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Lledó B, Piqueras JJ, Lozano FM, Hortal M, Morales R, Ortiz JA, Guerrero J, Benabeu A, Bernabeu R. Exome sequencing in genuine empty follicle syndrome: Novel candidate genes. Eur J Obstet Gynecol Reprod Biol 2024; 297:221-226. [PMID: 38691974 DOI: 10.1016/j.ejogrb.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/18/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE(S) Empty follicle syndrome (EFS) is a condition in which no oocytes are retrieved in an IVF cycle despite apparently normal follicular development and meticulous follicular aspiration following ovulation induction. The EFS is called genuine (gEFS) when the trigger administration is correct. The existence of gEFS is a subject of controversy, and it is quite rare with an undetermined etiology. Genetic defects in specific genes have been demonstrated to be responsible for this condition in some patients. Our objective was to identify novel genetic variants associated with gEFS. STUDY DESIGN We conducted a prospective observational study including 1,689 egg donors from July 2017 to February 2023. WES were performed in patients suffering gEFS. RESULTS Only 7 patients (0.41 %) exhibited gEFS after two ovarian stimulation cycles and we subsequently performed whole exome sequencing (WES) on these patients. Following stringent filtering, we identified 6 variants in 5 affected patients as pathogenic in new candidate genes which have not been previously associated with gEFS before, but which are involved in important biological processes related to folliculogenesis. These genetic variants included c.603_618del in HMMR, c.1025_1028del in LMNB1, c.1091-1G > A in TDG, c.607C > T in HABP2, c.100 + 2 T > C in HAPLN1 and c.3592_3593del in JAG2. CONCLUSION As a conclusion, we identified new candidate genes related to gEFS that expand the mutational spectrum of genes related to gEFS.This study show that WES might be an efficient tool to identify the genetic etiology of gEFS and provide further understanding of the pathogenic mechanism of gEFS.
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Affiliation(s)
- Belen Lledó
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain.
| | - Juan J Piqueras
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain
| | | | - Mónica Hortal
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain
| | - Ruth Morales
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain
| | - José A Ortiz
- Molecular Biology Department, Instituto Bernabeu, Alicante, Spain
| | - Jaime Guerrero
- Reproductive Biology Department, Instituto Bernabeu, Alicante, Spain
| | - Andrea Benabeu
- Reproductive Medicine Department, Instituto Bernabeu, Alicante, Spain; Chair Community Medicine UMH and Health Reproductive, Miguel Hernández University, Alicante, Spain
| | - Rafael Bernabeu
- Reproductive Medicine Department, Instituto Bernabeu, Alicante, Spain; Chair Community Medicine UMH and Health Reproductive, Miguel Hernández University, Alicante, Spain
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Jin H, Yang H, Zheng J, Zhou J, Yu R. Risk factors for low oocyte retrieval in patients with polycystic ovarian syndrome undergoing in vitro fertilization. Reprod Biol Endocrinol 2023; 21:66. [PMID: 37468927 DOI: 10.1186/s12958-023-01118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The number of oocytes retrieved does not always coincide with the number of follicles aspirated in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Patients with high expectation of retrieval sometimes obtain few oocytes, which may be induced by improper operation or therapeutic factors. The purpose of this study was to evaluate the distribution data of oocyte retrieval rate (ORR) and to explore the risk factors for low ORR in patients with polycystic ovary syndrome (PCOS) undergoing IVF/ICSI. METHODS A total of 2478 patients with PCOS undergoing IVF/ICSI were involved in this retrospective case-control study from March 2016 to October 2021. The oocyte retrieval rate was calculated as the ratio of the number of obtained oocytes to the number of follicles (≥ 12 mm) on the trigger day. Patients were divided into a low ORR and a normal ORR group with the boundary of one standard deviation from the mean value of ORR. The patient characteristics, treatment protocols, serum hormone levels, and embryonic and pregnancy outcomes were analyzed. RESULTS The ORR exhibited a non-normal distribution, with a median of 0.818. The incidence of complete empty follicle syndrome was 0.12% (3/2478). The proportion of patients in the low ORR group who received the progestin-primed protocol was significantly higher than that in the normal ORR group (30.30% vs. 17.69%). A logistic regression analysis showed that the serum estradiol level/follicle (≥ 12 mm) ratio (OR: 0.600 (0.545-0.661)) and progesterone level (OR: 0.783 (0.720-0.853)) on the trigger day were significant factors in the development of a low ORR, with optimal cutoff values of 172.85 pg/ml and 0.83 ng/ml, respectively, as determined by receiver operating curve. Fewer high-quality embryos (2 vs. 5) and more cycles with no available embryos (5.42% vs. 0.43%) were found in the low ORR group. CONCLUSIONS For patients with PCOS, low estradiol levels/follicles (≥ 12 mm) and progesterone levels on the trigger day and the use of the progestin-primed protocol could be risk factors for low ORR, which leads to a limited number of embryos and more cycle cancellations.
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Affiliation(s)
- Hao Jin
- The Urological Surgical Department, The First Affiliated Hospital of Wenzhou Medical University, No. 96, Fuxue Road, Lucheng District, Wenzhou, China
| | - Haiyan Yang
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiujia Zheng
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiechun Zhou
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rong Yu
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Pujalte M, Camo M, Celton N, Attencourt C, Lefranc E, Jedraszak G, Scheffler F. A ZP1 gene mutation in a patient with empty follicle syndrome: A case report and literature review. Eur J Obstet Gynecol Reprod Biol 2023; 280:193-197. [PMID: 36529558 DOI: 10.1016/j.ejogrb.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Genuine empty follicle syndrome (gEFS) is a rare cause of female infertility; it is defined as the presence of cumulus-oocyte complexes (COCs) in follicular fluid but the absence of oocytes after denudation in an in vitro fertilization (IVF) programme. Mutations in one of the four genes encoding zona pellucida (ZP) proteins have been implicated in gEFS. The objectives of the present study were to explore the molecular basis of idiopathic infertility in a 35-year-old woman with gEFS (observed after four ovarian retrievals), compare her phenotype and genotype with those of other patients described in the literature, and discuss therapeutic approaches that could be adopted by reproductive health centres in this situation. Sequencing of the ZP genes revealed a new homozygous missense variant in ZP1: c.1097G > A;p.(Arg366Gln). The variant is located in the ZP-N domain, which is essential for ZP protein polymerization. An immunohistochemical assessment of an ovarian biopsy confirmed the absence of ZP1 protein. The novel variant appears to prevent ZP assembly, which would explain the absence of normal oocytes after denudation in our patient (and despite the retrieval of COCs). ZP gene sequencing should be considered for patients with a phenotype suggestive of gEFS. An etiological genetic diagnosis enables appropriate genetic counselling and a switch to an IVF programme (with a suitable denudation technique) or an oocyte donation programme.
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Affiliation(s)
- Mathilde Pujalte
- Department of Constitutional Genetics, Amiens University Hospital, Amiens, France
| | - Maïté Camo
- Reproductive Medicine and Biology Department, CECOS of Picardy, Amiens University Hospital, Amiens, France
| | - Noémie Celton
- Department of Constitutional Genetics, Amiens University Hospital, Amiens, France
| | - Christophe Attencourt
- Department of Anatomy and Pathological Cytology, Amiens University Hospital, Amiens, France
| | - Elodie Lefranc
- Reproductive Medicine and Biology Department, CECOS of Picardy, Amiens University Hospital, Amiens, France
| | - Guillaume Jedraszak
- Department of Constitutional Genetics, Amiens University Hospital, Amiens, France; EMATIM UR4666, CURS, Jules Verne University of Picardy, Amiens, France
| | - Florence Scheffler
- Reproductive Medicine and Biology Department, CECOS of Picardy, Amiens University Hospital, Amiens, France; Peritox UMR_I 01, CURS, Jules Verne University of Picardy, Amiens, France.
