Empty follicle syndrome (EFS) is a condition in which no eggs (oocytes) are retrieved from mature ovarian follicles during an IVF or other assisted reproductive technology cycle, even though the scans and oestrogen levels showed apparently normal follicle development, and despite repeated aspiration and flushing. It is a frustrating situation for a couple who have prepared for weeks. This page explains what EFS is, the two types (genuine and false), the causes and risk factors, what usually happens next, and how homeopathic treatment of empty follicle syndrome is offered at Welling Homeopathy in Mumbai and online.
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Empty follicle syndrome at a glance
- What it is: no eggs are retrieved at egg collection although many mature-looking follicles are present.
- Two types: false EFS, due to a problem with the trigger injection or its timing, and genuine EFS, where eggs are not retrieved despite a proper trigger.
- How common: uncommon, in a small percentage of retrievals; it can recur, and the risk rises with age.
- What it does not mean: it does not always predict permanently reduced fertility; many women have eggs in the next cycle.
- Care: check the trigger hormone level, correct the trigger, repeat the cycle, and discuss options with the IVF team.
What is empty follicle syndrome?
Empty follicle syndrome is defined as a condition in which no oocytes are retrieved from mature ovarian follicles with apparently normal follicular development and oestradiol levels, after controlled ovarian hyperstimulation (COH) for an assisted reproductive technology (ART) cycle, despite repeated aspiration and flushing. No oocytes are retrieved even though many ultrasounds and oestradiol levels show many potential follicles.
It is a frustrating situation at times, but EFS is not necessarily a permanent condition: most cases occur only sporadically, and the follicles of patients with so-called EFS may not actually be devoid of viable oocytes.
Genuine and false empty follicle syndrome
| Genuine EFS (GEFS) | False EFS (FEFS) | |
|---|---|---|
| Definition | Failure to retrieve oocytes from mature follicles after controlled ovarian stimulation, despite an optimal trigger and normal hCG level on the day of retrieval | Failure to retrieve oocytes when the beta-hCG level on the day of retrieval is low |
| Likely reason | Dysfunctional folliculogenesis: the eggs cannot be released from the follicle wall, or are abnormal | Human or pharmaceutical reasons: a wrongly timed, wrongly injected or poor-quality trigger |
| What helps | Specialist review; a different protocol or trigger; repeat cycle | Check hCG on the day; repeat the trigger and retrieval correctly |
Risk factors and causes
The risk of empty follicle syndrome increases with age, and it can recur in a later cycle. Causes and contributors include:
- Inappropriate timing, dose or absorption of the hCG trigger injection
- PCOS
- Dysfunctional folliculogenesis, in which oocyte atresia occurs despite a normal hormonal response
- Genetic factors
- Advanced ovarian ageing through altered folliculogenesis
- Poor bioavailability of LH or hCG, or too short an interval between the trigger and egg retrieval
Why the egg may not come free
The egg undergoes ripening to prepare for fertilisation under the influence of the LH surge, which precedes spontaneous ovulation, while hCG and various fertility drugs are given to induce ovulation. At the same time, enzymes are released that loosen the cells (the cumulus) that surround and bind the egg to the inner wall of the follicle. This is necessary to enable the egg to come free at ovulation or at the time of egg retrieval.
With poorly developed eggs, this mechanism often fails, leaving eggs tightly stuck to the follicle wall and unable to come free, even with vigorous attempts to flush them loose. That is why the more difficult it is to aspirate an egg, the more likely it is that the egg is chromosomally abnormal and unable to develop into a normal pregnancy. EFS does not predict reduced fertility potential in every future cycle, but whatever its cause, patients should be counselled about the possibility of recurrence.
What usually happens next
- Your IVF team checks the beta-hCG level on the day of retrieval, to decide whether it is false or genuine EFS.
- If the trigger was the problem, the retrieval may be repeated after a corrected trigger (for example, a repeat hCG injection or a dual trigger) and a later retrieval time.
- In a later cycle, the stimulation protocol, the type and timing of the trigger and the time to retrieval may be changed.
- If EFS recurs, specialists discuss further tests, donor eggs or other options.
- Emotional support is important; EFS can be distressing after a long cycle.
Homeopathic treatment of empty follicle syndrome
At Welling Homeopathy, we do not treat empty follicle syndrome by stimulating the ovaries with more hormones. We take a detailed history of your cycles, hormones, previous IVF protocols, associated conditions such as PCOS or low AMH, stress and general health, and plan individualised treatment for you and your partner, aimed at supporting natural ovulation and egg development. It can be used before or between IVF cycles, and Homeopathic care does not replace your IVF team’s advice.
Our clinical experience with empty follicle syndrome
The right treatment for empty follicle syndrome will be non-hormonal that will gently stimulate the follicular maturation, to release healthy eggs for natural conceiving without any side effects.
All these criteria are fulfilled only by the Homeopathic treatment of empty follicle syndrome through HART treatment protocol.
To know more about our treatment programme, read homeopathy infertility treatment, the guide to what to do if IVF fails and low AMH.
Frequently asked questions about empty follicle syndrome
1. What is empty follicle syndrome?
It is a condition in which no eggs are retrieved from mature-looking follicles during IVF, despite normal follicle growth and oestradiol levels and repeated aspiration and flushing.
2. What causes empty follicle syndrome?
Most often a problem with the timing, dose or absorption of the hCG trigger (false EFS). In genuine EFS, causes include dysfunctional follicle development, PCOS, genetic factors and advanced ovarian ageing.
3. What is the difference between genuine and false empty follicle syndrome?
In false EFS the hCG level on the day of retrieval is low, pointing to a trigger problem. In genuine EFS, hCG is adequate but no eggs are retrieved.
4. Will empty follicle syndrome happen again?
It can recur, and the risk increases with age, but many women have eggs retrieved in the next cycle, especially if the trigger is corrected.
5. Does empty follicle syndrome mean I cannot get pregnant?
Not necessarily. EFS does not always predict reduced fertility in future cycles, but you should be counselled about the possibility of recurrence.
6. What should I do after an empty follicle cycle?
Ask your IVF team whether the beta-hCG was checked, whether the trigger can be repeated or changed, and what the plan for the next cycle is.
7. Can homeopathy help in empty follicle syndrome?
Welling Homeopathy offers a non-hormonal approach to support follicular maturation and natural conception, as described in our clinical experience above; results vary from person to person.
8. Can I try natural conception after EFS?
Some women try a period of natural conception with supportive treatment, depending on age and AMH. Discuss the timing with your fertility specialist, especially if you are over 35.
Related Reading
- Things You Must Do After a Failed IVF Cycle
- Homeopathy Treatment for Low AMH
- Homeopathy Infertility Treatment: HART, a Proven Way to Conceive Naturally
- What Is The Success Rate Of IVF? By Age, By Cycle and How To Improve It
- Unexplained Infertility: Is It Really Unexplainable?
- Homeopathy Treatment of Luteinized Unruptured Follicle Syndrome (LUFS)
To consult Welling Homeopathy experts, call +91 80 80 850 950.
Disclaimer: this page is for information only and is not a substitute for professional medical advice, diagnosis or treatment. Results vary from person to person.
