Follicle flushing does not improve live birth and increases procedure time: a systematic review and meta-analysis of randomized controlled trials

Martini, Anne E.; Dunn, Ariel; Wells, Lauren; Rollene, N.L.; Saunders, Rhiana D.; Healy, M.W.; Terry, Nancy; DeCherney, Alan H.; Hill, Micah J.

doi:10.1016/j.fertnstert.2020.10.064

Cited by 13 publications

(12 citation statements)

References 22 publications

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“…The ndings obtained in the study support the meta-analyses that found that FF did not affect oocyte retrieval [17]. Non-randomized studies with a small sample size published with the debut of the FF have shown that the FF has an effect [5,6,18].…”

Section: Discussionsupporting

confidence: 74%

“…However, in the study that included only normal responding patients, there were 13.09 oocytes in direct aspiration, while there were 12.25 oocytes in the FF group. In cases that are thought to be related to an intrinsic gametogenesis problem, signi cant results cannot be obtained with FF, and the duration of the oocyte retrieval process will be prolonged [17].…”

Section: Discussionmentioning

confidence: 99%

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Flushing of the Follicules in Ovum Pick-Up Procedures Gives a Better Chance for Pregnancy in Low Ovarian Reserve Patients

Oral

Şişmanoğlu

2022

Preprint

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Background This study aims compare the pregnancy and live birth rates between the oocytes retrieved without follicular flushing FF(-) in the oocyte pick-up (OPU) procedure performed in women with diminished ovarian reserve (DOR) and those retrieved by follicular flushing FF(+). Results The study was conducted among patients diagnosed with DOR according to Bologna criteria and applied to the clinic for IVF between 2017–2020. A total of 358 infertile women with follicles three and below on the hCG day, between the ages of 21 and 42, without severe male factor, without uterine anomaly, without uterine surgery, and who did not undergo PGD were included in the study. Each follicle was aspirated once in the OPU procedure, and if a follicle was retrieved, it was moved to the other follicle. If the follicle could not be retrieved, the oocyte was tried to be retrieved by flushing a maximum of 3 times. The number of oocytes retrieved, clinical pregnancy rate, and live birth rate were compared. Since all the oocytes retrieved in 143 patients were retrieved directly without the need for FF, it was named FF(-) group. Since at least one oocyte of the remaining 215 patients was retrieved by performing FF, it was named FF(+) group. Since some of the oocytes retrieved from 112 patients in the FF(+) group were retrieved with FF and some without FF, they were excluded from the study, and the remaining 103 cases formed the FF(+) group a total of 246 patients were compared. The mean number of MII oocytes ,the pregnancy rates, rates of live births and the abortion rates between two groups did not show any statistical difference. Conclusion FF applied during oocyte retrieval in DOR did not positively affect the number of retrieved oocytes, clinical pregnancy, and live birth rates even doing this may decrease the pregnancy rate because of the probable low quality egg but we should not forget that if we did not do flushing after once we aspirated the follicle we would not be able to obtain any pregnancy at all in this patients.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Flushing of the Follicules in Ovum Pick-Up Procedures Gives a Better Chance for Pregnancy in Low Ovarian Reserve Patients

Oral

Şişmanoğlu

2022

Preprint

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“…No differences in the fertilization of mature oocytes were reported between the ushing and non-ushing groups 23 and similar clinical pregnancy rates between the non-ushing and ushing. Martini et al 14 in January 2021 published the most recent systematic review and meta-analysis on this topic con rming that no signi cant differences in live birth rates and other OR outcomes could be observed, except for a prolonged procedure time in the double-lumen procedures. The total number of retrieved oocytes is one of the most important prognostic factors in IVF.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

“…From the literature review it is clear that the debate among SLN and DLN is still heated 13 . Single needles seem to give shorter operating time, shorter anesthesia, less drugs needed and consequently possible reduced complications 14 . However, double needles are still thought to yield a higher number of oocytes, even though a higher number of the oocytes recovered with ushing could be immature.…”

