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Actor Hwang Bo-ra, 43, said she experienced severe facial swelling and skin problems during in vitro fertilization treatment as she tries to conceive a second child. She also revealed that doctors had detected follicles but she still came away from one egg retrieval attempt empty-handed. Women in their 40s, whose ovarian function is declining, face a range of factors that can affect follicle development and egg retrieval outcomes.

Hwang shared details of her journey to a second pregnancy on her YouTube channel "Hwang Bo-ra Boraiety" on Tuesday.

She said an ultrasound had detected two follicles after she had gone roughly two months without a period. But doctors told her the follicles were likely empty — because her ovarian function had declined — and she did not proceed with egg retrieval at that point.

When follicles were detected again, she decided to try IVF once more. As part of the treatment to support follicle growth, she was also prescribed growth hormone injections.

Hwang showed her followers what the injections had done to her face — significant swelling and skin breakouts. "I'm really puffy," she said. "I feel extremely fatigued."

One egg retrieval attempt still ended in failure. "They said there were definitely eggs there," she said, expressing her disappointment. She later shared that she resumed treatment and eventually succeeded in retrieving eggs.

IVF involves a comprehensive assessment of how the ovaries respond to hormonal stimulation and whether eggs are developing normally inside follicles. The number of eggs that can be retrieved varies depending on ovarian function, age and how a patient responds to treatment.

Even when follicles appear on an ultrasound, egg retrieval can fail — and empty follicle syndrome is often the reason. A follicle is a small, fluid-filled sac inside the ovary where an egg develops. It contains the egg, surrounding cells and follicular fluid.

In a normal menstrual cycle, several follicles begin to grow, but typically one becomes dominant and leads to ovulation.

In IVF, follicle-stimulating hormone and other medications are used to stimulate multiple follicles to grow simultaneously. Ultrasound and blood tests are then used to monitor follicle size and estrogen levels before the timing of egg retrieval is determined.

Once follicles reach a certain size, a trigger injection is given to prompt the final maturation of the eggs. Retrieval is typically performed about 34 to 36 hours later.

Even so, the number of eggs actually retrieved can fall short of expectations. Follicle size and egg maturity do not always align, and some eggs may not develop normally. In some cases, the ovaries do not respond sufficiently to hormonal stimulation, making it difficult to obtain mature eggs.

When aspiration of a follicle yields no egg, the phenomenon is associated with empty follicle syndrome — a condition in which egg retrieval is attempted from follicles that appear to have developed adequately, yet no egg is recovered.

The causes are varied. Problems with the timing or administration of the trigger injection used to induce final egg maturation can make retrieval difficult.

In patients with diminished ovarian reserve, changes in how follicles and eggs develop can mean retrieval results fall below expectations.

In some cases, eggs are not recovered even after adequate follicle growth and appropriate triggering.

When predicting egg retrieval outcomes in IVF, clinicians look not only at the number of follicles but also at their size, hormone levels and the results of previous cycles.

For patients like Hwang, who have experienced a failed retrieval despite visible follicles, reviewing the follicle development, hormonal response and medication protocol from that cycle can help inform the next treatment plan.

The growth hormone Hwang said she used during treatment is a drug prescribed as an adjunct therapy for some patients undergoing fertility treatment. Swelling after growth hormone injections is linked to fluid retention in the body.

Growth hormone is secreted by the pituitary gland and plays a role in physical growth, protein synthesis and the metabolism of fat and carbohydrates.

In fertility treatment, research has examined whether growth hormone can influence the action of growth factors within the ovary and support follicle development — particularly whether adding it for patients who respond poorly to ovarian stimulation can improve egg retrieval outcomes or pregnancy rates.

The evidence, however, is inconsistent.

In its 2025 revised guidelines on ovarian stimulation, the European Society of Human Reproduction and Embryology did not recommend adding growth hormone for patients with a normal ovarian response. It also concluded that routine use of growth hormone could not be recommended even for poor responders, citing insufficient quality and scale of the supporting research, despite some studies reporting positive results.

