How to avoid it?

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This topic contains 14 replies, has 15 voices, and was last updated by Apple Apple 1 year, 9 months ago.

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  • #201
    Clea
    Clea
    Participant

    I understand that it is almost impossible to do something for preventing the Empty Follicle Syndrome, because this disease belongs to those which are impossible even to notice by yourself. Only specialists can diagnose it and there are even people who may live for years with this syndrome without knowing about it. But does it still mean that it is impossible to avoid it somehow? How to find out that you are at the risk group of the Empty Follicle Syndrome? Are there at least some signs according to which you may suspect that you are risking to have it or already have it? And what should you do to avoid it somehow, if it is possible? It is always better to prevent than to cure.

    #229
    Jody
    Jody
    Participant

    Frequently, when following vigorous and often repeated flushing of follicles at egg retrieval they fail to yield eggs, it is ascribed to “Empty Follicle Syndrome.” This is a gross misnomer, because all follicles contain eggs. So why were no eggs retrieved from the follicles? Most likely it was because they would/could not yield the eggs they harbored. This situation is most commonly seen in older women, women who have severely diminished ovarian reserve, and in women with polycystic ovarian syndrome (PCOS). In my opinion it is often preventable when an optimal, individualized and strategic protocol for controlled ovarian stimulation (COS) is employed and the correct timing and dosage is applied. Normally, following optimal ovarian stimulation, the hCG “trigger shot” is given for the purpose of it triggering meiosis (reproductive division) that is intended to halve the number of chromosomes from 46 to 23 within 32-36 hours. The hCG trigger also enables the egg to signal the “cumulus cells” that bind it firmly to the inner wall of the follicle (through enzymatic activity), to loosen or disperse, so that the egg can detach and readily be captured at egg retrieval (ER).Older women, women with diminished ovarian reserve, and those with polycystic ovarian syndrome, tend to have more biologically active LH in circulation. LH causes production of male hormone (androgens, predominantly testosterone), by ovarian connective tissue (stroma/theca). A little testosterone is needed for optimal follicle development and for FSH-induced ovogenesis (egg development). Too much LH activity compromises the latter, and eggs so affected are far more likely to be aneuploid following meiosis.

    #234
    Alice
    Alice
    Participant

    The underlying mechanism of the EFS remains hypothetical. Some Authors have suggested that it is related to the “cause” leading to female infertility, whereas others have pointed to the alternative suggestion that it might reflect dysfunctional folliculogenesis, with early oocyte atresia and apparently normal hormonal response. Moreover, some Authors believe that the EFS does not exist, and that the oocyte retrieval failure is a pharmacological fault. The risk of recurrence is higher as the age of the patients increases. The EFS cannot be predicted by the pattern of ovarian response to stimulation either sonographically or hormonally. Consequently, the diagnosis of EFS is retrospective. Whatever the underlying cause of an EFS cycle, patients with an EFS cycle should be counselled regarding the possibility of recurrence of such an event in future cycles.

    #285
    Kate
    Kate
    Participant

    The mechanism responsible for EFS remains obscure. Many hypotheses have been put forward, but none truly explain this syndrome. The most likely cause of EFS is ovarian aging, as many patients who suffer from EFS are also reduced responders. It is also possible that a patient may experience EFS if the trigger injection is mistimed. The egg collection procedure is usually scheduled for 36 hours after the trigger injection is administered. Much later than this can result in the eggs being ovulated from the ovary before the doctor has been able to perform the procedure.EFS is an infrequent event and has been estimated to occur in between 2 – 7% of IVF cycles. However, the overall risk of recurrence in later IVF cycles is 20% and the risk of recurrence is higher as the age of the patient increases, with a risk of recurrence of <10% in patients <35 years, 24% for those between 35 and 39 years, and 57% for those over 40 years of age.