Section: Introductionmentioning

confidence: 99%

A monocentric randomized controlled clinical trial to compare single- and double-lumen needles in oocytes retrieval procedure in Assisted Reproductive Technologies

Ronchetti

Cirillo

Immediata

et al. 2022

Preprint

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The present randomized controlled trial included oocytes retrieval procedures in IVF and ICSI cycles performed in 18/42-year-old women between March 2019 and January 2021 at a tertiary-care Fertility Centre, using two different needles: the single-lumen needle (SLN) with aspiration versus the double-lumen needle (DLN) with follicle flushing after aspiration. The purpose was to determine any difference in outcomes between the two different needles, primarily in terms of number of retrieved oocytes per procedure. A total of 200 ORs were randomized, 100 in each group. No significant difference in the number of retrieved oocytes between the groups (10.2 ± 6.5 for DLNs vs 10.7 ± 7.0 for SLNs, p = 0.810) was recorded. No significant differences were observed also in terms of number of retrieved oocytes/punctured follicles (83.0%±27.0% vs 81.0%±22.0%, p = 0.916), number of retrieved oocytes/follicles at trigger (78.0% ± 29.0% vs 78.0% ± 27.0%, p = 0.881), number of mature oocytes (7.6 ± 5.3 vs 8.0 ± 5.1, p = 0.519) and pregnancy rate (27% vs 23%, p = 0.514). However, the time required to retrieve each oocyte was longer using the DLN (1.5 ± 1.3 vs 1.1 ± 0.9 minutes, p = 0.002). To conclude, the present study confirmed the new perspectives on the sole use of SLNs in terms of saving time, without affecting the number of retrieved oocytes.

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“…Despite limited evidence supporting the use of follicular flushing (36), it continues to be common practice in many infertility clinics (37). Von Horn et al in 2017 examined a double-lumen needle follicular flushing system, comparing it with a single-lumen aspiration needle in IVF patients with poor ovarian response (38).…”

Section: Double Lumen Needle Follicular Flushing Systemmentioning

confidence: 99%

Researching the Phenomenon of Poor Ovarian Responders and Management Strategies in IVF: A Narrative Review

Galatis

Kalopita

Grypiotis

et al. 2022

ama

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This narrative review aims to summarize all the latest studies published between 2015-2021 concerning the management protocols adopted for poor ovarian response (POR) cases. Patients defined as “poor responders” show minimal response to controlled ovarian hyperstimulation, although there is no standard definition for POR. Although infertility specialists are endeavoring to improve cycle outcomes in poor responders by adopting multiple management strategies, still the estimated risk of cycle cancellation is about 20%. All the studies performed during this study period were evaluated and their results were recorded. The latest published protocols to improve oocyte retrieval in poor responders include: anti-Mϋllerian hormone, clomiphene citrate, co-enzyme Q10, corifollitropin, dehydroepiandrosterone, double stimulation, Follicle Stimulation Hormone, Growth Hormone, Gonadotropin-releasing hormone agonists, letrozole, human chorionic gonadotropin, Luteinizing Hormone, progesterone and testosterone. Conclusion. Although many strategies have been suggested to manage POR, none has been proven superior to the others. Further large-scale randomized studies are needed to validate experimental techniques leading towards successful individualized treatment regimens.

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Follicle flushing does not improve live birth and increases procedure time: a systematic review and meta-analysis of randomized controlled trials

Cited by 13 publications

References 22 publications

Flushing of the Follicules in Ovum Pick-Up Procedures Gives a Better Chance for Pregnancy in Low Ovarian Reserve Patients

Flushing of the Follicules in Ovum Pick-Up Procedures Gives a Better Chance for Pregnancy in Low Ovarian Reserve Patients

A monocentric randomized controlled clinical trial to compare single- and double-lumen needles in oocytes retrieval procedure in Assisted Reproductive Technologies

Researching the Phenomenon of Poor Ovarian Responders and Management Strategies in IVF: A Narrative Review

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