• Jingyan Song and Zhengao Sun.
• Shandong University of Traditional Chinese Medicine.
• Medicine (Baltimore). 2019 Jul 1; 98 (27): e16213.

RationaleThe borderline form of empty follicle syndrome (EFS) is a phenomenon where only a few mature or immature oocytes are retrieved despite adequate response to controlled ovarian hyperstimulation (COH). It is a rare phenomenon with an unclear underlying mechanism, and there is currently no effective treatment.Patient ConcernsThe patient received 3 assisted reproductive technology cycles, and although her follicular development and estrogen levels were normal during COH, the outcome with respect to the oocytes obtained was unsatisfactory.DiagnosesBorderline form of EFS.InterventionsIn the context of undergoing GnRH-antagonist protocol, we implemented a double-trigger with human chorionic gonadotropin (hCG) after 6 hours of gonadotropin-releasing hormone agonist (GnRH-a) administration.OutcomesEleven oocytes were obtained (M I × 3, M II × 8), which underwent in vitro fertilization (IVF). After 18 hours, 7 oocytes showed normal fertilization, with 2 embryos formed 72 hours later (embryo rating, 6C II × 1, 9C II × 1); the embryos were then frozen.LessonsOocyte maturation and ovulation are time-dependent processes, and that different patients require different lengths/intervals of time for treatment. Therefore, the borderline form of EFS, in general, may be treatable, and our novel trigger method provides a new treatment option for such patients in the future.

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