The use of follicle flushing during oocyte retrieval in assisted reproductive technologies: a systematic review and meta-analysis.
OBJECTIVE
Does follicular flushing during assisted reproductive technologies (ART) improve the number of oocytes retrieved?


CONCLUSIONS
Follicular flushing during ART does not result in a greater number of oocytes in normal responders.


BACKGROUND
Despite limited evidence supporting the use of follicular flushing, it continues to be a common procedure in many ART clinics. Prior studies have provided conflicting results regarding the routine use of flushing during oocyte retrieval.


METHODS
Systematic review and meta-analysis of 518 patients who participated in 6 randomized trials over 20 years.


METHODS
Literature searches were conducted to retrieve randomized controlled trials on follicle or ovarian flushing in ART. Databases searched included PubMed, EMBASE, Web of Science and the Cochrane Database of Clinical Trials (CENTRAL). Six trials that included 518 subjects matched the inclusion criteria. Studies included were limited to trials that were published, randomized trials comparing oocyte retrieval with a single-lumen pick-up needle versus follicle flushing after direct aspiration with a multi-channel oocyte pick-up needle in ART patients.


RESULTS
In each of the trials, measures of the oocyte yield (oocytes retrieved divided by follicles aspirated), total oocytes retrieved, fertilization or pregnancy were not different when comparing direct aspiration with follicle flushing. Four trials reported a higher operative time with follicle flushing. Results of the meta-analysis indicated no significant differences in the oocytes retrieved [weighted mean difference: 0.07, 95% confidence interval (CI): -0.13 to 0.29] or the oocyte yield (odds ratio: 1.06, 95% CI: 0.95-1.18) between the non-flushing and flushing groups.


CONCLUSIONS
All trials featured an open label design and the majority of patients in this meta-analysis were normal responders. The applications of these results to poor responders, patients undergoing natural cycle ART or minimal stimulation ART should be made with caution.


CONCLUSIONS
Follicle flushing does not improve ART outcomes in normal-responding patients and should not be performed. This meta-analysis should solidify this recommendation as it includes the largest trial published on the subject and is consistent with a recently published Cochrane review.


BACKGROUND
This work was supported, in part, by the Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD. The authors have no competing interests to declare.


BACKGROUND
N/A.
Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Gary
G
Levy
Micah J
MJ
Hill
Christina I
CI
Ramirez
Luiz
L
Correa
Mary E
ME
Ryan
Alan H
AH
DeCherney
Eric D
ED
Levens
Brian W
BW
Whitcomb
D000328:Adult; D016208:Databases, Factual; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D054315:Oocyte Retrieval / Q000379:methods*; D009865:Oocytes / Q000166:cytology / Q000378:metabolism; D006080:Ovarian Follicle / Q000473:pathology; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D027724:Reproductive Techniques, Assisted; D012306:Risk