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Zhou J, Wang M, Yang Q, Li D, Li Z, Hu J, Jin L, Zhu L. Can successful pregnancy be achieved and predicted from patients with identified ZP mutations? A literature review. Reprod Biol Endocrinol 2022; 20:166. [PMID: 36476320 PMCID: PMC9730648 DOI: 10.1186/s12958-022-01046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In mammals, normal fertilization depends on the structural and functional integrity of the zona pellucida (ZP), which is an extracellular matrix surrounding oocytes. Mutations in ZP may affect oogenesis, fertilization and early embryonic development, which may cause female infertility. METHODS A PubMed literature search using the keywords 'zona pellucida', 'mutation' and 'variant' limited to humans was performed, with the last research on June 30, 2022. The mutation types, clinical phenotypes and pregnancy outcomes were summarized and analyzed. The naive Bayes classifier was used to predict clinical pregnancy outcomes for patients with ZP mutations. RESULTS A total of 29 publications were included in the final analysis. Sixty-nine mutations of the ZP genes were reported in 87 patients with different clinical phenotypes, including empty follicle syndrome (EFS), ZP-free oocytes (ZFO), ZP-thin oocytes (ZTO), degenerated and immature oocytes. The phenotypes of patients were influenced by the types and location of the mutations. The most common effects of ZP mutations are protein truncation and dysfunction. Three patients with ZP1 mutations, two with ZP2 mutations, and three with ZP4 mutations had successful pregnancies through Intracytoplasmic sperm injection (ICSI) from ZFO or ZTO. A prediction model of pregnancy outcome in patients with ZP mutation was constructed to assess the chance of pregnancy with the area under the curve (AUC) of 0.898. The normalized confusion matrix showed the true positive rate was 1.00 and the true negative rate was 0.38. CONCLUSION Phenotypes in patients with ZP mutations might be associated with mutation sites or the degree of protein dysfunction. Successful pregnancy outcomes could be achieved in some patients with identified ZP mutations. Clinical pregnancy prediction model based on ZP mutations and clinical characteristics will be helpful to precisely evaluate pregnancy chance and provide references and guidance for the clinical treatment of relevant patients.
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Affiliation(s)
- Juepu Zhou
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030 China
| | - Meng Wang
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030 China
| | - Qiyu Yang
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030 China
| | - Dan Li
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030 China
| | - Zhou Li
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030 China
| | - Juan Hu
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030 China
| | - Lei Jin
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030 China
| | - Lixia Zhu
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030 China
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Zou T, Xi Q, Liu Z, Li Z, Hou M, Zhu L, Jin L, Zhang X. A Novel Homozygous Nonsense Mutation in ZP1 Causes Female Infertility due to Empty Follicle Syndrome. Reprod Sci 2022; 29:3516-3520. [PMID: 35773450 DOI: 10.1007/s43032-022-01024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022]
Abstract
ZP1 is a critical glycoprotein in the formation of the zona pellucida. It plays an indispensable role in the maturation of oocytes. To identify the causative gene of empty follicle syndrome (EFS) in a patient from a consanguineous family, whole-exome sequencing was performed in the proband. We identified a novel homozygous nonsense mutation c.1260C > G (p. Tyr420X) in the ZP1 gene from two primary infertile patients. Western blot showed that Y420X mutation in ZP1 gene produced a truncated protein. However, the mutation had no significant effect on subcellular localization of the mutant protein. Our findings confirmed the important role of the ZP1 gene in human female reproduction, enriched the mutation spectrums of ZP1 gene, and expanded its applications in the clinical and molecular diagnoses of EFS.
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Affiliation(s)
- Tingting Zou
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Qingsong Xi
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Zhenxing Liu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Zhou Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Meiqi Hou
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China.
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Xianqin Zhang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China.
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6
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Kumar P, Rao S, Mundkur A, Adiga P, Ullagaddi RK, Poojari VG. Crossing the Hurdle of a Low Oocyte Yield in an in vitro Fertilization Cycle to Obtain Mature Oocytes. J Hum Reprod Sci 2022; 15:197-199. [PMID: 35928459 PMCID: PMC9345269 DOI: 10.4103/jhrs.jhrs_40_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
The complex process of oocyte maturation involves a coordinated set of events to take place so that an adequate number of oocytes can be obtained during an oocyte pickup procedure following controlled ovarian stimulation. A weak link in any of the steps can yield a sparse number of oocytes which can be a setback in the process.
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Affiliation(s)
- Pratap Kumar
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Shubha Rao
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Anjali Mundkur
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Prashanth Adiga
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Rashmi K Ullagaddi
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Vidyashree G Poojari
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
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Hatırnaz Ş, Hatırnaz ES, Ellibeş Kaya A, Hatırnaz K, Soyer Çalışkan C, Sezer Ö, Dokuzeylül Güngor N, Demirel C, Baltacı V, Tan S, Dahan M. Oocyte maturation abnormalities - A systematic review of the evidence and mechanisms in a rare but difficult to manage fertility pheneomina. Turk J Obstet Gynecol 2022; 19:60-80. [PMID: 35343221 PMCID: PMC8966321 DOI: 10.4274/tjod.galenos.2022.76329] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A small proportion of infertile women experience repeated oocyte maturation abnormalities (OMAS). OMAS include degenerated and dysmorphic oocytes, empty follicle syndrome, oocyte maturation arrest (OMA), resistant ovary syndrome and maturation defects due to primary ovarian insufficiency. Genetic factors play an important role in OMAS but still need specifications. This review documents the spectrum of OMAS and to evaluate the multiple subtypes classified as OMAS. In this review, readers will be able to understand the oocyte maturation mechanism, gene expression and their regulation that lead to different subtypes of OMAs, and it will discuss the animal and human studies related to OMAS and lastly the treatment options for OMAs. Literature searches using PubMed, MEDLINE, Embase, National Institute for Health and Care Excellence were performed to identify articles written in English focusing on Oocyte Maturation Abnormalities by looking for the following relevant keywords. A search was made with the specified keywords and included books and documents, clinical trials, animal studies, human studies, meta-analysis, randomized controlled trials, reviews, systematic reviews and options written in english. The search detected 3,953 sources published from 1961 to 2021. After title and abstract screening for study type, duplicates and relevancy, 2,914 studies were excluded. The remaining 1,039 records were assessed for eligibility by full-text reading and 886 records were then excluded. Two hundred and twenty seven full-text articles and 0 book chapters from the database were selected for inclusion. Overall, 227 articles, one unpublished and one abstract paper were included in this final review. In this review study, OMAS were classified and extensively evaluatedand possible treatment options under the light of current information, present literature and ongoing studies. Either genetic studies or in vitro maturation studies that will be handled in the future will lead more informations to be reached and may make it possible to obtain pregnancies.
