Empty follicle syndrome in the setting of dramatic weight loss after bariatric surgery: case report and review of available literature.
OBJECTIVE
To describe empty follicle syndrome, potentially due to route of human chorionic gonadotropin (hCG) administration, in a patient who had previously undergone bariatric surgery.


METHODS
Case report and review of literature.


METHODS
Academic medical center.


METHODS
A 42-year-old nulliparous, morbidly obese woman who had presented for assisted reproduction treatment after having lost 175 pounds via gastric bypass surgery, resulting in abdominal skin redundancy.


METHODS
The patient's gastric bypass surgery had resulted in abdominal skin redundancy. In her first cycle, recombinant hCG was used with a luteal gonadotropin-releasing hormone (GnRH) agonist/recombinant follicle-stimulation hormone (FSH) protocol. At hCG administration, her estradiol level was 2342 pg/mL, and 18 follicles were measured. At retrieval, no oocytes were recovered, and her serum hCG level was 19 mIU/mL. In the subsequent cycle, identical ovarian stimulation was performed, with peak estradiol of 2891 pg/mL, but intramuscular hCG was administered. At retrieval, her serum hCG level was 45 mIU/mL, and 19 oocytes were recovered, resulting in 10 embryos. Five embryos were transferred, and a singleton pregnancy resulted.


METHODS
Recovery of oocytes.


RESULTS
Clinical pregnancy.


CONCLUSIONS
Abdominal skin redundancy after bariatric surgery may alter the absorption of subcutaneously administered infertility medications. Additional studies are needed to treat infertile patients optimally after weight-reduction surgery.
Hirshfeld-Cytron
Jennifer
J
Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, The University of Chicago, Chicago, Illinois 60637, USA. jennifer.hirshfeld@uchospitals.edu
Kim
Helen H
HH
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D009767:Obesity, Morbid / Q000601:surgery*; D054315:Oocyte Retrieval; D010049:Ovarian Diseases / Q000188:drug therapy* / Q000209:etiology*; D006080:Ovarian Follicle / Q000473:pathology; D010062:Ovulation Induction / Q000379:methods*; D016896:Treatment Outcome; D015431:Weight Loss
D005300:Fertility Agents, Female