Successful outcome of assisted reproductive technology in women with polycystic ovary syndrome combined with empty follicle syndrome: A case report

Rationale: Empty follicle syndrome (EFS) is a rare and difficult-to-treat condition. Obese polycystic ovary syndrome (PCOS) is considered an independent risk factor for it. In this study, we report a case of successful pregnancy in an obese patient with PCOS combined with EFS and discuss the pathogenesis of EFS and optimal treatment strategies. Patient concerns: A 25-year-old woman presents with “6 years of infertility without contraception.” Diagnoses: Primary infertility, bilateral fallopian tube obstruction, PCOS, and EFS. Interventions: The patient underwent 2 cycles of controlled ovarian stimulation. In the first cycle, despite adequate ovarian stimulation, oocytes were not obtained and a diagnosis of EFS was made. In the second cycle, the following optimization measures were taken: the use of beinaglutide to help the patient lose weight and improve her blood glucose levels, supplementation with luteinizing hormone-active medications (e.g., Menotropins for injection), an increase in the dose of human chorionic gonadotropin, and the addition of growth hormone to improve the outcome of oocytes retrieval once the patient’s blood glucose levels had stabilized. Outcomes: In the second cycle, 15 oocytes were successfully obtained, 13 oocytes of which were Metaphase II, resulting in the culture of 5 high-quality embryos. The patient had a successful pregnancy after frozen embryo transfer and was followed up to late-term pregnancy without abnormalities. Lessons: Multiple complex mechanisms may be involved in the development of EFS, and preconditioning and individualized treatment protocols are essential for improving outcomes in patients with EFS. Our treatment protocol provides some reference basis for the treatment of EFS.