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

Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
Current opinion in obstetrics & gynecology (Impact Factor: 2.07). 06/2010; 22(3):208-12. DOI: 10.1097/GCO.0b013e3283373bfe
Source: PubMed


Follicular flushing utilizing double-lumen retrieval needles attempts to increase oocyte yield during transvaginal retrieval. The original work on this topic, now more than 2 decades old, examined its utility in normal-responding assisted reproductive technologies (ART) patients. Newer studies examining its utility have focused on special populations expected to demonstrate benefit: poor responders, natural cycle and minimal stimulation ART, and in-vitro maturation cycles. This review assesses the current evidence regarding the effectiveness of ovarian follicular flushing in improving oocyte yield.
Follicular flushing offers no substantive benefit in oocyte yield, fertilization rates, or pregnancy outcomes for normal and poor-responding ART patients. Patients undergoing natural cycle or minimal stimulation ART may benefit from follicular flushing resulting in more mature embryos but unclear effects on cycle outcome.
Randomized controlled trials consistently demonstrate no benefit and increased procedural time with follicular flushing in both normal and poor-responding ART patients. Nonrandomized data suggest a possible role for follicular flushing in natural cycle or minimal stimulation ART and in those undergoing in-vitro maturation IVF cycles; however, randomized controlled trials are needed to verify this finding. Presently, there is insufficient evidence to recommend the routine use of follicular flushing.

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    • "Systems of aspiration with double lumen allow the aspirated follicle to be flushed and subsequently re-aspirated (follicular flushing) to increase individual traceability. The duration of the oocyte retrieval procedure would undoubtedly increase, as well as patients’ discomfort during the procedure (Hill and Levens, 2010). This change, however, is a prerequisite for the assessment of individual FF G-CSF concentrations, to increase the subsequent pregnancy rate by a more precise and accurate choice of embryos with the best potential for implantation and live birth. "
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