Empty follicles at Egg Aspiration


Hi Everyone,

Today was my ER and sort of good/bad news. Half my follicles were empty so we ended up with 10 eggs. I did a cheap pregnancy to make sure the HCG was in my system and the test was positive. So waiting on my report tomorrow. Trying not to stress out to much but of course I am. Has anyone had this happen and still end up with a BFP. I asked the doctor if they might be immature eggs that were not ready and she said that in that case they at least would have gotten some cells out of the follicle even if no egg. ( I think the same would hold true if I had ovulated them early there would have been some cells left behind) She said mine were completely empty :grr:. On the Day of my trigger my estradiol was 4300 with a lining of 10.1 that is triple layer.

Any info would be great.

Hope all is well with everyone & Baby Dust, Dana


I believe the general opinion is empty follicle syndrome is a myth.


It really means that they couldn’t get the egg out of the follicle. Either, as you suspected, you ovulated early or the eggs were too immature and still stuck to the side of the follicle. What size were the smaller follicles? They very well might not be able to get an egg out of smaller follicles.

If there’s a next time, hopefully there won’t be, you could do a double dose of Ganirelix (any sign of a premature LH surge?) and wait until the follicles are a little bigger to trigger. Of course, your doc probably triggered a little early because of your high E2 which could be the whole reason for the “empty” follicles.

What was your fertilization report today?

By the way, that is an outstanding response for your age and low dose meds you were on.


Hi Xerxella, Thanks for your reply. Just got the call of my 10 eggs 8 were mature and 6 fertilized without ISCI. So now just waiting to see if I will have a 3 day or 5 day transfer. Baby Dust, Dana


Hi My11:11wish, I am really hoping for a 5 day transfer and will find out tomorrow if the embryos look good enough to wait. My RE is telling me that for my age some empty follicles are to be expected. And now that I have had some time to think things it over I feel that having so many eggs that might have been frozen would have caused me some distress on what to do with them in the long term. So “yes” I am really wanting a day five transfer. Best Wishes, Dana


Bumping the thread up. In the same boat. The dr did not tell me how many follicles were aspirated, but my husband counted 15. Given that the dr had to go in-out of the lead follicle twice because it would not drain, I am going to say 12-13 were aspirated. I read some articles, and it says that abnormal eggs don’t separate well. Hoping, it’s true.


Dr. Sher has an article that may help explain… http://haveababy.com/fertility-information/ivf-authority/empty-follicles-explained/


@BreezyBoo - thanks for the link, very interesting. I have read what this dr has to say, and it is… a bit controversial, however, maybe he is onto something. First, yes, I believe his explanation of the “empty follicle” is correct. There is no way the follicle would grow without an egg in it. Second, his theory about testosterone impact on follicle lining is what is controversial. Essentially, he says that the eggs were of bad quality because the protocol was wrong. Now, for further info I combed through his full blog - he blames poor quality on too much LH, particularly in cycles where Menopur is used, and those antagonist suppression. Which, incidentally, happened in both of our cases. Also, I did not have that issue on the long Lupron rFSH only protocol three years ago, which again makes it a perfect sample of three. As I like to say (and I am a director of analytics by trade), one is an accident, two is coincident, and three is a trend. So, I went on to look whether his opinion is supported by the studies. And that’s where it gets dicey. He blames the mechanism by which LH screws up the eggs on testosterone, and he seems to be pretty knowledgeable on oocyte development, at least from my layman POV. However, there were studies that showed that testosterone priming is good for women over 35. They are a little questionable, though, with lower sample sizes. More studies concluded the opposite to what Dr. Sher says, i.e. LH supplementation was good for older women and low responders. However, the most recent study showed LH supplementation in the later part of the stim period did not have any effect on anything. This is the study I trust the most because the methodology was pretty solid, and the sample size was good. Here is the link: http://www.ncbi.nlm.nih.gov/pubmed/23838159 In conclusion, based on my experience, if this cycle fails, I will go back to the long Lupron with no LH in sight.