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Affiliation(s)
- Şafak Hatırnaz
- Medicana Samsun International Hospital, In Vitro Fertilization-In Vitro Maturation Unit, Samsun, Turkey
| | - Ebru Saynur Hatırnaz
- Medicana Samsun International Hospital, In Vitro Fertilization-In Vitro Maturation Unit, Samsun, Turkey
| | - Aşkı Ellibeş Kaya
- Private Office, Clinic of Obstetrics and Gynecology Specialist, Samsun, Turkey
| | - Kaan Hatırnaz
- Ondokuz Mayıs University Faculty of Medicine, Department of Molecular Biology and Genetics, Samsun, Turkey
| | - Canan Soyer Çalışkan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Clinic of Obstetrics and Gynecology, Samsun, Turkey
| | - Özlem Sezer
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Clinic of Genetics, Samsun, Turkey
| | | | - Cem Demirel
- Memorial Ataşehir Hospital, In Vitro Fertilization Unit, İstanbul, Turkey
| | | | - Seang Tan
- James Edmund Dodds Chair in ObGyn, Department of ObGyn, McGill University, OriginElle Fertility Clinic and Women, QC, Canada
| | - Michael Dahan
- McGill Reproductive Centre, Department of ObGyn, McGill University Montreal, Quebec, Canada
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Wang J, Yang X, Sun X, Ma L, Yin Y, He G, Zhang Y, Zhou J, Cai L, Liu J, Ma X. A novel homozygous nonsense mutation in zona pellucida 1 (ZP1) causes human female empty follicle syndrome. J Assist Reprod Genet 2021; 38:1459-1468. [PMID: 33665726 DOI: 10.1007/s10815-021-02136-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/25/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To identify a pathogenic gene mutation in a female infertility proband characterized by empty follicle syndrome (EFS) and explore the genetic cause of EFS. METHODS Whole exome sequencing (WES) was performed to identify the candidate pathogenic mutation. Sanger sequencing was used to validate the mutation in family members. The pathogenicity of the identified variant and its possible effects on the protein were evaluated with in silico tools. Immunofluorescence staining was used to study the possible mechanism of the mutation on affected oocyte. RESULTS We identified a family with a novel homozygous nonsense mutation in zona pellucida 1 (ZP1) (c.199G > T [p.Glu67Ter]). Based on bioinformatics analysis, the mutation was predicted to be pathogenic. This variant generates a premature stop codon in exon 2 at the 199th nucleotide, and was inferred to result in a truncated ZP1 protein of 67 amino acids at the ZP-N1 domain. An in vitro study showed that the oocyte of the EFS proband was degenerated and the zona pellucida was absent. Additionally, the mutant ZP1 proteins were localized in the cytoplasm of the degenerated oocyte but not at the surface. CONCLUSIONS The novel mutation in ZP1 is a genetic cause of female infertility characterized by EFS. Our finding expands the genetic spectrum for EFS and will help justify the EFS diagnosis in patients.
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Affiliation(s)
- Jing Wang
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiaoyu Yang
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xueping Sun
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Long Ma
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yaoxue Yin
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Guoxiang He
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yuan Zhang
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jie Zhou
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lingbo Cai
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiang Ma
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Yang P, Chen T, Liu Y, Hou Z, Wu K, Cao Y, Zhang J, Wang Z, Zhao H. The critical role of ZP genes in female infertility characterized by empty follicle syndrome and oocyte degeneration. Fertil Steril 2020; 115:1259-1269. [PMID: 33272616 DOI: 10.1016/j.fertnstert.2020.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify the major causative gene(s) of genuine empty follicle syndrome (GEFS) characterized by oocyte degeneration. DESIGN Genetic and functional studies. SETTING University-based reproductive medicine center. PATIENT(S) Thirty-five unrelated women with GEFS and oocyte degeneration. INTERVENTION(S) Whole-exome sequencing (WES) and targeted Sanger sequencing. MAIN OUTCOME MEASURE(S) Variants predicted by software and the functional effects of variants assessed via Western blot and immunofluorescence in Chinese hamster ovary (CHO) cells. RESULT(S) We identified zona pellucida (ZP) gene variants in 18 individuals, which included 20 variants in the ZP1 gene, two variants in the ZP2 gene, and one previously reported recurrent variant in the ZP3 gene. The women carrying ZP variants constituted 51.43% of the GEFS cohort. The ZP1 variants were inherited in an autosomal recessive pattern; the ZP2 and ZP3 variants were inherited in an autosomal dominant pattern. All variants were predicted to be deleterious. Studies in CHO cells suggested that most ZP1 variants led to increased intracytoplasmic protein and some variants influenced the intracellular transportation of other ZP proteins. Variant p.R642Q of ZP2 caused the secretion of ZP2 protein with an increased molecular weight, suggesting altered protein modification. Variant p.I619N of ZP2 resulted in increased ZP2 protein in cell lysate and decreased ZP2 protein in culture medium. These results showed that ZP variants might block the intracellular transportation and secretion of ZP proteins and disrupt the zona pellucida. CONCLUSION(S) We identified novel variants of ZP genes in more than half the cohort with GEFS and oocyte degeneration. Variants of ZP genes caused protein intracellular sequestration and failure to assemble the ZP filaments, resulting in EFS and female infertility. Our findings not only reveal the critical roles of ZP genes but also pave the way for the efficient genetic diagnosis of females with GEFS and oocyte degeneration.
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Affiliation(s)
- Ping Yang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Shandong Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China
| | - Tailai Chen
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yuqing Liu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Shandong Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China
| | - Zhenzhen Hou
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Shandong Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China
| | - Keliang Wu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Shandong Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China
| | - Yongzhi Cao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Shandong Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China
| | - Jiangtao Zhang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Shandong Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China
| | - Zhao Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Shandong Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China
| | - Han Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Shandong Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China.
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10
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Dai C, Chen Y, Hu L, Du J, Gong F, Dai J, Zhang S, Wang M, Chen J, Guo J, Zheng W, Lu C, Wu Y, Lu G, Lin G. ZP1 mutations are associated with empty follicle syndrome: evidence for the existence of an intact oocyte and a zona pellucida in follicles up to the early antral stage. A case report. Hum Reprod 2020; 34:2201-2207. [PMID: 31734689 DOI: 10.1093/humrep/dez174] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/26/2019] [Indexed: 11/14/2022] Open
Abstract
Empty follicle syndrome (EFS) is the complete failure to retrieve oocytes after ovarian stimulation. Although LHCGR and ZP3 were identified as causative genes, it is still unclear what happens to these patients' oocytes, and the pathogenesis of EFS remains obscure. Here, we identified six novel ZP1 mutations associated with EFS and female infertility that was inherited recessively in five unrelated families. Studies in CHO-K1 cells showed that these mutations resulted in either degradation or truncation of ZP1 protein. Immunohistochemistry using ovarian serial sections demonstrated that all preantral follicles had normal architecture, but with a thin ZP, lacking ZP1, surrounding the growing oocytes. The antral follicles were also defective in normal cumulus-oocyte complex organisation, leading us to speculate that the lack of ZP1 might lead to oocyte degeneration or increased fragility of the oocyte during follicular puncture, ultimately resulting in EFS. To our knowledge, this is the first study that presents morphological evidence showing normal preantral folliculogenesis with abnormal ZP assembly in EFS patients. Our data provides a better understanding of the biological functions of ZP1 in human ZP assembly and folliculogenesis and gives new insights into the pathogenesis of EFS and possible therapeutic developments.
