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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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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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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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