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Lee WHY, Lin KT, Hsieh YC, Kao TC, Huang TC, Chao KH, Chen MJ, Yang JH, Chen SU. The value of LH maximum level in predicting optimal oocyte yield following GnRH agonist trigger. Front Endocrinol (Lausanne) 2023; 14:1216584. [PMID: 37608795 PMCID: PMC10441777 DOI: 10.3389/fendo.2023.1216584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/22/2023] [Indexed: 08/24/2023] Open
Abstract
Background Risk factors associated with a suboptimal response to Gonadotropin-releasing hormone (GnRH) agonists include a high or low body mass index (BMI), prolonged use of oral contraceptive pills, and low luteinizing hormone (LH) levels on either the start or trigger days of controlled ovarian stimulation (COS). However, this approach may increase the need for a dual trigger and may also result in a higher incidence of ovarian hyperstimulation syndrome (OHSS) in hyper-responders. We aimed to investigate whether the maximum LH level during stimulation can serve as a predictive factor for achieving an optimal oocyte yield using the GnRH agonist trigger alone. Methods We retrospectively reviewed all antagonist protocols or progestin-primed ovarian stimulation (PPOS) protocols triggered with GnRH agonist only between May 2012 and December 2022. Subjects were divided into three groups, depending on basal LH level and LH maximum level. The freeze-all strategy was implemented in all cycles: Group 1, consistently low LH levels throughout COS; Group 2, low basal LH level with high LH max level during COS; Group 3, consistently high LH levels throughout COS. The primary outcome was the oocyte yield rate. The secondary outcome includes the number of collected oocytes, suboptimal response to GnRH agonist trigger, oocyte maturity rate, fertilized rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate. The pregnancy outcomes were calculated for the first FET cycle. Results Following confounder adjustment, multivariable regression analysis showed that Group 1 (cycles with consistently low LH levels throughout COS) remains an independent predictor of suboptimal response (OR: 6.99; 95% CI 1.035-47.274). Group 1 (b = -12.72; 95% CI -20.9 to -4.55) and BMI (b = -0.25; 95% CI -0.5 to -0.004) were negatively associated with oocyte yield rate. Patients with low basal LH but high LH max levels had similar clinical outcomes compared to those with high LH max levels through COS. Conclusions The maximum LH level during COS may serve as an indicator of LH reserve and could be a more reliable predictor of achieving an optimal oocyte yield when compared to relying solely on the basal LH level. In the case of hyper-responders where trigger agents (agonist-only or dual trigger) are being considered, we propose a novel strategy that incorporates the maximum LH level, rather than just the basal or trigger-day LH level, as a reference for assessing LH reserve. This approach aims to minimize the risk of obtaining suboptimal oocyte yield and improve overall treatment outcomes.
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Affiliation(s)
- William Hao-Yu Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Ting Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yun-Chiao Hsieh
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Ching Kao
- Infertility Center, Chien-Shin Hospital, Kaohsiung, Taiwan
| | - Ting-Chi Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- Taipei IVF Clinic, Taipei, Taiwan
| | - Kuang-Han Chao
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Jou Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- Livia Shangyu Wan Chair Professor of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jehn-Hsiahn Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
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Gordon CE, Lanes A, Srouji SS, Ginsburg ES. Association between oocyte retrieval technique and number of oocytes retrieved. J Assist Reprod Genet 2022; 39:2747-2754. [PMID: 36374395 PMCID: PMC9790833 DOI: 10.1007/s10815-022-02650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess if there is an optimal oocyte retrieval (OR) technique to retrieve a maximum number of oocytes and mature oocytes (MII). METHODS Retrospective cohort study in which nine physicians completed a survey on OR techniques. Number of oocytes/follicle cohort, MIIs/follicle cohort, and MIIs/oocytes retrieved (%MII) were assessed for each technique for patients undergoing OR from 3/2013 to 7/2019. Data were stratified by number of follicles on ultrasound on day of trigger (< 6, 6-10, > 10). RESULTS Patient demographics were equivalent between techniques. For < 6 follicles, three techniques resulted in significantly fewer oocyte/follicle (0.97 ± 0.48, 0.95 ± 0.66, and 0.90 ± 0.41) compared to the top-performing technique (TPT) (1.11 ± 0.55). For 6-10 follicles, two techniques resulted in significantly fewer oocyte/follicle (0.95 ± 0.39 and 0.93 ± 0.35) compared to the TPT (1.06 ± 0.42). A different technique had higher %MII (0.77 ± 0.19) compared to two techniques (0.74 ± 0.21 and 0.72 ± 0.22). For > 10 follicles, two techniques resulted in significantly fewer oocyte/follicle (1.01 ± 0.42 and 1.07 ± 0.40) compared to the TPT (1.15 ± 0.41). These two techniques also resulted in fewer MII/follicle (0.75 ± 0.33 and 0.81 ± 0.34 vs. 0.87 ± 0.34). There was no consistent TPT across follicle number groups or for all outcome variables. CONCLUSIONS There does not appear to be a clear TPT, even for patients with few follicles. Providers who perform OR in a similar fashion to physicians at our institution should feel confident that those techniques obtain equivalent oocyte yields.