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Affiliation(s)
- Can Dai
- Department of Basic Medicine, School of Medicine, Hunan Normal University, No. 371 Tongzipo Road, Changsha 410013, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, No. 88 Xiangya Road, Changsha 410008, China
| | - Yongzhe Chen
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China
| | - Liang Hu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, No. 88 Xiangya Road, Changsha 410008, China.,National Engineering and Research Center of Human Stem Cell, No. 8 Luyun Road, Changsha 410205, China
| | - Juan Du
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, No. 88 Xiangya Road, Changsha 410008, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, No. 88 Xiangya Road, Changsha 410008, China
| | - Jing Dai
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China
| | - Shuoping Zhang
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China
| | - Mingyi Wang
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China
| | - Jing Chen
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China
| | - Jing Guo
- Department of Basic Medicine, School of Medicine, Hunan Normal University, No. 371 Tongzipo Road, Changsha 410013, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China
| | - Wei Zheng
- Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China
| | - Changfu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, No. 88 Xiangya Road, Changsha 410008, China
| | - Yueren Wu
- Department of Basic Medicine, School of Medicine, Hunan Normal University, No. 371 Tongzipo Road, Changsha 410013, China
| | - Guangxiu Lu
- Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, No. 88 Xiangya Road, Changsha 410008, China.,National Engineering and Research Center of Human Stem Cell, No. 8 Luyun Road, Changsha 410205, China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, No. 88 Xiangya Road, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84 Xiangya Road, Changsha 410008, China.,Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, No. 88 Xiangya Road, Changsha 410008, China.,National Engineering and Research Center of Human Stem Cell, No. 8 Luyun Road, Changsha 410205, China
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11
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Xu Q, Zhu X, Maqsood M, Li W, Tong X, Kong S, Wang F, Liu X, Wei Z, Zhang Z, Zhu F, Cao Y, Bao J. A novel homozygous nonsense ZP1 variant causes human female infertility associated with empty follicle syndrome (EFS). Mol Genet Genomic Med 2020; 8:e1269. [PMID: 32329253 PMCID: PMC7336750 DOI: 10.1002/mgg3.1269] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
Background Empty follicle syndrome (EFS) is a rare but severe condition in which no oocyte is recovered in female patients undergoing in vitro fertilization (IVF) after sufficient ovarian response to hormonal trigger. Accumulating evidence highlights the genetic basis of EFS occurrence. Methods In this study, we report a patient with primary infertility showing the characteristics of EFS from a consanguineous family. Under the treatment of assisted reproductive technique (ART), no oocyte was retrieved following the aspiration of mature follicles. Through whole‐exome sequencing (WES), we discovered a novel recessively transmitted mutation in ZP1 (c.769 C>T, p. Q257*). Results In vitro Co‐immunoprecipitation assays showed that mutant ZP1 protein failed to interact with either ZP2 or ZP3, which explains the degenerated oocytes in the patient with EFS. Conclusion Together, our data further expand the spectrum of ZP1 mutations that are associated with human EFS and thus provide novel insight into the diagnosis of EFS patients.
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Affiliation(s)
- Qianhua Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China
| | - Xiaoli Zhu
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui, China
| | - Madiha Maqsood
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui, China
| | - Wenqing Li
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui, China
| | - Xianhong Tong
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui, China
| | - Shuai Kong
- School of Life Science, Anhui Medical University, Hefei, China
| | - Fengsong Wang
- School of Life Science, Anhui Medical University, Hefei, China
| | - Xiaoman Liu
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui, China
| | - Zhaolian Wei
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China
| | - Zhiguo Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China
| | - Fuxi Zhu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China
| | - Jianqiang Bao
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui, China
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12
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Hajshafiha M, Behrouzi Lak T, Hajiloo N, Deldar Y, Ghorbani M, Haghollahi F. Evaluation of follicular fluid's Beta-Human chorionic gonadotropin in the follicles of patient undergoing Intracytoplasmic sperm injection: A cross-sectional study. Int J Reprod Biomed 2019; 16. [PMID: 31417985 PMCID: PMC6600285 DOI: 10.18502/ijrm.v16i12.3686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/13/2018] [Accepted: 08/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background The failure to retrieve oocytes from mature ovarian follicles is referred to as empty follicle syndrome. There is no exact explanation to this problem and it cannot be predicted using ultrasound or serum hormonal levels. The underlying mechanism of Empty follicle syndrome remains obscure. Objective In this study, the authors have investigated the relationship between the Beta-Human chorionic gonadotropin ( β HCG) levels in the follicular fluid with or without the oocyte in the follicles of patients undergoing Intracytoplasmic Sperm Injection. Materials and Methods Seventy-three infertile couples underwent standard long protocol induction ovulation for Intracytoplasmic sperm injection. On the day of oocyte retrieval, each patient had two samples; follicular fluid including 2-3 follicles with oocyte and follicular fluid including of 2-3 follicles without oocyte were collected in separate tubes. These follicles had similar shape and size. The Samples were transferred to a laboratory for measuring the β HCG level, after which the β HCG levels were compared to the follicles with and without the oocyte in each patient. Results In this study, the β HCG level of follicular fluid in the follicles containing oocyte was 18.20 (8.35-42.92) IU/L and in the follicles without the oocyte was 13.50 (5.45-25.81) IU/L. Levels of β HCG in the follicular fluids containing the oocyte were higher than without oocytes, This difference was not statistically significant (p = 0.16). Conclusion It seems that the follicular fluid β HCG isn't caused by empty follicle syndrome, and that dysfunctional folliculogenesis may be the cause of this syndrome.
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Affiliation(s)
- Masoumeh Hajshafiha
- Department of Obstetrics and Gynecology, Urmia Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Tahere Behrouzi Lak
- Department of Obstetrics and Gynecology, Urmia Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Nasrin Hajiloo
- Motahary Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Yaghoub Deldar
- Clinical Biochemistry, Urmia University of Medical Sciences, Urmia, Iran
| | - Mina Ghorbani
- Motahary Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Fedyeh Haghollahi
- Vali-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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13
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Yakovi S, Izhaki I, Ben-Ami M, Younis JS. Does the empty follicle syndrome occur in cases of low number of maturing follicles in assisted reproduction? Gynecol Endocrinol 2019; 35:305-308. [PMID: 30303699 DOI: 10.1080/09513590.2018.1519793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The pathophysiology of the genuine empty follicle syndrome (EFS) is still debated. Ovarian aging has been contested as a cause of this condition. Our aim was to investigate the occurrence of the genuine EFS in cases of a low number of mature follicles in a prospective manner. Ninety-five infertile women were recruited and evaluated following conventional controlled ovarian stimulation (COS) with ≤ six follicles of ≥14 mm diameter on the day of hCG administration. Enrolled women were 37.5 ± 5.2 years of age with basal FSH level of 9.1 ± 3.7 mIU/L, antral follicle count (AFC) of 6.9 ± 4.6, and number of ≥14 mm follicles (on the day of hCG) of 3.4 ± 1.5. Among the 95 women, four were complicated by the genuine EFS (4.2%) with features of the depleted ovarian reserve. Comparison between these four cases and the 91 controls revealed significant differences between age, AFC, number of ≥14 mm follicles, and serum E2 level corresponding to 41.8 ± 1.7 versus 37.4 ± 5.2 years, 1.7 ± 0.6 versus 7.1 ± 4.5, 2.0 ± 0.8 versus 3.4 ± 1.5 follicles, and 356 ± 200 versus 975 ± 557 pg/mL, respectively. Post hoc analysis revealed that 56 among the 95 women fulfilled the Bologna criteria for poor ovarian response and all four cases matched the definition of the genuine EFS raising its incidence to 7.1% in this group. A logistic regression analysis showed that AFC was a significant factor in the development of the genuine EFS. We conclude that the genuine EFS complicates infertile women characterized by a low number of mature follicles. Our findings suggest that the mechanism behind this occurrence is associated with a more exhausted ovarian reserve.
