The following is a summary of “Does follicular flushing increase oocyte number in poor responders? An update of a systematic review,” published in the February 2023 issue of Reproductive Biomedicine Online by Neumann, et al.
Does follicle flushing during ovum retrieval enhance the number of retrieved oocytes in IVF patients with the poor response? To find randomized controlled trials (RCT) comparing follicular flushing to no flushing in women who had a poor response to IVF treatment, an update of an electronic literature search was conducted. There were no exclusion standards for stimulation, needle type, or technique. RevMan 5.4 was used to carry out a meta-analysis.
Six RCTs were found, and their main goal was to determine whether there was a difference between flushing and no flushing in the average number of cumulus-oocyte complexes or/and metaphase II oocytes. Five trials employed double-lumen needles, one study looked at a pseudo-double-lumen needle, and the control groups all used standard single-lumen needles. The absence of blinding of the doctors performing the puncture and insufficient data in four trials pose the biggest risks of bias in all the analyzed research.
A synthesis of the data is not possible due to the variability of the direction and magnitude of the effect of follicular flushing on the mean number of oocytes recovered (I = 80, P = 0.0001). One study revealed comparable oocyte numbers, two showed a drop or tendency towards a decrease in oocyte numbers, and one demonstrated a substantial tendency towards increased oocyte numbers after flushing. Oocytes in metaphase II displayed a comparable pattern (I = 73, P = 0.002). It is unclear whether follicular flushing in IVF patients with a poor response impacts the number of retrieved oocytes. The impact of flushing on oocyte counts and clinical outcomes in patients with poor responses and mono follicular patients requires larger pragmatic trials.
Source: sciencedirect.com/science/article/abs/pii/S1472648322008173