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Affiliation(s)
- C E Gordon
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - A Lanes
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - S S Srouji
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - E S Ginsburg
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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Sadek S, Ramadan H, Matitashvili T, Stadtmauer L. To curette or not to curette; efficiency of oocyte retrieval technique. Arch Gynecol Obstet 2022; 306:1771-1776. [PMID: 36066617 DOI: 10.1007/s00404-022-06695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Follicular curetting is the gentle and rapidly rotating movement of the aspiration needle in a clockwise and counterclockwise fashion. The aim of our study is to assess this retrieval technique comparing cycle and pregnancy outcomes between curetting and non-curetting. METHODS This was a retrospective review of 817 patients that underwent oocyte retrieval at our fertility center from January 1st, 2016 until August 31st, 2019. All patients enrolled in the study underwent standard ovarian stimulation protocols. Three physicians routinely utilized follicle curetting during oocyte retrieval, while a fourth physician did not curette. Retrievals and embryo transfers were performed based on a rotating physician schedule. RESULTS Retrievals that were performed using a curetting technique had a significantly higher number of total oocytes retrieved 12.4 ± 8.1 vs 10.7 ± 7.5 (p = 0.01), and number of M2 oocytes retrieved 8.1 ± 6.4 vs 6.9 ± 6.0 (p = 0.03), resulting in an increased M2 oocyte yield 63.7% ± 41.3 vs 50.9% ± 30.6 (p = 0.0001). These patients also had a significant increase in clinical pregnancy rate per retrieval 55 vs 41% (p = 0.0016), live birth rate per retrieval 42 vs 34% (p = 0.04) and with no significant difference in multiple gestations or OHSS. CONCLUSIONS A significant improvement in clinical pregnancy rates and live birth per retrieval was detected in patients undergoing curetting. These patients had more embryos frozen, leading to more transfers and more successful pregnancies.
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Affiliation(s)
- Seifeldin Sadek
- Department of ObGyn, Eastern Virginia Medical School, The Jones Institute for Reproductive Medicine, 601 Colley Avenue, Norfolk, VA, 23507, USA.
| | - Hadi Ramadan
- Department of ObGyn, Eastern Virginia Medical School, The Jones Institute for Reproductive Medicine, 601 Colley Avenue, Norfolk, VA, 23507, USA
| | - Tamar Matitashvili
- Department of ObGyn, Eastern Virginia Medical School, The Jones Institute for Reproductive Medicine, 601 Colley Avenue, Norfolk, VA, 23507, USA
| | - Laurel Stadtmauer
- Department of ObGyn, Eastern Virginia Medical School, The Jones Institute for Reproductive Medicine, 601 Colley Avenue, Norfolk, VA, 23507, USA
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D’Angelo A, Panayotidis C, Amso N, Marci R, Matorras R, Onofriescu M, Turp AB, Vandekerckhove F, Veleva Z, Vermeulen N, Vlaisavljevic V. Recommendations for good practice in ultrasound: oocyte pick up †. Hum Reprod Open 2019; 2019:hoz025. [PMID: 31844683 PMCID: PMC6903452 DOI: 10.1093/hropen/hoz025] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 06/22/2019] [Accepted: 07/29/2019] [Indexed: 01/13/2023] Open
Abstract
STUDY QUESTION What is good practice in ultrasound (US), and more specifically during the different stages of transvaginal oocyte retrieval, based on evidence in the literature and expert opinion on US practice in ART? SUMMARY ANSWER This document provides good practice recommendations covering technical aspects of US-guided transvaginal oocyte retrieval (oocyte pick up: OPU) formulated by a group of experts after considering the published data, and including the preparatory stage of OPU, the actual procedure and post-procedure care. WHAT IS KNOWN ALREADY US-guided transvaginal OPU is a widely performed procedure, but standards for best practice are not available. STUDY DESIGN SIZE DURATION A working group (WG) collaborated on writing recommendations on the practical aspects of transvaginal OPU. A literature search for evidence of the key aspects of the procedure was carried out. Selected papers (n = 190) relevant to the topic were analyzed by the WG. PARTICIPANTS/MATERIALS SETTING METHODS The WG members considered the following key points in the papers: whether US practice standards were explained; to what extent the OPU technique was described and whether complications or incidents and how to prevent such events were reported. In the end, only 108 papers could be used to support the recommendations in this document, which focused on transvaginal OPU. Laparoscopic OPU, transabdominal OPU and OPU for IVM were outside the scope of the study. MAIN RESULTS AND THE ROLE OF CHANCE There was a