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

Current Opinion in Obstetrics and Gynecology

Volumn 22, Issue 3, 2010, Pages 208-212

  Hill, Micah J ^a   Levens, Eric D ^a  

^a EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT   (United States)

Author keywords

Assisted reproductive technologies; Double lumen retrieval needle; Oocyte retrieval; Ovarian follicle flushing; Poor responders

Indexed keywords

GONADORELIN ANTAGONIST; GONADOTROPIN DERIVATIVE;

CLINICAL TRIAL; FERTILIZATION IN VITRO; FOLLICULAR ASPIRATION; FOLLICULAR FLUSHING; GAMETE INTRAFALLOPIAN TRANSFER; HUMAN; INFERTILITY THERAPY; INTRACYTOPLASMIC SPERM INJECTION; NIDATION; OOCYTE MATURATION; OOCYTE RETRIEVAL; OVARY FOLLICLE DEVELOPMENT; OVULATION INDUCTION; PREGNANCY OUTCOME; PREGNANCY RATE; PRIORITY JOURNAL; REPRODUCTIVE PROCEDURES; REVIEW;

FEMALE; HUMANS; INFERTILITY, FEMALE; OOCYTE RETRIEVAL; OVARIAN FOLLICLE; OVULATION INDUCTION; PREGNANCY; REPRODUCTIVE TECHNIQUES, ASSISTED;

EID: 77951902303     PISSN: 1040872X     EISSN: None     Source Type: Journal    
DOI: 10.1097/GCO.0b013e3283373bfe     Document Type: Review

References (28)