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Affiliation(s)
- Shiran Yakovi
- a Reproductive Medicine Unit, Department of Obstetrics and Gynecology , Poriya Medical Center , Tiberias , Israel
| | - Ido Izhaki
- b Department of Evolutionary and Environmental Biology , University of Haifa , Haifa , Israel
| | - Moshe Ben-Ami
- a Reproductive Medicine Unit, Department of Obstetrics and Gynecology , Poriya Medical Center , Tiberias , Israel
- c Faculty of Medicine in Galilee , Bar-Ilan University , Israel
| | - Johnny S Younis
- a Reproductive Medicine Unit, Department of Obstetrics and Gynecology , Poriya Medical Center , Tiberias , Israel
- c Faculty of Medicine in Galilee , Bar-Ilan University , Israel
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14
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Chen C, Xu X, Kong L, Li P, Zhou F, Zhao S, Xin X, Tan J, Zhang X. Novel homozygous nonsense mutations in LHCGR lead to empty follicle syndrome and 46, XY disorder of sex development. Hum Reprod 2019; 33:1364-1369. [PMID: 29912377 DOI: 10.1093/humrep/dey215] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/31/2018] [Indexed: 11/14/2022] Open
Abstract
Empty follicle syndrome (EFS) is a disorder associated with female infertility and presents as a complete failure to retrieve oocytes during ART cycles despite normal follicle development and careful aspiration. To date, only two EFS cases have been reported with homozygous missense mutations in the luteinizing hormone/chorionic gonadotropin receptor (LHCGR) gene, and both cases showed normal estradiol (E2) production during ovulation induction. The molecular genetic mechanisms of EFS remain unknown. Herein, we report two novel homozygous inactivating LHCGR mutations, c.736 C>T (p.Q246*) and c.846dupT (p.R283*), in two female EFS patients from unrelated consanguineous families. The probands had impaired E2 production during the ART process, which differs from previously reported EFS cases. The inactivating mutations not only led to EFS in the two female probands, but also resulted in 46, XY disorder of sex development (46, XY DSD) in their male siblings. As far as we know, this is the first report of LHCGR mutations leading to both EFS and 46, XY DSD within the same pedigree. Our findings provide researchers and clinicians with a better understanding of phenotype-genotype correlations between EFS and 46, XY DSD and the LHCGR gene.
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Affiliation(s)
- C Chen
- The Research Center for Medical Genomics, Key Laboratory of Cell Biology, Ministry of Public Health, Key Laboratory of Medical Cell Biology, Ministry of Education, College of Basic Medical Science, China Medical University, No. 77 Puhe Road, North New Area, Shenyang, China
| | - X Xu
- Reproductive Medical Center of Gynecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, No. 39 Huaxiang Road, Tiexi, Shenyang, China
| | - L Kong
- Reproductive Medical Center of Gynecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, No. 39 Huaxiang Road, Tiexi, Shenyang, China
| | - P Li
- Reproductive Medical Center of Gynecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, No. 39 Huaxiang Road, Tiexi, Shenyang, China
| | - F Zhou
- Reproductive Medical Center of Gynecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, No. 39 Huaxiang Road, Tiexi, Shenyang, China
| | - S Zhao
- Reproductive Medical Center of Gynecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, No. 39 Huaxiang Road, Tiexi, Shenyang, China
| | - X Xin
- Reproductive Medical Center of Gynecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, No. 39 Huaxiang Road, Tiexi, Shenyang, China
| | - J Tan
- Reproductive Medical Center of Gynecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, No. 39 Huaxiang Road, Tiexi, Shenyang, China
| | - X Zhang
- The Research Center for Medical Genomics, Key Laboratory of Cell Biology, Ministry of Public Health, Key Laboratory of Medical Cell Biology, Ministry of Education, College of Basic Medical Science, China Medical University, No. 77 Puhe Road, North New Area, Shenyang, China
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, No. 5 Dongdan Santiao, Beijing, China
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15
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Al-Hussaini TK, Yosef AH, El-Nashar IH, Shaaban OM. Repeated recovery of immature oocytes in a woman with a previous history of empty follicle syndrome. JBRA Assist Reprod 2019; 23:72-74. [PMID: 30376278 PMCID: PMC6364283 DOI: 10.5935/1518-0557.20180068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The empty follicle syndrome (EFS) is defined as a failure to aspirate any oocyte
(s) from the follicles after ovarian hyperstimulation in preparation for
IVF/ICSI. It is a frustrating and vague syndrome; and a controversial one
concerning its existence, causes and possible treatment. Recurrent EFS or the
recovery of immature oocytes thereafter is a more challenging problem. Delayed
injection after leaving the immature oocytes for in
vitro-maturation (IVM) has been suggested to be a possible option if
immature oocytes are retrieved. Here, we present a case of repeated retrieval of
a few immature oocytes after a first incidence of EFS. IVM was tried twice for
those immature oocytes. Unfortunately, in this case IVM was unsuccessful and the
oocytes failed to mature in vitro. Assistance is required for
future management of these unfortunate couples.
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Affiliation(s)
- Tarek K Al-Hussaini
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, El-Salama IVF/ICSI Centre, Assiut, Egypt
| | - Ali H Yosef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, El-Salama IVF/ICSI Centre, Assiut, Egypt
| | - Ihab H El-Nashar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, El-Salama IVF/ICSI Centre, Assiut, Egypt
| | - Omar M Shaaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, El-Salama IVF/ICSI Centre, Assiut, Egypt
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16
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Deepika K, Sindhuma D, Kiran B, Ravishankar N, Gautham P, Kamini R. Empty Follicle Syndrome Following GnRHa Trigger in PCOS Patients Undergoing IVF Cycles. J Reprod Infertil 2018; 19:16-25. [PMID: 29850443 PMCID: PMC5960047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND The objective of this study was to analyze the incidence and the underlying mechanisms of empty follicle syndrome (EFS) occurring in gonadotropin releasing hormone agonist (GnRHa) triggered in in vitro fertilization (IVF) cycles with GnRH antagonist protocol in women with polycystic ovary syndrome (PCOS) of Indian origin. The study also intended to evaluate the cycle outcome following a rescue trigger. METHODS Retrospective cohort analysis of data was extracted from the hospital database of 271 PCOS patients who underwent IVF in antagonist protocol triggered with GnRHa from August 2014 to December 2016. All cases with failure to obtain oocytes following retrieval were analyzed. Continuous variables were expressed as mean±SD using t-test and Chi-squared test for categorical variables. A p<0.05 was considered statistically significant. RESULTS Incidence of EFS following GnRHa trigger was found to be 3.3%. False empty follicle syndrome (FEFS) accounted for majority of the cases (8/9=88.8%). Of the nine EFS, six cases were salvaged with a rescue trigger, resulted in transfer of reasonably good quality embryos in a frozen-thawed embryo replacement cycle achieving clinical pregnancy in three cases (3/6=50%). CONCLUSION Our experience with EFS cases following GnRHa, albeit small, given the rarity of its occurrence, suggests that majority of EFS are of false forms and can be effectively salvaged which results in reasonably favorable outcome.