scarcity of studies on the actual procedural OPU technique. The document presents general recommendations for transvaginal OPU, and specific recommendations for its different stages, including prior to, during and after the procedure. Most evidence focussed on comparing different equipment (needles) and on complications and risks, including the risk of infection. For these topics, the recommendations were largely based on the results of the studies. Recommendations are provided on equipment and materials, possible risks and complications, audit and training. One of the major research gaps was training and competence. This paper has also outlined a list of research priorities (including clarification on the value or full blood count, antibiotic prophylaxis and flushing, and the need for training and proficiency). LIMITATIONS REASONS FOR CAUTION The recommendations of this paper were mostly based on clinical expertise, as at present, only a few clinical trials have focused on the oocyte retrieval techniques, and almost all available data are observational. In addition, studies focusing on OPU were heterogeneous with significant difference in techniques used, which made drafting conclusions and recommendations based on these studies even more challenging. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on the management of good laboratory practice in ART. Some useful troubleshooting/checklist recommendations are given for easy implementation in clinical practice. These recommendations aim to contribute to the standardization of a rather common procedure that is still performed with great heterogeneity. STUDY FUNDING/COMPETING INTERESTS The meetings of the WG were funded by ESHRE. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER NA.ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Arianna D’Angelo
- Wales Fertility Institute, University Hospital of Wales, Cardiff University, Cardiff, UK
| | | | - Nazar Amso
- Cardiff University, Cardiff, South Glamorgan, UK
| | - Roberto Marci
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Roberto Matorras
- Instituto Valenciano de Infertilidad, IVI Bilbao, Bilbao, Spain; Human Reproduction Unit, Cruces University Hospital, Bilbao, Spain; Department of Obstetrics and Gynecology, Basque Country University, Spain; BioCruces Research Center Bilbao, Bilbao, Spain
| | - Mircea Onofriescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr.T.Popa”, Iasie, Romania
| | - Ahmet Berkiz Turp
- Department of Obstetrics and Gynecology, IVF Unit, Harran University, Sanliurfa 63300, Turkey
| | | | - Zdravka Veleva
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
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Qu J, Che Y, Xu P, Xia Y, Wu X, Wang Y. The Higher Response of Vascular Endothelial Growth Factor and Angiotensin-II to Human Chorionic Gonadotropin in Women with Polycystic Ovary Syndrome. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 8:373-8. [PMID: 25780518 PMCID: PMC4355923 DOI: 10.22074/ijfs.2015.4176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/27/2013] [Indexed: 11/30/2022]
Abstract
Background This research investigated the response of vascular active factors, vascular
endothelial growth factor (VEGF) and angiotensin-II (AT-II) to ovarian stimulation during 24 hours in patients with polycystic ovary syndrome (PCOS). Materials and Methods In this clinical trial study, 52 patients with PCOS and 8 control
cases were stimulated with human chorionic gonadotropin (HCG) on the 4th to 7th day
of the patients’ natural or induced menstrual cycles. We measured VEGF and AT-II by
radioimmunoassay before the injection (0 hour) and 3, 8, 12, 18 and 24 hours after the
stimulation. Results After ovarian stimulation, there was substantially higher level of VEGF in
typical PCOS patients than the other three groups at the 3 hour time point (p<0.05),
while there were no significant differences in VEGF at all the other time points
among the four groups. As for AT-II, before and at all time points after the ovarian
stimulation, it seemed that the AT-II levels in patients’ sera with different phenotypes of PCOS by the Rotterdam criteria were all higher than in the control group
although the differences were not statistically significant. The level of AT-II in typical PCOS patients was also significantly higher than the other three groups at the 3
hour time point (p<0.05), while no significant differences at all the other time points
among the four groups were observed. Conclusion The response to the stimulation varied among patients with different phenotypes of PCOS according to the Rotterdam criteria. Serum VEGF and AT-II were possible contributors to an increased risk of developing ovarian hyperstimulation syndrome
(OHSS) in patients with typical PCOS during the early follicular phase (3 hours) after
ovarian stimulation (Registration Number: NCT02265861).