    #300

    Camila
    Participant

    The risk factor for Empty follicle syndrome increases with age.
    About 24% of patients between the age of 35 to 39 years of age & 57% for those > 40 years of age.
    It has also 20% chances of recurrence & the risk of recurrence increases with advancing age of the patient.

    #304
    Milka
    Milka
    Participant

    At the end of the egg collection, the first question every patient wants to know is – How many eggs did you collect, doctor ? Egg retrieval is usually a very straightforward procedure, and we usually get at least one egg from each mature follicle ( more than 18 mm in size) . This is why we expect to collect at least as many eggs as there are mature follicles . However, sometimes, much to the doctor’s chagrin and the patient’s dismay, sometimes we do not get any eggs at all. This is not common, but let’s examine why this happens , and what we can do about it. Technically, if we do not collect any eggs at all , this condition is called ” empty follicle syndrome ( EFS) “. Sadly, this term is abused and misused by many IVF doctors, who are happy to make this “diagnosis” and blame this condition when they are not able to collect any eggs from the patient.

    #337
    Molly
    Molly
    Participant

    It is often preventable when an optimal, individualized and strategic protocol for controlled ovarian stimulation (COS) is employed and the correct timing and dosage is applied to the “hCG trigger shot.” Normally, following optimal ovarian stimulation, the hCG “trigger shot” is given for the purpose of it triggering meiosis (reproductive division) that is intended to halve the number of chromosomes from 46 to 23 within 32-36 hours. The hCG trigger also enables the egg to signal the “cumulus cells” that bind it firmly to the inner wall of the follicle (through enzymatic activity), to loosen or disperse, so that the egg can detach and readily be captured at egg retrieval (ER).Ordinarily, normal eggs (and even those with only one or two chromosomal irregularities) will readily detach and be captured with the very first attempt to empty a follicle. Eggs that have several chromosomal numerical abnormalities (i.e., are “complex aneuploid”) are often unable to facilitate this process. This explains why when the egg is complex aneuploid, its follicle will not yield an egg…and why, when it requires repeated flushing of a follicle to harvest an egg, it is highly suggestive of it being aneuploid and thus “incompetent” (i.e., incapable of subsequently propagating a normal embryo).

    #363

    Wilma
    Participant

    At the risk of such diseases are all women. Nowadays it is very hard to stay healthy. The most useful thing is keeping yourself healthy. Do you know the principles of healthy lifestyle? They are very simple: drink water, eat healthy products and stop all the bad habits. I know that this might be not enough for preventing any disease, however I think that there is no other way. Also, in the process of becoming pregnant there are always two participants. What do I want to say, is that your husband, lover, BF, the guy with whom you`d like to have a baby need to lead the healthy lifestyle too. These are just simple tips for any person how to stay healthy and I hope that this can help all of us.

    #402
    Monica
    Monica
    Participant

    One successful outcome has been reported using two combined strategies, prolonging the interval between ovulation triggering and OPU and inducing ovulation using GnRH agonist . GnRH agonist triggering to induce an endogenous LH surge in a GnRH antagonist cycle has been suggested as one strategy to prevent the occurrence of EFS . A patient had undergone seven repetitive borderline EFS cycles. In the treatment cycle, ovulation was triggered using GnRH agonist 40 hours prior to OPU and hCG was added 6 hours after the first trigger. That resulted in aspiration of mature oocytes, pregnancy, and delivery. However, it is impossible to differentiate whether the two strategies exerted the desired outcome.

