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. 2018 Nov 16;18(1):186.
doi: 10.1186/s12905-018-0681-2.

Follicular flushing increases the number of oocytes retrieved in poor ovarian responders undergoing in vitro fertilization: a retrospective cohort study

Yu Xiao  1 , Yong Wang  2 , Min Wang  2 , Kai Liu  2
Affiliations

Follicular flushing increases the number of oocytes retrieved in poor ovarian responders undergoing in vitro fertilization: a retrospective cohort study

Yu Xiao et al. BMC Womens Health. .

Abstract

Background: To investigate the impact of follicular flushing on the number of oocytes retrieved and embryo quality and to determine the optimal number of flushings for poor ovarian responders (PORs) undergoing in vitro fertilization (IVF).

Methods: This retrospective study included 291 IVF cycles in 224 patients who were PORs and had no more than three dominant follicles on retrieval day. During oocyte retrieval, follicular fluid was aspirated and examined for an oocyte. If no oocyte was identified, follicular flushing was repeated until an oocyte was retrieved or up to a maximum of nine times.

Results: The mean number of oocytes retrieved by aspiration and subsequent flushes was significantly higher than the number retrieved from the initial aspirate (1.73 ± 0.96 VS. 1.23 ± 1.00, P = 0.000). The total recovery rate was 83.7% (503/601), which was significantly higher than the 59.6% recovery rate for direct aspiration (P = 0.000). Before the 4th follicular flushing, the cumulative recovery rate increased significantly as flushing was repeated, but after the 4th flushing, the ascending trend was mitigated; and the risk ratio of recovering fewer oocytes after 4 flushes compared with after 9 flushes was 0.765 (95%CI, 0.570-1.026, P = 0.074). Significant differences were not observed in maturation rate, fertilization rate, cleavage rate or high-quality embryo rate (P > 0.05).

Conclusions: Follicular flushing may increase the number of oocytes retrieved and does not have adverse effects on oocyte or embryo quality in PORs undergoing IVF. Four times may be an optimal number of follicular flushings.

Keywords: Follicular flushing; In vitro fertilization; Oocyte retrieval; Poor ovarian response.

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Conflict of interest statement

Ethics approval and consent to participate

Our study protocol was approved by the Medical Ethics Committee of the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University (Reference number: GKLW 2017–87). And as the study was designed to retrospectively analyze the data of patients who had finished their treatments, the informed consents for collecting and analyzing their medical records were previously signed at the beginning of their treatments.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The number of follicular flushings and cumulative recovery rates. Up to the 4th flushing, each flushing contributed to an obvious ascending tendency in the cumulative recovery rate; however, with 5 or more flushings, the upward trend was greatly mitigated
Fig. 2
Fig. 2
Laboratory embryology outcomes for each flushing. The mature oocyte rates, fertilization rates, cleavage rates, and high-quality embryo rates did not differ significantly among the flushing groups (P>0.05)
Fig. 3
Fig. 3
Risk ratios and 95% confidence intervals for the cumulative oocyte yield of each flush compared with the initial aspirate and 9 flushes. RR: risk ratio; CI: confidence interval
See this image and copyright information in PMC

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