Abstract
Objective
To investigate the occurrence of the “vanishing follicle” phenomenon in women with
low number of developing follicles in assisted reproduction.
Study design
Women with ≤ 6 follicles on the day of hCG administration with ≥ 14 mm diameter were prospectively studied. Primary outcome measures were disappearance
of ≥14 mm and all-diameter follicles on the day of oocyte pick-up compared to the day of
hCG administration.
Results
Among the 120 women recruited, 95 were found eligible and completed the study. The
“vanishing follicle” phenomenon occurred in 3.1% (95% confidence level: 0.7%–9.0%)
and 18.9% (95% confidence level: 11.6%–28.3%) of cases affecting ≥14 mm and all-diameter follicles, respectively. In all cases, mid-late follicular serum
LH and P levels remained within normal follicular phase range and trans-vaginal scan
did not show signs of ovulation. Markedly, the main significant difference between
the study and control groups in the ≥14 mm follicle group was serum E2 level on the day of hCG administration; median (Interquartile range), corresponding
to 395 (382.0–405.5) versus 823.0 (544.5–1291.0) pg/mL, respectively (P = 0.04). The same trend was encountered in all-diameter vanishing follicles group but
it did not reach significance. Interestingly, in all-diameter vanishing group, chronic
smoking and the P/E2 ratio on the hCG day were significantly higher than controls. Post hoc multiple logistic
regression analysis of data in accordance with the Bologna criteria reveled that antral
follicle count was found to significantly affect the development of the “vanishing
follicle” phenomenon.
Conclusions
The “vanishing follicle” phenomenon occasionally occurs in women with low number of
developing follicles during assisted reproduction with no signs of ovulation. Our
preliminary findings suggest that this phenomenon may be related to exhausted ovarian
reserve however, an early-unrecognized LH elevation could not be ruled out.
Keywords
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Article info
Publication history
Published online: November 03, 2017
Accepted:
November 1,
2017
Received in revised form:
October 20,
2017
Received:
August 14,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