I have no idea why mine were empty. I have a great AMH 4.6, and my Antral follicle count at the start of this cycle was 21. It makes me start to wonder if that was why my IUIs were failing. Of the 10 they collected, 8 were mature and 6 fertilized. 3 were transferred at 3 days and 2 made it to Day 6 for snow babies. So only one was discarded. My doctor seems extremely pleased with the eggs they did collect and said that as long as “all” of my follicles were not empty then it was not really a problem other than maybe related to age. It seems like some IVF is still really in an “ART” when it comes to getting things just right. My daily sonogram tech was very surprised since she had said I had so many follicles on top of each other she could not count them. An my E2 was 4300/200 = 21.5 follicle over size 11 and they still had two more day for it to keep going up before egg retrieval. Baby Dust


I also have all good bloodwork, AMH of 2.8 and FSH of 5.2. Antral count was around ~15 (previous cycle, before my polypectomy - my practice does not do antral count before IVF). The egg reserve and good response was confirmed in a previous cycle, and I was going on 36 back then already, so no spring chicken. I was stimming with less drugs this time around to avoid OHSS, just 225IUs a day, and just for 8 days (same duration as 3 years ago). My E2 was pretty low (825) on day 7 of stimming, but again that’s just me, I had it ~1,600 in the last cycle, too. The dr recorded 10 follicles during the last appoint before ER, with 3-5 more still growing. My husband counted 15 pokes on the u/s during ER , and though I could not count myself due to pain, I would say it was 12-13 because some follicles had to have double takes. However, the results of cycles were drastically different. The last time I had 22 eggs, which was close to the number of pokes (I counted 23, then I had to tell the dr to stop ER because of unbearable pain), and 21 were mature. So, you think it might be you, but I have to raise a possibility it was the protocol itself.


@LadyDanaDragon, I was just thinking how eerie similar our cases were. The same age (I turned 39 in Sept), excellent ovarian reserve, the same protocol, both took Menopur… If that dr is right, then the eggs that were not retrieved were [email protected] ones, anyway. And given your positive test, it seems that you got pretty good embryos. Also, the fact that you had some frozen blasts says that your embryo quality in this cycle was very high - at least those that made it through. By the way, I think, you are pregnant with twins :-))) I will post Wednesday or Thursday whether any of my embryos made it to blast/freezing. If they do, I might have better chances than I originally thought.


Hi Trans-Siberian,

I had been told not to get upset if my embryos did not make it freeze, since only 30% of the clinic’s blast meet the criteria for day 6 freezing. We also had a 75% fertilization rate, and the clinic’s normal is 70%. The only problem we can think of is I may have infertility due to an appendectomy at age 13 that made internal scar tissue around my ovaries to the tubes. My tubes were open for the HSG test, no uterine fibroids or polyps found on saline infused ultrasound. Exploratory surgery seemed pointless since IVF would fix the only problem that I might have.

I am hoping for twins and know that I have help from family already (They are helping with the bill for IVF). I told them their is a 30% chance of twins.

Baby Dust and Best Wishes, Dana


Guess what, I had an appendectomy at the age of 7. Mine went pretty bad, though. The drs would not operate me at the local hospital because I have three kidneys, and decided to transfer to the regional children’s hospital. The transfer took hours, and as a result, ruptured appendix, peritonitis, and as I found out later, busted tubes. The right one is closed at the far end, and the left one is open but the dye does not spill out, so drs think there is damage. My family situation is completely different, though - no family in the country (or anywhere less than 15 hrs flying) for both me and my husband. Thus, we want to rule out twins. And we can attest from our own experience, kids are a lot of work (and can be pretty expensive)! Best of luck with your beta, it’s coming up pretty soon!


I understand not wanting more than one at a time. Hoping you have some snow babies also. Best wishes