    #478
    Bridget
    Bridget
    Participant

    In the U.S., about 10% of women ages 15 – 44, or about 6.1 million women, have problems getting pregnant or carrying a baby to term.
    Age. Fertility declines as a woman ages. Fertility begins to decline when a woman reaches her mid-30s, and rapidly declines after her late 30s. As a woman ages, her ovaries produce fewer eggs. In addition, the quality of the eggs is poorer than those of younger women. Older women have a higher risk for eggs with chromosomal abnormalities, which increase the risk for miscarriage and birth defects. Older women are also more likely to have health problems that may interfere with fertility.
    Weight. Although most of a woman’s estrogen is manufactured in her ovaries, 30% is produced by fat cells, which transform male hormones produced by the adrenal glands into estrogen. Because a normal hormonal balance is essential for the process of conception, extreme weight levels (either high or low) can contribute to infertility.
    Being Overweight. Being overweight or obese (fat levels that are 10 – 15% above normal) can contribute to infertility in various ways. Obesity is also associated with polycystic ovarian syndrome (PCOS), an endocrinologic disorder that can cause infertility.
    Being Underweight. Body fat levels 10 – 15% below normal can completely shut down the reproductive process. Women at risk include:
    • Women with eating disorders, such as anorexia or bulimia nervosa.
    • Women on very low-calorie or restrictive diets are at risk, especially if their periods are irregular.
    • Strict vegetarians might have difficulties if they lack important nutrients, such as vitamin B12, zinc, iron, and folic acid.
    • Marathon runners, dancers, and others who exercise very intensely.
    Smoking. Cigarette smoking can harm a woman’s ovaries and contribute to a decrease in eggs. Studies show that women who smoke are more likely to reach menopause earlier than women who do not smoke.

    #614
    Sarah
    Sarah
    Participant

    I really think that you cannot prevent such desease…May be it is bad luck that we have empty follicle syndrome :negative: But i also heard that it happens among older women more often than among youth, so you are likely to have such desease if you are under 30 years old…Also bad habits – we all know that smoking is very harm for women’s health, but it also provokes EFS. And being overweight is also dangerous cause then you have potencial risk to be diagnosed ESF…

    #645

    Daria
    Participant

    There are true (ISPF) and false (LSPF) SPF. ISPF is defined as the inability to obtain oocytes from mature ovarian follicle after ovulation induction with their normal development and steroidogenesis in the normal background level of optimal β-hCG day of aspiration. On LSPF say in cases where the oocytes are not possible to obtain low background β-hCG for its administration errors or low biological activity.The mechanism of ISPF remains unclear. Some authors have even questioned the very existence of this syndrome.We present a case report in which a patient with four mailbox failed to obtain oocytes. In three cycles, only one to four oocytes of poor quality was obtained by aspiration. Change the treatment protocol has led to success.

    #690
    Ana
    Ana
    Participant

    i think that first of all, all women should know the reasons of it and when the risk is the highest. about 24% of patients between the age of 35 to 39 years of age & 57% for those > 40 years of age. it has also 20% chances of recurrence and the risk of recurrence increases with advancing age of the patient. and of course there are different causes of it, when you know something that it is better to consult the doctor. one of the reasons is PCOS, then of course dysfunctional folliculogenesis, in which oocyte atresia occurs with normal hormonal response
    and genetic factors.

    #741

    Donna
    Participant

    Despite the fact that in itself cyst formation and growth occurs even at quite healthy young women with an average frequency of 1-2 times per year, this discovery plunges women undergoing IVF cycle shock.
    Remember, no one except vrachej “IVFs” never sees either in the basal temperature or the US: there oocyte in the follicle or not. Accordingly, one can never exclude the possibility of anomalies in advance of oocytes, empty follicles while the doctor does not receive the follicular fluid and does not consider it under a microscope.

    • This reply was modified 1 year, 10 months ago by  Donna.
    #819
    Apple
    Apple
    Participant

    Some Authors have suggested that it is related to the “cause” leading to female infertility, whereas others have pointed to the alternative suggestion that it might reflect dysfunctional folliculogenesis, with early oocyte atresia and apparently normal hormonal response. Moreover, some Authors believe that the EFS does not exist, and that the oocyte retrieval failure is a pharmacological fault. The risk of recurrence is higher as the age of the patients increases.
    The EFS cannot be predicted by the pattern of ovarian response to stimulation either sonographically or hormonally. Consequently, the diagnosis of EFS is retrospective.

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