To investigate the occurrence of the “vanishing follicle” phenomenon in women with low number of developing follicles in assisted reproduction.
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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Obstetrics and Gynecology and Reproductive Biology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Trends in ‘poor responder' research: lessons learned from RCTs in assisted conception.Hum Reprod Update. 2016; 22: 306-319
- Oocyte-secreted factors: regulators of cumulus cell function and oocyte quality.Hum Reprod Update. 2008; 14: 159-177
- Understanding follicle growth in vivo.Hum Reprod. 2010; 25: 2944-2954
- Empty follicle syndrome: evidence for recurrence.Hum Reprod. 2000; 15: 999-1002
- Poor oocyte retrieval is a manifestation of low ovarian reserve.Fertil Steril. 2005; 83: 504-507
- Premature luteinization: could it be an early manifestation of low ovarian reserve.Fertil Steril. 1998; 69: 461-465
- Increased progesterone/estradiol ratio in the late follicular phase could be related to low ovarian reserve in in vitro fertilization-embryo transfer cycles with a long gonadotropin-releasing hormone agonist.Fertil Steril. 2001; 76: 294-299
- Evidence for different aetiologies of low estradiol response to FSH: age-related accelerated luteinization of follicles or presence of ovarian autoantibodies.Hum Reprod. 2002; 17: 2641-2649
- The vanishing follicle in women aged over forty: premature, mechanical, LH-independent luteinization may reflect oocyte-follicle low quality.Med Hypotheses. 2008; 70: 1227-1228
- ESHRE working group on Poor Ovarian Response Definition: ESHRE consensus on the definition of ‘poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria.Hum Reprod. 2011; 26: 1616-1624
- Diminished ovarian reserve is the predominant risk factor for gonadotropin-releasing hormone antagonist failure resulting in breakthrough luteinizing hormone surges in in vitro fertilization cycles.Fertil Steril. 2014; 102: 99-102
- Is a premature rise in luteinizing hormone in the absence of increased progesterone levels detrimental to pregnancy outcome in GnRH antagonist in vitro fertilization cycles.Fertil Steril. 2011; 96: 585-589
- In vitro fertilization outcomes in patients experiencing a premature rise in luteinizing hormone during a gonadotropin-releasing hormone antagonist cycle.Fertil Steril. 2011; 95: 2592-2594
- An oocentric view of folliculogenesis and embryogenesis.Reprod Biomed Online. 2007; 14: 758-764
- Functional ovarian cysts in premenopausal and gynecologically healthy women.Contraception. 2002; 66: 153-157
- Cigarette smoke causes follicle loss in mice ovaries at concentrations representative of human exposure.Hum Reprod. 2009; 24: 1452-1459
Published online: November 03, 2017
Accepted: November 1, 2017
Received in revised form: October 20, 2017
Received: August 14, 2017
© 2017 Elsevier B.V. All rights reserved.