Evidence of 'genuine empty follicles' in follicular aspirate: a case report†
Evidence of 'genuine empty follicles' in follicular aspirate: a case report†
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DOI：
10.1093/humrep/den497
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发表时间：
2009-05-01
影响因子：
6.1
通讯作者：
Falcone, T.
中科院分区：
文献类型：
--
作者：
Desai, N.;Austin, C.;Falcone, T.
在正常的卵巢刺激后未能取回卵母细胞被称为“空卵泡综合征”（EFS）。真正的EFS的存在一直受到质疑，仍然存在争议。在这里，我们报告了一个不寻常的情况下，一个异常数量的空卵泡样结构被确定在卵巢穿刺时检索。一位31岁的女性，有4年的原发性不孕病史，并接受了促排卵治疗。患者给予hCG，36 h后进行取卵。在取卵过程中，在卵巢穿刺液中发现了200多个类似腔前卵泡的微小结构。它们表现出两到三层颗粒细胞，似乎包围着一个未成熟的卵母细胞。它们的大小变化很大，在40至80 μ m之间。通过电子显微镜进一步表征这些结构，并在体外培养以评估激素分泌。发现卵泡中没有卵母细胞，但每个卵泡都有一个容易识别的卵母细胞。激素测定显示，这些卵泡分泌的雌二醇水平增加。第二次体外受精试验也得到了类似的结果。这些数据提示卵母细胞成熟过程中的一些失败。我们推测，这可能是第一个支持真正空卵泡存在的实际证据，如果让其在体内生长，可能会导致空涂鸦卵泡和真正的EFS。
Failure to retrieve oocytes after normal ovarian stimulation has been labeled 'empty follicle syndrome' (EFS). The existence of genuine EFS has been questioned and is still controversial. Here, we report an unusual case in which an extraordinary number of empty follicle-like structures were identified in the ovarian aspirate at the time of retrieval. A 31-year-old woman presented with a 4-year history of primary infertility and underwent ovulation induction. The patient was given hCG and oocyte retrieval was performed 36 h later. During the oocyte retrieval, more than 200 tiny structures resembling pre-antral follicles were noted in the ovarian aspirate. They exhibited two to three layers of granulosa cells and appeared to enclose an immature oocyte. They showed a great variation in size ranging between 40 and 80 mu m. These structures were further characterized by electron microscopy and cultivated in vitro to assess hormone secretion. The follicles were found to be devoid of oocytes, but each had a readily identifiable zona. Hormone assays revealed that these follicles were secreting increasing levels of estradiol. A second in vitro fertilization attempt gave similar results. These data are suggestive of some failure in the oocyte maturation process. We speculate that this may be the first actual evidence to support the existence of true empty follicles, which if left to grow in vivo might lead to empty graffian follicles and genuine EFS.