Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2020; 8(4): 825-830
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.825
Borderline form of empty follicle syndrome treated with a novel dual trigger method combined with delayed oocyte retrieval: A case report
Xian-Ling Cao, Zhen-Gao Sun
Xian-Ling Cao, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
Xian-Ling Cao, Zhen-Gao Sun, Integrative Medicine Research Centre of Reproduction and Heredity, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
Author contributions: Cao XL reviewed the literature and contributed to manuscript drafting; Sun ZG was responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhen-Gao Sun, PhD, Doctor, Division of Reproductive Medicine, Shandong Traditional Chinese Medicine University, No. 42 Wen Hua Xi Road, Jinan 250011, Shandong Province, China. sunzhengao77@126.com
Received: November 26, 2019
Peer-review started: December 10, 2019
First decision: January 7, 2020
Revised: January 10, 2020
Accepted: January 15, 2020
Article in press: January 15, 2020
Published online: February 26, 2020
Abstract
BACKGROUND

Borderline form of empty follicle syndrome is a condition in which only a few mature or immature oocytes are recovered after meticulous follicular aspiration, despite adequate ovarian response to stimulation. It is a rare phenomenon with an unclear cause. Currently, the condition still lacks effective treatment.

CASE SUMMARY

A patient with secondary infertility who had undergone three cycles of assisted reproductive technique (ART) is described. With regard to good follicular response, two oocytes were obtained in the first two ART cycles, but no embryo was formed. In the third ART cycle, which is the subject of this study, ovulation was induced by dual trigger of a supernormal dose of human chorionic gonadotropin (HCG) combined with a delayed oocyte retrieval approach. The method involved administration of gonadotropin-releasing hormone agonist, recombinant HCG, and urinary HCG 39 h before ovum pick-up. Ten oocytes were recovered, two out of three mature eggs were fertilized after intracytoplasmic sperm injection, resulting in two embryos that were subsequently cryopreserved. The case report guidelines have been used herein to present the first case of this novel dual trigger method.

CONCLUSION

This approach provides a new treatment option for patients with a similar condition in the future. This study can also inspire further investigation on the effects of various β-HCG serum levels 36 h after intramuscular HCG administration.

Keywords: Empty follicle syndrome, Dual trigger, Delayed oocyte retrieval, β-HCG threshold, Case report

Core tip: Although there is still a dispute regarding the existence of a borderline form of empty follicle syndrome, it is undeniable that this phenomenon does exist. Our case study reports a new ovulation triggering approach that involves a dual trigger of a supernormal dose of human chorionic gonadotropin combined with delayed oocyte retrieval. Our study provides a new technique for the treatment of borderline empty follicle syndrome.