Swelling is one side effect to watch for when using growth hormone. The hormone can affect how the kidneys regulate sodium and fluid, potentially causing fluid retention in the body. This may lead to swelling in the hands, feet and face, as well as temporary weight gain.

Fluid retention, peripheral edema, joint pain and muscle pain are listed as major adverse reactions in the prescribing information for growth hormone products registered with the FDA.

Fluid retention-related symptoms in adults receiving growth hormone treatment can occur early in the course of administration and may vary in severity depending on the dose.

Growth hormone can also affect blood sugar regulation. Some patients may experience increased insulin resistance or elevated blood glucose levels, making assessment based on underlying conditions and treatment status necessary.

IVF involves multiple medications beyond growth hormone, including hormone injections to stimulate the ovaries. If swelling occurs during treatment, the medications being used, hormonal changes and overall health should all be evaluated together.

If the face or the area around the eyes swells severely or the swelling persists, patients should notify their prescribing physician and have the cause investigated.

Sudden swelling of the lips or tongue accompanied by difficulty breathing may indicate an acute allergic reaction and requires immediate emergency care.

During fertility treatment, patients should also watch closely for abdominal bloating, abdominal pain, rapid weight gain and decreased urine output, as these can be signs of an excessive response to ovarian stimulation.

The type and dosage of treatment medications are determined based on a patient's ovarian function and prior response, and if side effects occur, adjustments to the medication regimen are evaluated.

As women age, ovarian function gradually declines — and in their 40s, both the quantity and quality of eggs must be considered.

Women are born with a fixed number of eggs, and the number of follicles and eggs naturally decreases over time.

The rate of decline in ovarian reserve accelerates from the late 30s, and by the 40s the likelihood of a poor response to ovarian stimulation increases significantly.

Ovarian reserve refers to the quantity of eggs remaining in the ovaries.

The two most commonly used tests to assess it are the anti-Müllerian hormone (AMH) test and antral follicle count (AFC) measured by ultrasound.

AMH is a hormone secreted by small follicles in the ovaries. As the number of remaining follicles decreases, AMH levels tend to fall as well.

Antral follicle count involves using ultrasound to identify small follicles present in the ovaries.

According to the American Society for Reproductive Medicine, AMH and antral follicle count are useful for assessing ovarian response to stimulation and estimating the expected number of eggs retrievable in IVF.

A woman's age is a critical factor in egg quality. As women grow older, the likelihood of errors during chromosomal separation in eggs increases. Eggs with chromosomal abnormalities can encounter difficulties during fertilization or embryo development and also contribute to the risk of early miscarriage.

Ovarian reserve testing and egg quality assessment are distinct processes. While AMH levels help predict how many eggs can be retrieved, the likelihood of achieving pregnancy and a live birth is influenced by a range of factors including age and embryo condition.

In IVF, the method of hormonal stimulation, medication dosage and timing of egg retrieval are all adjusted according to a patient's ovarian function.

If a previous cycle resulted in failed or limited egg retrieval, the next attempt can be planned around the follicle growth pattern and hormonal response observed in that cycle.

Patients with limited follicle development may be able to retrieve only a small number of eggs in a single cycle. Some patients consider a strategy of accumulating eggs or embryos across multiple cycles.

Whether to pursue repeated cycles is decided after a comprehensive review of age, ovarian function, prior results and overall health.

During fertility treatment, basic health maintenance also matters — adequate nutrition, regular sleep and appropriate physical activity. Women planning a pregnancy are advised to take 400 micrograms of folic acid daily to help prevent neural tube defects in the fetus. Avoiding smoking and alcohol and checking with a physician about any existing medications are also recommended.

In fertility treatment for women in their 40s, ongoing assessment of follicle count, development and hormonal response is essential. Treatment plans can be tailored based on previous cycle results, with side effects managed carefully as patients prepare for their next attempt at pregnancy.


rainbow@heraldcorp.com