Empty Follicle Syndrome In 40 Year Old Attributed To Age Factor

Question:

Hello Doctor,

I am from Cuba but I live in Miami. I am 40 y/o now. I had my first IVF cycle at 39 that failed, back in July. I started 2nd round in Sept.- Oct. but it was just cancelled due to empty follies. It is possible that I have no more eggs in my ovaries?

I have another theory but I am not an expert and I don't know if it is possible to be true. The first step was taking birth control pill. I took them for 21 days. After that I had NO PERIOD. I did have symptoms "as if" my period was there (cramping, pain) but no bleeding. I did an ultrasound but the endometrium was not big enough to shed. At day 7 after the last pill, my Dr. told me to start the stimulation for IVF anyways. There were 6 follies formed but empty. What do you think? Could this (bcp) be the cause for no eggs retrieved? Thank you very much. I am very frustrated. T. from Florida

Answer:

Hello T. from Florida,

We tend to see a higher incidence of "empty follicle syndrome" with increasing age. This is indeed because there are fewer and fewer eggs left. However, no eggs at the time of retrieval is not related to having used the birth control pill and not having a period. There are other reasons, besides age, where no follicles are retrieved as well.

I have had several cases of EFS in my career (16 years) of doing IVF and in some cases they were in younger women, so the age factor did not apply. Those younger cases I attributed to a lack of adequate HCG triggering. I used to use a generic HCG, and it is possible that either the medication was not stored correctly and lost its efficacy, or it was not injected properly, or it was a bad batch of medicine. For that reason, I switched to Ovidrel, which is what I still use. I have not had a case of EFS in a young woman since. I still do see older women that have no eggs retrieved, however, and that is the age factor. Nothing can be done about the age factor except continuing to try in the hopes that (1) the next cycle will yield some eggs and (2) there will be a good one in the group.

Good Luck,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

http://www.montereybayivf.com/

Monterey, California, U.S.A.