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Affiliation(s)
- Krishna Deepika
- Corresponding Author: Krishna Deepika, Senior Consultant in Reproductive Medicine, Milann, The Fertility Center, A Unit of BACC Health care pvt Ltd, #7, East Park Road, Kumara Park East, Bangalore-560001, Karnataka, India, E-mail:
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17
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Chen T, Bian Y, Liu X, Zhao S, Wu K, Yan L, Li M, Yang Z, Liu H, Zhao H, Chen ZJ. A Recurrent Missense Mutation in ZP3 Causes Empty Follicle Syndrome and Female Infertility. Am J Hum Genet 2017; 101:459-465. [PMID: 28886344 DOI: 10.1016/j.ajhg.2017.08.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022] Open
Abstract
Empty follicle syndrome (EFS) is defined as the failure to aspirate oocytes from mature ovarian follicles during in vitro fertilization. Except for some cases caused by pharmacological or iatrogenic problems, the etiology of EFS remains enigmatic. In the present study, we describe a large family with a dominant inheritance pattern of female infertility characterized by recurrent EFS. Genome-wide linkage analyses and whole-exome sequencing revealed a paternally transmitted heterozygous missense mutation of c.400 G>A (p.Ala134Thr) in zona pellucida glycoprotein 3 (ZP3). The same mutation was identified in an unrelated EFS pedigree. Haplotype analysis revealed that the disease allele of these two families came from different origins. Furthermore, in a cohort of 21 cases of EFS, two were also found to have the ZP3 c.400 G>A mutation. Immunofluorescence and histological analysis indicated that the oocytes of the EFS female had degenerated and lacked the zona pellucida (ZP). ZP3 is a major component of the ZP filament. When mutant ZP3 was co-expressed with wild-type ZP3, the interaction between wild-type ZP3 and ZP2 was markedly decreased as a result of the binding of wild-type ZP3 and mutant ZP3, via dominant negative inhibition. As a result, the assembly of ZP was impeded and the communication between cumulus cells and the oocyte was prevented, resulting in oocyte degeneration. These results identified a genetic basis for EFS and oocyte degeneration and, moreover, might pave the way for genetic diagnosis of infertile females with this phenotype.
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18
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Revelli A, Carosso A, Grassi G, Gennarelli G, Canosa S, Benedetto C. Empty follicle syndrome revisited: definition, incidence, aetiology, early diagnosis and treatment. Reprod Biomed Online 2017; 35:132-138. [PMID: 28596003 DOI: 10.1016/j.rbmo.2017.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 02/06/2023]
Abstract
In this review, the definition, incidence and possible causes of empty follicle syndrome (EFS), including molecular mechanisms that may underlie the syndrome, are discussed, along with prevention and treatment options. EFS is the complete failure to retrieve oocytes after ovarian stimulation, despite apparently normal follicle development and adequate follicular steroidogenesis. Two variants of EFS have been described: the 'genuine' form (gEFS), which occurs in the presence of adequate circulating HCG levels at the time of oocyte aspiration, and the 'false' form (f-EFS), which is associated with circulating HCG below a critical threshold. Heterogeneous HCG concentration thresholds, however, have been used to define gEFS, and to date no standardization exist. The situation is unclear when GnRH-analogues are used for ovulation trigger, as the threshold circulating LH and progesterone levels used to define EFS as 'genuine' are not established. The cause of fEFS has been clearly identified as an error in HCG administration at the time of ovulation trigger; in contrast, the cause of gEFS is still unclear, although some pathogenetic hypotheses have been proposed. Optimal treatment and prognosis of these patients are still poorly understood. Large, systematic multi-centre studies are needed to increase the understanding of EFS.
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Affiliation(s)
- Alberto Revelli
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy.
| | - Andrea Carosso
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
| | - Giuseppina Grassi
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
| | - Gianluca Gennarelli
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
| | - Stefano Canosa
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy
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Yuan P, He Z, Zheng L, Wang W, Li Y, Zhao H, Zhang VW, Zhang Q, Yang D. Genetic evidence of ‘genuine’ empty follicle syndrome: a novel effective mutation in the LHCGR gene and review of the literature. Hum Reprod 2017; 32:944-953. [PMID: 28175319 DOI: 10.1093/humrep/dex015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 01/17/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ping Yuan
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, China
| | - Zuyong He
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, 135 Xingang Xi Road, Guangzhou, Guangdong 510275, China
| | - Lingyan Zheng
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, China
| | - Wenjun Wang
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, China
| | - Yu Li
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, China
| | - Haijing Zhao
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, China
| | - Victor Wei Zhang
- Department of Molecular and Human Genetics, Baylor College of Medicine, one Baylor Plaza, Houston, TX77030, US
- AmCare Genomics Laboratory, International BioIsland, Luoxuan 4th Road, 2-4C-201, Guangzhou, Guangdong 510300, China
| | - Qingxue Zhang
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, China
| | - Dongzi Yang
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, China
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Deepika K, Baiju P, Gautham P, Suvarna R, Arveen V, Kamini R. Repeat Dose of Gonadotropin-releasing Hormone Agonist Trigger in Polycystic Ovarian Syndrome Undergoing In Vitro Fertilization Cycles Provides a Better Cycle Outcome - A proof-of-concept Study. J Hum Reprod Sci 2017; 10:271-280. [PMID: 29430154 PMCID: PMC5799931 DOI: 10.4103/jhrs.jhrs_102_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: Is a single dose of gonadotropin-releasing hormone agonist (GnRHa) trigger to induce final oocyte maturation in polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization (IVF) cycles with GnRH antagonist protocol sufficient to provide optimal oocyte maturity? Design: This is a prospective, randomized, double-blind, proof-of-concept study. Setting: This study was carried out at a tertiary care center. Material and Methods: A total of 125 patients diagnosed with PCOS defined as per the ESHRE/ASRM Rotterdam criteria (2003) undergoing IVF in antagonist protocol were randomized into two groups. Group A: single dose of GnRHa 0.2 mg, 35 h prior to oocyte retrieval, and Group B: 0.2 mg GnRHa 35 h prior to oocyte retrieval + repeat dose of 0.1 mg 12 h following the 1st dose. 12 h post-trigger, luteinizing hormone (LH), progesterone (P4), and follicle-stimulating hormone (FSH) values were estimated. Statistical Analysis: Continuous variables were expressed as mean ± standard deviation and categorical variables as proportions where applicable. Independent sample t-test was used for continuous variables which were normally distributed and Mann–Whitney U-test for data not normally distributed. Chi-square test or Fisher's exact test was used for categorical variables where appropriate. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated. In addition, receiver operating characteristic curve was used to evaluate the post-trigger LH, P4, and FSH values at 12 h as predictors of oocyte maturity. Main Outcome Measures: Primary outcome: maturity rate of the oocytes. Secondary outcomes: oocyte yield, fertilization rate, availability of good quality embryos on day 3, blastocyst conversion, OHSS rates, post-trigger serum LH (IU/L), FSH (IU/L), and P4 (ng/mL) levels implantation rate and clinical pregnancy rate. Results: A higher number of mature (metaphase II) oocytes were obtained in Group B compared to Group A (OR of 0.47; CI: 0.38–0.57; P < 0.01). Significantly a higher number of blastocysts were obtained in Group B than Group A (4.00 vs. 3.04; P = 0.023). The odds of clinical pregnancy per patient were higher in Group B (OR = 0.56; CI [0.27–1.24]), with a trend towards better clinical pregnancy in Group B than in Group A. Conclusions: A repeat dose of GnRHa trigger 12 h following the first dose probably by maintaining a sustained level of gonadotropins yielded a better maturity of oocytes, higher number of blastocysts, and a trend towards higher clinical pregnancy than a single dose in PCOS patients undergoing IVF in antagonist cycles.