1. Lenz S, Lauritsen JG, Kjellow M. Collection of human oocytes for in vitro fertilisation by ultrasonically guided follicular puncture. Lancet 1981; 1: 1163-1164.
2. Porter MB. Ultrasound in assisted reproductive technology. Semin Reprod Med 2008; 26: 266-276.
3. Wikland M, Enk L, Hamberger L. Transvesical and transvaginal approaches for the aspiration of follicles by use of ultrasound. Ann N Y Acad Sci 1985; 442: 182-194. (Pubitemid 15228160)
4. Ludwig AK, Glawatz M, Griesinger G, et al. Perioperative and postoperative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of >1000 oocyte retrievals. Hum Reprod 2006; 21: 3235-3240. (Pubitemid 44811628)
5. Wiseman DA, Short WB, Pattinson HA, et al. Oocyte retrieval in an in vitro fertilization-embryo transfer program: comparison of four methods. Radiology 1989; 173: 99-102.
6. Gembruch U, Diedrich K, Welker B, et al. Transvaginal sonographically guided oocyte retrieval for in-vitro fertilization. Hum Reprod 1988; 3 (Suppl 2) : 59-63.
7. Awonuga A, Waterstone J, Oyesanya O, et al. A prospective randomized study comparing needles of different diameters for transvaginal ultrasounddirected follicle aspiration. Fertil Steril 1996; 65: 109-113. (Pubitemid 26006656)
8. Eisermann J, Yang V, Register K, et al. Ovarian stimulation with pure folliclestimulating hormone/human menopausal gonadotropin and improved laparoscopic aspiration needles influence the success of an in vitro fertilization program. Fertil Steril 1989; 51: 112-116. (Pubitemid 19033729)
9. Miller KA, Elkind-Hirsch K, Benson M, et al. A new follicle aspiration needle set is equally effective and as well tolerated as the standard needle when used in a prospective randomized trial in a large in vitro fertilization program. Fertil Steril 2004; 81: 191-193. (Pubitemid 38058347)
10. Haines CJ, Emes AL, O'Shea RT, et al. Choice of needle for ovum pickup. J In Vitro Fert Embryo Transf 1989; 6: 111-112.
11. Knight DC, Tyler JP, Driscoll GL. Follicular flushing at oocyte retrieval: a reappraisal. Aust N Z J Obstet Gynaecol 2001; 41: 210-213.
12. Aziz N, Biljan MM, Taylor CT, et al. Effect of aspirating needle calibre on outcome of in-vitro fertilization. Hum Reprod 1993; 8: 1098-1100. (Pubitemid 23204698)
13. Waterstone JJ, Parsons JH. A prospective study to investigate the value of flushing follicles during transvaginal ultrasound-directed follicle aspiration. Fertil Steril 1992; 57: 221-223.
14. el Hussein 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.
15. Bagtharia S, Haloob AR. Is there a benefit from routine follicular flushing for oocyte retrieval? J Obstet Gynaecol 2005; 25: 374-376. (Pubitemid 43186988)
16. Tan SL, Waterstone J, Wren M, et al. A prospective randomized study comparing aspiration only with aspiration and flushing for transvaginal ultrasound-directed oocyte recovery. Fertil Steril 1992; 58: 356-360.
17. Kingsland CR, Taylor CT, Aziz N, et al. Is follicular flushing necessary for oocyte retrieval? A randomized trial. Hum Reprod 1991; 6: 382-383.
18. Scott RT, Hofmann GE, Muasher SJ, et al. A prospective randomized comparison of single-and double-lumen needles for transvaginal follicular aspiration. J In Vitro Fert Embryo Transf 1989; 6: 98-100.
19. Mohamed KA, Davies WA, Allsopp J, et al. Agonist 'flare-up' versus antagonist in the management of poor responders undergoing in vitro fertilization treatment. Fertil Steril 2005; 83: 331-335. (Pubitemid 40221784)
20. Ulug U, Ben-Shlomo I, Turan E, et al. Conception rates following assisted reproduction in poor responder patients: a retrospective study in 300 consecutive cycles. Reprod Biomed Online 2003; 6: 439-443. (Pubitemid 36849804)
21. Levens ED, Whitcomb BW, Payson MD, et al. Ovarian follicular flushing •• among low-responding patients undergoing assisted reproductive technology. Fertil Steril 2009; 91: 1381-1384. This randomized controlled trial evaluating follicular flushing found no improvement in oocytes retrieved, mature oocytes, implantation rates, or ongoing pregnancy rates among poor-responding patients.
22. Lozano DH, Fanchin R, Chevalier N, et al. Optimising the semi natural cycle IVF: the importance of follicularflushing. J Indian Med Assoc 2006; 104: 423-427. (Pubitemid 44831702)
23. Mendez Lozano DH, Brum Scheffer J, Frydman N, et al. Optimal reproductive •• competence of oocytes retrieved through follicularflushing in minimal stimulation IVF. Reprod Biomed Online 2008; 16: 119-123. This comparative study evaluated the benefits of follicular flushing in poorresponder patients. Embryos derived from oocytes obtained from follicular flushing showed improved implantation rates and more top quality embryos. No difference was noted in the clinical pregnancy rate between the two groups. (Pubitemid 351187381)
24. Uzelac PS, Christensen GL, Nakajima ST. Follicular flushing avoids multiple • vaginal punctures and may aid in oocyte recovery in in vitro maturation (IVM). Fertil Steril 2009; 91: S5. This is the only study to evaluate follicular flushing for patients undergoing IVM. As the paper is limited by a very small sample size, the authors noted acceptable oocyte yield from mid-sized follicles and the avoidance of multiple vaginal punctures with follicular flushing.
25. Lin YC, Chang SY, Lan KC, et al. Human oocyte maturity in vivo determines the outcome of blastocyst development in vitro. J Assist Reprod Genet 2003; 20: 506-512.
26. Peeraer K, SpiessensC, De Jaegher N, et al. Correlation between the number of follicular flushings, oocyte/embryo quality and pregnancy rate for IVF: a prospective study. Hum Reprod 2007; 22: i168.
27. Bomsel-Helmreich O, Huyen LV, Durand-Gasselin I, et al. Timing of nuclear maturation and cumulus dissociation in human oocytes stimulated with clomiphene citrate, human menopausal gonadotropin, and human chorionic gonadotropin. Fertil Steril 1987; 48: 586-595. (Pubitemid 17154410)
28. Goud PT, Goud AP, Qian C, et al. In-vitro maturation of human germinal vesicle stage oocytes: role of cumulus cells and epidermal growth factor in the culture medium. Hum Reprod 1998; 13: 1638-1644. (Pubitemid 28310507)