Is there a benefit in follicular flushing in assisted reproductive technology?

Hill, Micah J.; Levens, Eric D.

doi:10.1097/gco.0b013e3283373bfe

Cited by 25 publications

(12 citation statements)

References 27 publications

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“…Systems of aspiration with double lumen allow the aspirated follicle to be flushed and subsequently re-aspirated (follicular flushing) to increase individual traceability. The duration of the oocyte retrieval procedure would undoubtedly increase, as well as patients’ discomfort during the procedure (Hill and Levens, 2010). This change, however, is a prerequisite for the assessment of individual FF G-CSF concentrations, to increase the subsequent pregnancy rate by a more precise and accurate choice of embryos with the best potential for implantation and live birth.…”

Section: Discussionmentioning

confidence: 99%

Impact of follicular G-CSF quantification on subsequent embryo transfer decisions: a proof of concept study

et al. 2012

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BACKGROUNDPrevious experiments have shown that granulocyte colony-stimulating factor (G-CSF), quantified in the follicular fluid (FF) of individual oocytes, correlates with the potential for an ongoing pregnancy of the corresponding fertilized oocytes among selected transferred embryos. Here we present a proof of concept study aimed at evaluating the impact of including FF G-CSF quantification in the embryo transfer decisions.METHODSFF G-CSF was quantified with the Luminex XMap technology in 523 individual FF samples corresponding to 116 fresh transferred embryos, 275 frozen embryos and 131 destroyed embryos from 78 patients undergoing ICSI.RESULTSFollicular G-CSF was highly predictive of subsequent implantation. The receiving operator characteristics curve methodology showed its higher discriminatory power to predict ongoing pregnancy in multivariate logistic regression analysis for FF G-CSF compared with embryo morphology [0.77 (0.69–0.83), P < 0.001 versus 0.66 (0.58–0.73), P = 0.01)]. Embryos were classified by their FF G-CSF concentration: Class I over 30 pg/ml (a highest positive predictive value for implantation), Class II from 30 to 18.4 pg/ml and Class III <18.4 pg/ml (a highest negative predictive value). Embryos derived from Class I follicles had a significantly higher implantation rate (IR) than those from Class II and III follicles (36 versus 16.6 and 6%, P < 0.001). Embryos derived from Class I follicles with an optimal morphology reached an IR of 54%. Frozen-thawed embryos transfer derived from Class I follicles had an IR of 37% significantly higher than those from Class II and III follicles, respectively, of 8 and 5% (P < 0.001). Thirty-five per cent of the frozen embryos but also 10% of the destroyed embryos were derived from G-CSF Class I follicles. Non-optimal embryos appear to have been transferred in 28% (22/78) of the women, and their pregnancy rate was significantly lower than that of women who received at least one optimal embryo (18 versus 36%, P = 0.04).CONCLUSIONSMonitoring FF G-CSF for the selection of embryos with a better potential for pregnancy might improve the effectiveness of IVF by reducing the time and cost required for obtaining a pregnancy.

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Section: Discussionmentioning

confidence: 99%

Impact of follicular G-CSF quantification on subsequent embryo transfer decisions: a proof of concept study

et al. 2012

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“…Larger multicenter prospective studies might reveal a difference between flushing and direct aspiration needle use in ART. Additional studies are needed to establish the efficiency of needle types in lowresponding patients undergoing ART (12).…”

mentioning

confidence: 99%

In vitro fertilization–intracytoplasmic sperm injection outcomes in single- versus double-lumen oocyte retrieval needles in normally responding patients: a randomized trial

Haydardedeoğlu

Çok

Kılıçdağ

et al. 2011

Fertility and Sterility

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“…This topic was recently reviewed by Hill and Levens (24). They concluded that "Randomized controlled trials consistently demonstrate no benefi t and increased procedural time with follicular fl ushing in both normal and poor-responding ART patients.…”

Section: Complicationsmentioning

confidence: 99%

Oocyte collection

Kovacs¹

2012

Textbook of Assisted Reproductive Techniques, Volume Two: Clinical Perspectives

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Is there a benefit in follicular flushing in assisted reproductive technology?

Cited by 25 publications

References 27 publications

Impact of follicular G-CSF quantification on subsequent embryo transfer decisions: a proof of concept study

Impact of follicular G-CSF quantification on subsequent embryo transfer decisions: a proof of concept study

In vitro fertilization–intracytoplasmic sperm injection outcomes in single- versus double-lumen oocyte retrieval needles in normally responding patients: a randomized trial

Oocyte collection

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