may have forgotten to dissolve the powder in the solvent while taking the trigger shot, and taken only the inert solvent
She may have taken a HMG injection instead of the hCG
She may have mis-timed it
She might have spilled the drug, and was too scared to tell the doctor what happened
Whatever be the case, most reproductive experts and researchers agree that a change in the treatment, as well as strict adherence to timing and accurate administration of the trigger, are just enough to do the trick, when it comes to Empty Follicles Syndrome.