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Journal of Assisted Reproduction and Genetics
Published in: Journal of Assisted Reproduction and Genetics 10/2017

01-10-2017 | Assisted Reproduction Technologies

Effect of follicular flushing on reproductive outcomes in patients with poor ovarian response undergoing assisted reproductive technology

Authors: Anna L M Souza, Marcos Sampaio, Graciele B Noronha, Ludiana G R Coster, Roberta S G de Oliveira, Selmo Geber

Published in: Journal of Assisted Reproduction and Genetics | Issue 10/2017

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Abstract

Purpose

The purpose of this study is to investigate the impact of follicular flushing on the number of oocytes retrieved, oocyte maturity, fertilization rate, embryo development, and pregnancy rate of poor ovarian responders (POR).

Methods

Retrospective study of 524 cycles of 384 patients with POR submitted to assisted reproductive technology (ART) and who had follicular flushing during oocyte retrieval was used in the study. We included patients with <5 oocytes at oocyte retrieval (POR group) and matching the Bologna criteria.

Results

POR patients had a mean age of 38.2 ± 4.2 years. A total of 1355 follicles (mean = 3.5 ± 1.6) were aspirated and 1040 oocytes recovered, with 709 (68.2%) obtained by direct aspiration and 331 (31.8%) by follicular flushing. We found a difference between the total number of oocytes and the number of aspirated oocytes. Overall pregnancy rate was 22%. Association was observed between pregnancy rate and the number of oocytes retrieved, the number of MII oocytes, and the number of embryos transferred. The patients matching the Bologna criteria had a mean age of 38.9 ± 3.9 years. A total of 309 follicles were aspirated (mean = 3.1 ± 1.5) and 242 oocytes recovered, with 156 (64.5%) obtained by direct aspiration and 86 (35.5%) by follicular flushing. There was a significant difference between the total number of oocytes and the number of aspirated oocytes. Overall pregnancy rate was 12.1%. There was no association between the pregnancy rate and the number of oocytes retrieved, the number of MII, and the number of embryos.

Conclusions

Follicular flushing might be a suitable alternative to increase the number of oocytes and pregnancy rates in patients with POR.
Literature
1.
Pellicer A, Lightman A, Diamond MP, Russell JB, DeCherney AH. Outcome of in vitro fertilization in women with low response to ovarian stimulation. Fertil Steril. 1987;47:812–5.CrossRefPubMed
2.
Szymusik I, Marianowski P, Zygula A, Wielgos M. Poor responders in IVF—is there any evidence-based treatment for them? Neuro Endocrinol Lett. 2015;36:209–13.PubMed
3.
Papathanasiou A, Searle BJ, King NM, Bhattacharya S. Trends in ‘poor responder’ research: lessons learned from RCTs in assisted conception. Hum Reprod Update. 2016 Apr;22(3).
4.
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;99:841–4.CrossRefPubMed
5.
Waterstone JJ, Parsons JH. A prospective study to investigate the value of flushing follicles during transvaginal ultrasound-directed follicle aspiration. Fertil Steril. 1992;57:221–3.CrossRefPubMed
6.
Levy G, Hill MJ, Ramirez CI, Correa L, Ryan ME, DeCherney AH, et al. The use of follicle flushing during oocyte retrieval in assisted reproductive technologies: a systematic review and meta-analysis. Hum Reprod. 2012;27:2373-9.CrossRefPubMed
7.
Roque M, Sampaio M, Geber S. Follicular flushing during oocyte retrieval: a systematic review and meta-analysis. J Assist Reprod Genet. 2012;29(11):1249–54.CrossRefPubMedPubMedCentral
8.
Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G. Gianaroli L; ESHRE working group on poor ovarian response definition. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26(7):1616–24.CrossRefPubMed
9.
Geber S, Sales L, Sampaio MA. Laboratory techniques for human embryos. Reprod BioMed Online. 2002;5(2):211–8.CrossRefPubMed
10.
Veeck L. An atlas of human gametes and conceptuses. Carnforth: Parthenon Publishing; 1999.CrossRef
11.
Geber S, Moreira AC, de Paula SO, Sampaio M. Comparison between two forms of vaginally administered progesterone for luteal phase support in assisted reproduction cycles. Reprod BioMed Online. 2007;14:155–8.CrossRefPubMed
12.
Pandian Z, McTavish AR, Aucott L, Hamilton MP, Bhattacharya S. Interventions for ‘poor responders’ to controlled ovarian hyper stimulation (COH) in in vitro fertilisation (IVF). Cochrane Database Syst Rev. 2010;20:CD004379.
13.
Levens ED, Whitcomb BW, Payson MD, Larsen FW. Ovarian follicular flushing among low-responding patients undergoing assisted reproductive technology. Fertil Steril. 2009;91(4 Suppl):1381–4.CrossRefPubMed
14.
Mok-Lin E, Brauer AA, Schattman G, Zaninovic N, Rosenwaks Z, Spandorfer S. Follicular flushing and in vitro fertilization outcomes in the poorest responders: a randomized controlled trial. Hum Reprod. 2013;28:2990–5.CrossRefPubMed
Metadata
Title
Effect of follicular flushing on reproductive outcomes in patients with poor ovarian response undergoing assisted reproductive technology
Authors
Anna L M Souza
Marcos Sampaio
Graciele B Noronha
Ludiana G R Coster
Roberta S G de Oliveira
Selmo Geber
Publication date
01-10-2017
Publisher
Springer US
Published in
Journal of Assisted Reproduction and Genetics / Issue 10/2017
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI
https://doi.org/10.1007/s10815-017-0991-6

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