A prospective randomized comparison of single- and double-lumen needles for transvaginal follicular aspiration

Abstract

Patients undergoing ultrasound-directed transvaginal follicular aspiration in a large in vitro fertilization (IVF) program were randomized for retrieval with either a single-lumen needle (SLN; N = 22) or a double-lumen needle (DLN; N = 22) to compare recovery rates and the technical aspects of their use. Two hundred ten and two hundred two follicles were aspirated with each needle, respectively. Follicular diameters were measured ultrasonically at the time of aspiration and recorded. One or more washes were performed when using the DLN and the SLN was withdrawn each time to recover the fluid in the dead space of the needle. The distribution of follicular sizes was the same for both needles. Oocyte recovery rates (SLN = 65.7%; DLN = 63.9%) and the incidence of fractured zonae (SLN = 9.1%; DLN = 6.4%) were the same for both needles (alpha greater than 0.50; beta less than 0.01). Although there were no differences between the two needles in the number of oocytes provided for IVF, there were technical differences. The DLN needle was more flexible and frequently deviated from the projected path as observed by ultrasound. The SLN may be preferable because it is technically easier to use; however, there may remain specific indications for the use of the DLN.

Is There a Correlation between the Number of Follicular Flushings, Oocyte/Embryo Quality and Pregnancy Rate in Assisted Reproductive Technology Cycles? Results from a Prospective Study

“…When compared to other RCTs [3,7,8,9,10,14,15] or other prospective trials [4,5,6,18] evaluating the clinical value of follicular flushing in ART, our study included the highest number of OR cycles with follicular flushing (n = 154). We also observed the second highest [10] total number of recovered oocytes (n = 1,495), the second highest [5] recovery rate of oocytes (85%), the second highest [18] fertilization rate (72%) and the highest mean number of fertilized oocytes per patient (6.2 ± 4.5).…”

“…However, to the best of our knowledge, we are not aware of published evidence reporting a recovery of >90% of oocytes in the initial aspirate. In fact, the recovery rate of OCCs in the initial aspirate has been reported to vary strongly between 40 and 82.9% [observational studies; [4,5,6]] and between 65.7 and 77.5% in non-flushing ORs [randomized trials; [3,7,8]].…”

“…However, so far randomized controlled trials (RCTs) in unselected ART populations [3,7,8,9,10,11,12,13] or poor responder population [14,15] have failed to demonstrate that OR combined with follicular flushing improved the number of retrieved oocytes, fertilization rate, embryo quality or pregnancy rate when compared to OR without follicular flushing [3,7,8,9,10,11,12,13,14,15]. In contrast, in these RCTs the utilization of follicular flushing was associated with an increase in the duration of the procedure [3,9,10,11,12,13,14,15] and in the use of anesthetic agents [3,11].…”

Follicle curetting at the time of oocyte retrieval increases the oocyte yield

“…There was no difference in the number of germinal vesicles (immature oocytes) between the groups which we may expect to see with an increase total number of oocytes retrieved. No other oocyte retrieval techniques, including follicle flushing and altering needle characteristics have been associated with increased oocyte yield [2][3][4][5][6][7][8]. This benefit would appear to outweigh the three extra minutes required to implement curetting during the retrieval procedure.…”

“…Follicle flushing after aspiration of the follicular fluid has not been shown to increase the number of oocytes retrieved by most studies [2][3][4][5]. The type and caliber of the needle used during oocyte retrieval was also examined and, while pain was directly associated with needle caliber, there were no significant differences in pregnancy outcomes [6][7][8].…”