Laporan Kasus: Empty Follicle Syndrome pada Siklus Fertilisasi In-Vitro

Dewi Karlina Rusly, Ruswana Anwar, Alvin Setiawan, Rina Nulianti, Kevin Dominique Tjandraprawira


Abstract


Pendahuluan: Empty follicle syndrome (EFS) adalah suatu kondisi langka, yaitu tidak terdapatnya oosit pada folikel ovarium yang matang saat tindakan ovum pick-up (OPU). Prevalensi kasus ini berkisar 2,7%.
Tujuan: Mengkaji kasus jarang yang terjadi pada siklus Fertilisasi In-Vitro (IVF) yang dilakukan stimulasi ovarium terkontrol.
Metode: Laporan kasus pada program IVF siklus pertama yang diberikan stimulasi dengan menggunakan short protocol pemberian human recombinant follicle stimulating hormone (rFSH) 150 IU sejak hari ke-2 sampai dengan hari ke-12 dan cetrotide 0.25 mg pada hari ke-7 hingga hari ke-12 dilanjutkan dengan trigger menggunakan choriogonadotropin alfa 250 μg.
Hasil: Perempuan berusia 30 tahun dengan infertilitas 4 tahun, mengikuti program IVF siklus I, dan diberikan stimulasi ovarium terkontrol dengan short protocol menggunakan rFSH 150 IU. Pada hari ke-12 didapatkan 10 folikel pada kedua ovarium, dengan estradiol >3000 pg/ml dan progesteron 0,94 ng/ml. Diputuskan untuk dilakukan trigger dengan choriogonadotropin alfa 250 μg. Setelah 36 jam trigger diberikan dan dilakukan OPU tidak didapatkan satu pun oosit pada cairan folikel tersebut, baik yang matur maupun yang imatur. β-hCG serum pasca-OPU adalah 2,3 mIU/ml. Pasien ditegakkan dengan diagnosis Empty Follicle Syndrome.
Kesimpulan. Penegakan diagnosis Empty Follicle Syndrome masih menjadi kontroversial, salah satu etiologinya adalah kadar HCG yang rendah pasca-trigger. Pasien direncanakan untuk IVF ulang dengan batch trigger berbeda dan evaluasi serum β-hCG 36 jam pasca-trigger (sebelum OPU), dan pengulangan trigger bila serum level belum adekuat.

Case Report: Empty Follicle Syndrome in an In-Vitro Fertilization Cycle

Abstract
Introduction: Empty follicle syndrome (EFS) is a rare condition in which no oocytes could be retrieved from mature ovarian follicles during ovum pick-up (OPU). Its prevalence ranges from 2,7%.
Objective: To review a rare case of In-Vitro Fertilization (IVF) cycle undergoing controlled ovarian hyperstimulation (COH).
Method: This is a case report of a first cycle IVF program that was stimulated using a short protocol of human recombinant follicle stimulating hormone (rFSH) 150 IU from day 2 to 12 and cetrotide 0.25 mg on day 7 to 12 followed by triggering using choriogonadotropin alpha 250 μg.
Results: A 30-year-old female with 4 years of primary infertility, was enrolled in her first IVF cycle, and was undergoing COH with short protocol using 150 IU rFSH. On day 12, 10 follicles were found on both ovaries, with favorable oestradiol >3000 pg/ml and progesterone 0.94 ng/ml levels. A trigger of 250 micrograms of choriogonadotropin alpha was administered. During oocyte retrieval, no oocyte (mature or immature) was present in the follicular fluid. Post OPU β-hCG serum was 2.3 mIU/ml. The patient was diagnosed with EFS.
Conclusion: The diagnosis of EFS is still controversial with an etiology being post-trigger low HCG level. The patient was recommended to undergo a repeat IVF cycle with a different batch of triggers and evaluation of serum β-hCG before OPU, and a repeat trigger if serum levels were not adequate.

Key words: Empty follicle syndrome, β-hCG, Oocytes, Trigger, Ovum Pick-Up

 

Keywords


Empty follicle syndrome; β-hCG; Oosit; Trigger; Ovum Pick Up

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DOI: http://dx.doi.org/10.24198/obgynia.v7i1.590

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