# Empty follicle syndrome following GnRH agonist stimulation, in a patient with PCOS treated with HCG rescue protocol, resulting in 3PN zygote formation: a case report

## TL;DR

A patient with PCOS experienced empty follicle syndrome during fertility treatment, but recovered oocytes using HCG, though they were of poor quality.

## Contribution

This case report highlights a rare instance of empty follicle syndrome and the use of HCG rescue protocol in PCOS patients.

## Key findings

- HCG rescue protocol retrieved oocytes after initial failure due to empty follicle syndrome.
- All retrieved oocytes were mature but resulted in 3PN zygotes, indicating cytoplasmic disorders.
- Empty follicle syndrome did not predict success in the patient's subsequent treatment cycle.

## Abstract

Empty follicle syndrome is a rare condition characterized by failure to retrieve
oocytes despite repeated careful aspiration of mature precursor follicles during
controlled ovarian stimulation. This report presents a case of empty follicle
syndrome in a patient with polycystic ovary syndrome using a
gonadotropin-releasing hormone agonist as a trigger for final oocyte maturation.
No oocytes were retrieved from the right ovary and the procedure was
discontinued. The patient was administered an injection with 10,000 units of HCG
and 3 oocytes were obtained after 24 hours. All oocytes were mature (MII);
fertilization was performed with sperm from the patient’s husband resulting in
3PN zygotes. The formation of 3PN zygotes from ICSI might be due to oocyte
cytoplasmic disorders caused by long-term exposure to gonadotropins and
increased duration of stimulation. Although our patient had false empty follicle
syndrome and the hCG rescue protocol led to the retrieval of oocytes, the
oocytes were not of good quality. As previously described, empty follicle
syndrome is not a predictor of success in subsequent cycles. Our patient’s next
cycle was uneventful.