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Meta-Analysis
. 2012 Aug;27(8):2373-9.
doi: 10.1093/humrep/des174. Epub 2012 May 30.

The use of follicle flushing during oocyte retrieval in assisted reproductive technologies: a systematic review and meta-analysis

Gary Levy  1 , Micah J Hill, Christina I Ramirez, Luiz Correa, Mary E Ryan, Alan H DeCherney, Eric D Levens, Brian W Whitcomb
Affiliations
Meta-Analysis

The use of follicle flushing during oocyte retrieval in assisted reproductive technologies: a systematic review and meta-analysis

Gary Levy et al. Hum Reprod. 2012 Aug.

Abstract

Study question: Does follicular flushing during assisted reproductive technologies (ART) improve the number of oocytes retrieved?

Summary answer: Follicular flushing during ART does not result in a greater number of oocytes in normal responders.

What is known already: Despite limited evidence supporting the use of follicular flushing, it continues to be a common procedure in many ART clinics. Prior studies have provided conflicting results regarding the routine use of flushing during oocyte retrieval.

Study design, size, duration: Systematic review and meta-analysis of 518 patients who participated in 6 randomized trials over 20 years.

Participants/materials, setting, methods: Literature searches were conducted to retrieve randomized controlled trials on follicle or ovarian flushing in ART. Databases searched included PubMed, EMBASE, Web of Science and the Cochrane Database of Clinical Trials (CENTRAL). Six trials that included 518 subjects matched the inclusion criteria. Studies included were limited to trials that were published, randomized trials comparing oocyte retrieval with a single-lumen pick-up needle versus follicle flushing after direct aspiration with a multi-channel oocyte pick-up needle in ART patients.

Main results and the role of chance: In each of the trials, measures of the oocyte yield (oocytes retrieved divided by follicles aspirated), total oocytes retrieved, fertilization or pregnancy were not different when comparing direct aspiration with follicle flushing. Four trials reported a higher operative time with follicle flushing. Results of the meta-analysis indicated no significant differences in the oocytes retrieved [weighted mean difference: 0.07, 95% confidence interval (CI): -0.13 to 0.29] or the oocyte yield (odds ratio: 1.06, 95% CI: 0.95-1.18) between the non-flushing and flushing groups.

Limitations, reasons for caution: All trials featured an open label design and the majority of patients in this meta-analysis were normal responders. The applications of these results to poor responders, patients undergoing natural cycle ART or minimal stimulation ART should be made with caution.

Wider implications of the findings: Follicle flushing does not improve ART outcomes in normal-responding patients and should not be performed. This meta-analysis should solidify this recommendation as it includes the largest trial published on the subject and is consistent with a recently published Cochrane review.

Study funding/competing interest(s): This work was supported, in part, by the Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD. The authors have no competing interests to declare.

Trial registration number: N/A.

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Figures

Figure 1
Figure 1
PRISMA four-phase flow diagram of search yield, screening and inclusion steps.
Figure 2
Figure 2
Forest plot comparing oocyte yield (oocytes retrieved/follicles aspirated) in the flushing and non-flushing groups. Data reported per oocyte aspirated.
Figure 3
Figure 3
Forest plot comparing the number of oocytes retrieved in the flushing and non-flushing groups. Data reported per patient.
See this image and copyright information in PMC

References

    1. Bagtharia S, Haloob ARK. Is there a benefit from routine follicular flushing for oocyte retrieval? J Obstet Gynaecol. 2005;25:374–376. - PubMed
    1. Eisermann J, Yang V, Register K, Swank N, Strickler RC. Ovarian stimulation with pure follicle-stimulating hormone/human menopausal gonadotropin and improved laparoscopic aspiration needles influence the success of an in vitro fertilization program. Fertil Steril. 1989;51:112–116. - PubMed
    1. Elhussein E, Balen AH, Tan SL. A prospective-study comparing the outcome of oocytes retrieved in the aspirate with those retrieved in the flush during transvaginal ultrasound directed oocyte recovery for in vitro fertilization. Br J Obstet Gynaecol. 1992;99:841–844. - PubMed
    1. Gembruch U, Diedrich K, Welker B, Wahode J, van der Ven H, Al-Hasani S, Krebs D. Transvaginal sonographically guided oocyte retrieval for in-vitro fertilization. Hum Reprod. 1988;3(Suppl. 2):59–63. - PubMed
    1. Haines CJ, Emes AL, Oshea RT, Weiss TJ. Choice of needle for ovum pickup. J In Vitro Fert Embryo Transf. 1989;6:111–112. - PubMed

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