Direct aspiration versus follicular flushing in poor responders undergoing intracytoplasmic sperm injection: a randomised controlled trial

Abstract

Objective: To compare follicle flushing three times with direct follicular aspiration in poor responders. Our hypothesis was that follicle flushing three times in poor responders would result in similar oocyte yield compared with direct aspiration in poor responders.

Design: A randomised controlled trial performed between January 2015 and June 2015.

Setting: University hospital.

Population or sample: Eighty eligible poor responders, who were defined as having five or fewer follicles ≥13 mm in average diameter with at least two follicles having maximum diameters >17 mm on the day of human chorionic gonadotrophin administration. Monofollicular cycles, including natural cycles, were excluded from the current trial.

Methods: In the double-lumen needle group, oocyte retrieval was performed by flushing three times with 2 ml in each follicle and in the single-lumen group direct follicle aspiration was performed.

Main outcome measure: Number of metaphase II oocytes retrieved.

Results: The mean number of metaphase II oocytes was similar in both groups (1.9 ± 0.1 versus 2.1 ± 0.1, respectively). The clinical pregnancy and live birth rates were similar in both groups (32.5% versus 25% and 25% versus 22.5%, respectively). The only significant difference between the two groups was the duration of oocyte retrieval (178.4 ± 13.4 versus 236.3 ± 24.1 seconds, respectively, P = 0.01).

Conclusion: Follicular flushing is time consuming and has similar results compared with direct follicle aspiration in poor responders.

Tweetable abstract: Direct follicle aspiration versus flushing in poor responders yields similar metaphase II oocytes.

Keywords: follicular flushing; in vitro fertilisation/ intracytoplasmic sperm injection; live birth rate; metaphase II oocyte; poor responders.