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Affiliation(s)
- Krishna Deepika
- Department of Reproductive Medicine, Milann, The Fertility Center, (A Unit of BACC Healthcare Pvt Ltd.), Bengaluru, Karnataka, India
| | - Pookilath Baiju
- Department of Reproductive Medicine, Milann, The Fertility Center, (A Unit of BACC Healthcare Pvt Ltd.), Bengaluru, Karnataka, India
| | - Praneesh Gautham
- Department of Reproductive Medicine, Milann, The Fertility Center, (A Unit of BACC Healthcare Pvt Ltd.), Bengaluru, Karnataka, India
| | - Rathore Suvarna
- Department of Reproductive Medicine, Milann, The Fertility Center, (A Unit of BACC Healthcare Pvt Ltd.), Bengaluru, Karnataka, India
| | - Vohra Arveen
- Department of Reproductive Medicine, Milann, The Fertility Center, (A Unit of BACC Healthcare Pvt Ltd.), Bengaluru, Karnataka, India
| | - Rao Kamini
- Department of Reproductive Medicine, Milann, The Fertility Center, (A Unit of BACC Healthcare Pvt Ltd.), Bengaluru, Karnataka, India
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González Pérez I, Romero Guadix B, Martínez Navarro L, Mozas Moreno J. Síndrome del folículo vacío genuino: a propósito de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Engmann L, Benadiva C, Humaidan P. GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis. Reprod Biomed Online 2016; 32:274-85. [PMID: 26803205 DOI: 10.1016/j.rbmo.2015.12.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 01/26/2023]
Abstract
Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of ovarian hyperstimulation syndrome during IVF treatment. This trigger concept, however, results in early corpora lutea demise and consequently luteal phase dysfunction and impaired endometrial receptivity. The aim of this strenghths, weaknesses, opportunities and threats analysis was to summarize the progress made over the past 15 years to optimize ongoing pregnancy rates after GnRHa trigger. The advantages and potential drawbacks of this type of triggering are reviewed. The current approach to the management of GnRHa trigger in autologous cycles is based on the peak serum oestradiol level or follicle number and aims at a fresh embryo transfer or a segmentation approach with elective cryopreservation policy. We recommend intensive luteal support with transdermal oestradiol and intramuscular progesterone alone if peak serum oestradiol is 4000 or more pg/ml after GnRHa trigger or dual trigger with GnRHa and HCG 1000 IU if peak serum oestradiol is less than 4000 pg/mL. On the contrary, we recommend HCG 1500 IU 35 h after GnRHa trigger if there are less than 25 follicles, or freeze all oocytes or embryos if there are over 25 follicles.
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Affiliation(s)
- Lawrence Engmann
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, USA.
| | - Claudio Benadiva
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, USA
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital and Faculty of Health, Aarhus University, Resenvej 25, 7800 Skive, Denmark
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Abstract
OBJECTIVES Empty follicle syndrome (EFS), although rare, is a disappointing condition in which no oocytes are retrieved from mature follicle after ovulation induction in in vitro fertilization (IVF) cycles. The aim of this study was to estimate the incidence and factors associated with EFS. METHODS All cycles resulting in EFS from May 2012 to September 2013 were retrospectively identified at a tertiary referral infertility center. Among the 3,356 cycles performed, 58 (1.7%) women who underwent their first IVF cycle and had no oocyte retrieval were enrolled in the study. Three different stimulation protocols (long, antagonist, and miniflare) were mainly used for induction of follicular growth. Data relating to the age, follicle stimulating hormone (FSH) level, anti-Müllerain hormone (AMH) level, and the number of ampules and follicles for each patient was obtained. RESULTS Out of 58 individuals, 10 (17.2%) showed false type and 48 (82.8%) showed genuine EFS. The most frequent findings in our study were diminished ovarian reserve, low anti-Müllerian hormone (AMH; ≤0.5 ng/mL), and less than four mature follicles, indicating EFS in 1.7% of the patients. CONCLUSION Low serum AMH levels and a small number of follicles after ovarian stimulation is the manifestation of diminished ovarian reserve. Thus, we suggest that EFS could be a manifestation of low ovarian reserve.
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Affiliation(s)
- Tahereh Madani
- Department of Endocrinology and Female Infertility, Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | - Nadia Jahangiri
- Department of Endocrinology and Female Infertility, Royan Institute for Reproductive Biomedicine, Tehran, Iran
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Hasegawa A, Takahashi T, Igarashi H, Amita M, Matsukawa J, Nagase S. Predictive factors for oocyte retrieval failure in controlled ovarian hyperstimulation protocols: a retrospective observational cohort study. Reprod Biol Endocrinol 2015; 13:53. [PMID: 26033112 PMCID: PMC4455053 DOI: 10.1186/s12958-015-0052-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oocyte retrieval failure following an ovarian hyperstimulation protocol is uncommon in assisted reproductive technology (ART) programs. We analyzed the predictive factors for oocyte retrieval failure following controlled ovarian hyperstimulation (COH) with gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist protocols in ART programs. METHODS This study was a retrospective cohort observational study. In total, 744 cycles from 361 patients who underwent controlled ovarian hyperstimulation with GnRH agonist long protocol or antagonist protocol were analyzed. Treatment cycles with oocyte retrieval failure and with one or more oocytes retrieved were compared to determine predictive factors for oocyte retrieval failure using univariate and multilevel multivariate logistic regression analyses. RESULTS Oocyte retrieval failure occurred in 38 cycles (5.1%). The oocyte retrieval failure rate of the GnRH antagonist protocol (8.1%) was significantly higher than that of the GnRH agonist long protocol (3.7%). On multilevel multivariate logistic analysis, cycles with GnRH antagonist protocol (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.05-8.96), estradiol level on the day of human chorionic gonadotropin (hCG) injection (OR 0.997, 95% CI 0.996-0.998), and luteinizing hormone (LH) level on the day of hCG injection (OR 1.19, 95% CI 1.06-1.33) were independent predictive factors for oocyte retrieval failure. The efficacy of estradiol and LH levels on the day of hCG injection for predicting oocyte retrieval failure was evaluated using receiver operating characteristic curves. In all cycles, the areas under the curve (AUCs) for estradiol and LH were 0.84 and 0.63, respectively, for all cycles; 0.84 and 0.52, respectively, for cycles with GnRH agonist long protocol; and 0.81 and 0.82, respectively, for cycles with GnRH antagonist protocol. CONCLUSIONS Our results suggest that in cycles with GnRH antagonist protocol, the levels of estradiol and LH on the day of hCG injection might be predictive factors for oocyte retrieval failure. This relationship may provide useful information to both patients and physicians for developing better COH protocols in ART programs.
