Partial follicular aspiration for salvaging an IVF cycle after improper hCG administration - A case report

BACKGROUND: Failure of oocyte retrieval during in vitro fertilization (IVF) is considered "empty follicle syndrome" Many theories have been postulated , some related to an underlying ovulatory disorder or premature oocyte atre sia. As illustrated in this case and in a review of empty follicle syndrome at our institution, often it is related to improper administration of huma n chorionic gonadotropin (hCG). CASE: A 40-year-old woman underwent IVF for a 10-year history of unexplaine d secondary infertility. Two ultrasound-guided oocyte retrievals were perfo rmed 34 hours apart due to improper hCG administration prior to the first p rocedure. The number of oocytes successfully aspirated at the second retrie val, fertilization rate and pregnancy outcome were analyzed. Successful ret rieval of 16 oocytes, all mature and fertilized, occurred subsequent to the second oocyte retrieval. No pregnancy was established with the fresh cycle . CONCLUSION: This case report supports the premise that an IVF cycle in whic h improper hCG administration occurs can be salvaged. After partial follicu lar aspiration, no ovulation or luteinization of the remaining follicles oc curred because of continued suppression by the gonadotropin releasing hormo ne analog. It is critical to consider the possibility of improper hCG admin istration when facing failure of oocyte retrieval. The procedure should be terminated and hCG readministered, and a second retrieval should be perform ed 34 hours later.