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Affiliation(s)
- Ayumi Hasegawa
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, 990-9585, Japan.
| | - Toshifumi Takahashi
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, 990-9585, Japan.
| | - Hideki Igarashi
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, 990-9585, Japan.
| | - Mitsuyoshi Amita
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, 990-9585, Japan.
| | - Jun Matsukawa
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, 990-9585, Japan.
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, 990-9585, Japan.
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Gülekli B, Göde F, Sertkaya Z, Işık AZ. Gonadotropin-releasing hormone agonist triggering is effective, even at a low dose, for final oocyte maturation in ART cycles: Case series. J Turk Ger Gynecol Assoc 2015; 16:35-40. [PMID: 25788848 DOI: 10.5152/jtgga.2015.15084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 12/05/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the efficacy of low-dose gonadotropin-releasing hormone (GnRH) agonist for final oocyte maturation in females undergoing assisted reproductive treatment (ART) cycles. MATERIAL AND METHODS Nine females undergoing ovarian stimulation in a GnRH antagonist protocol who received triptorelin 0.1 mg to trigger final oocyte maturation were included. Treatment outcomes of these patients were compared with those of controls, matched for age and oocyte number (n=14), who received 0.2 mg triptorelin at the same time. The luteal phase was supported with vaginal micronized progesterone and oral estradiol hemihydrate 2 mg twice daily. RESULTS The mean (±) numbers of retrieved, metaphase II, and fertilized oocytes were 15.66±7.82, 14±7.28, and 10.11±5.86, respectively. The implantation and clinical pregnancy rates were 46.1% and 71.4%, respectively. Of the pregnancies, 2 were live births, 1 was a preterm birth (twins), 2 are on-going, and 2 ended as miscarriages. No case of OHSS was encountered. On comparison of the results of these patients (fresh cycles; n=7) with those of matched controls, there were no significant differences in terms of retrieved mature oocytes, implantation rates, or clinical pregnancy rates (p>0.05). CONCLUSION These findings suggest that low-dose GnRH agonist triggering has similar efficacy as standard doses in terms of retrieved mature oocytes and clinical pregnancy rates in in vitro fertilization cycles.
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Affiliation(s)
- Bülent Gülekli
- Department of Obstetrics and Gynecology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Funda Göde
- Irenbe in Vitro Fertilization Centre, İzmir, Turkey
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26
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Haas J, Zilberberg E, Dar S, Kedem A, Machtinger R, Orvieto R. Co-administration of GnRH-agonist and hCG for final oocyte maturation (double trigger) in patients with low number of oocytes retrieved per number of preovulatory follicles--a preliminary report. J Ovarian Res 2014; 7:77. [PMID: 25296696 PMCID: PMC4237863 DOI: 10.1186/1757-2215-7-77] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 05/28/2023] Open
Abstract
Background Recently, the co-administration of GnRH agonist and hCG for final oocyte maturation- 40 and 34 hours prior to OPU, respectively (double trigger) was suggested as the treatment of genuine empty follicle syndrome. In the present study, we aim to evaluate whether the double trigger improves the number of oocytes retrieved in patients with low (<50%) number of oocytes retrieved per number of preovulatory follicles. Methods In this proof of concept cohort historical study, we compared the stimulation characteristics of 8 IVF cycles, which include the double trigger to the patients’ previous IVF attempt, triggered with hCG-only. Results Patients who received the double trigger (study group) had a significantly higher number of oocytes retrieved, number of 2PN, number of embryos transferred and significantly higher proportions of the number of oocytes retrieved to the number of follicles >10 mm and >14 mm in diameter on day of hCG administration, with a tendency toward a higher number of TQE, as compared to their previous cycles (hCG-only trigger). Three ongoing clinical pregnancies were recorded in the study group and none in the hCG-only trigger group. Conclusions Co-administration of GnRH-agonist and hCG for final oocyte maturation, 40 and 34 hours prior to OPU, respectively (double trigger), is suggested as a valuable new tool in the armamentarium for treating patients with low/poor oocytes yield despite an apparently normal follicular development and E2 levels and in the presence of optimal hCG levels on the day of OPU.
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27
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Blazquez A, Guillén JJ, Colomé C, Coll O, Vassena R, Vernaeve V. Empty follicle syndrome prevalence and management in oocyte donors. Hum Reprod 2014; 29:2221-7. [DOI: 10.1093/humrep/deu203] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Kim JH, Jee BC. Empty follicle syndrome. Clin Exp Reprod Med 2012; 39:132-7. [PMID: 23346522 PMCID: PMC3548070 DOI: 10.5653/cerm.2012.39.4.132] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 11/06/2022] Open
Abstract
Empty follicle syndrome (EFS) is a condition in which no oocytes are retrieved after an apparently adequate ovarian response to stimulation and meticulous follicular aspiration. EFS can be classified into 'genuine' and 'false' types according to hCG levels. It is a rare condition of obscure etiology. The existence of genuine EFS has been questioned and is still controversial. The limitation around EFS is that the definition of EFS is obscure. Management of patients with EFS is a challenge to physicians. No single treatment is known to be universally effective. However, patients should be adequately informed regarding the importance of correct hCG administration because improper hCG administration is a common and preventable cause of EFS. EFS is a syndrome that deserves additional study because such investigation could lead to a further understanding of ovarian biology and infertility.
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Affiliation(s)
- Jee Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
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29
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Kummer NE, Feinn RS, Griffin DW, Nulsen JC, Benadiva CA, Engmann LL. Predicting successful induction of oocyte maturation after gonadotropin-releasing hormone agonist (GnRHa) trigger. Hum Reprod 2012; 28:152-9. [DOI: 10.1093/humrep/des361] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Mesen TB, Segars JH. Reply of the Authors. Fertil Steril 2012. [DOI: 10.1016/j.fertnstert.2012.07.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Younis JS. The genuine empty follicle syndrome: is the king naked? Fertil Steril 2012; 98:e20-1; author reply e22. [DOI: 10.1016/j.fertnstert.2012.07.1098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 07/10/2012] [Indexed: 11/24/2022]
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Beck-Fruchter R, Weiss A, Lavee M, Geslevich Y, Shalev E. Empty follicle syndrome: successful treatment in a recurrent case and review of the literature. Hum Reprod 2012; 27:1357-67. [PMID: 22357773 DOI: 10.1093/humrep/des037] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Empty follicle syndrome is a condition in which no oocytes are retrieved after an apparently adequate ovarian response to stimulation and meticulous follicular aspiration. It is a rare condition of obscure etiology. A patient with primary infertility who underwent seven assisted reproductive technique cycles is described. In spite of a satisfactory ovarian response, aspiration yielded no oocytes in four cycles and 1-4 low quality oocytes in three cycles. In the index treatment cycle, ovulation was triggered using GnRH agonist 40 h prior to ovum pickup and hCG was added 6 h after the first trigger. Eighteen oocytes were recovered, of which 16 were mature and were inseminated by ICSI. Two embryos were transferred 48 h after aspiration and nine embryos were cryopreserved. The patient conceived and delivered a healthy boy at 38 weeks of gestation. The literature is reviewed and possible etiologies and treatment options of this enigmatic syndrome are suggested.
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Affiliation(s)
- R Beck-Fruchter
- Fertility and In-Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel.
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