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Affiliation(s)
- Junwei Qu
- Department of Gynecological Oncology Surgery, Jiangsu Cancer Hospital and Institute, Nanjing 210009, China
| | - Yena Che
- Translational Medicine Center and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China
| | - Pei Xu
- Translational Medicine Center and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China
| | - Yanjie Xia
- Translational Medicine Center and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Yong Wang
- Translational Medicine Center and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China
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Rose BI. Approaches to oocyte retrieval for advanced reproductive technology cycles planning to utilize in vitro maturation: a review of the many choices to be made. J Assist Reprod Genet 2014; 31:1409-19. [PMID: 25212532 DOI: 10.1007/s10815-014-0334-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/01/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the minutiae associated with oocyte retrieval for use in human in vitro maturation IVF cycles. Many of the relevant features of oocyte retrieval were identified by the Trounson group in the first publication on successful in vitro maturation using transvaginal oocyte harvesting and these were a major focus of this review. METHODS Published human and animal studies, together with topics from mathematics and mechanics, were used to try to understand the importance of different choices that could be made in structuring a transvaginal oocyte retrieval procedure in humans. RESULTS The published literature suggests that the highest oocyte recovery rate occurs using higher pressures and thicker needles, but this comes at the cost of damaging the cumulus oocyte complex. It is likely that this damage is caused by the sheer stress forces exerted on the cumulus oocyte complex due to parabolic forces associated with laminar flow within the needle and is likely worsened by irregular forces during intervals of turbulent flow occurring with entry into the needle. Larger needles also cause more pain and may be associated with more blood loss. Higher velocity entry into the follicle, needle rotation to prevent premature blockage of the lumen, and carefully timed applications of aspiration pressure theoretically optimize oocyte retrieval technique. CONCLUSIONS Oocyte retrieval for in vitro maturation is effected by the interaction of the many choices that need to be made in planning for the procedure. The most difficult decision involves aspiration pressure or fluid flow rate and needle size.
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Affiliation(s)
- B I Rose
- Infertility Solutions, P. C., 1275 South Cedar Crest Boulevard, Allentown, PA, 18103, USA,
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Kushnir VA, Kim A, Gleicher N, Barad DH. A pilot trial of large versus small diameter needles for oocyte retrieval. Reprod Biol Endocrinol 2013; 11:22. [PMID: 23510450 PMCID: PMC3620559 DOI: 10.1186/1477-7827-11-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 03/17/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study was designed to determine whether small diameter needles for oocyte retrieval alter oocyte yields in patients undergoing IVF in comparison to standard large diameter needles. METHODS We conducted a prospective pilot study of 21 consecutive favorable prognosis patients. In each patient one ovary was randomly allocated to retrieval with either a 20 G/ 35 mm (thin) or 17 G/ 35 mm (standard) needle, the other ovary was then retrieved with the opposite needle. RESULTS The standard diameter needle was used to collect a total of 215 oocytes from 355 aspirated follicles (60.6%) compared to 203 oocytes from 352 aspirated follicles (57.7%) with the thinner needle (p = 0.23). Stratifying outcomes by anti-Müllerian hormone (AMH), as indicator of ovarian reserve, and by body mass index (BMI) the oocyte yields, still, did not differ (AMH, r (17) = -0.20, p = 0.44; BMI, r (17) =0.02, p = 0.96). Outcomes also did not vary among women with diminished ovarian reserve (p = 0.17) and in women with normal ovarian reserve (p = 1.00). Operating time was, however, significantly increased by 3.3 minutes per ovary (z = -3.08, p = 0.002) with the thinner needle. CONCLUSIONS Needle diameter does not affect oocyte yield, including in obese patients and patients with diminished ovarian reserve. Thinner needles appear to significantly prolong operating time.
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Affiliation(s)
- Vitaly A Kushnir
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA
| | - Ann Kim
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA
- Foundation for Reproductive Medicine, New York, NY 10021, USA
| | - David H Barad
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA
- Foundation for Reproductive Medicine, New York, NY 10021, USA
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Wongtra-Ngan S, Vutyavanich T, Brown J. Follicular flushing during oocyte retrieval in assisted reproductive techniques. Cochrane Database Syst Rev 2010:CD004634. [PMID: 20824839 DOI: 10.1002/14651858.cd004634.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ultrasound guided transvaginal aspiration of oocytes has replaced other methods of oocyte retrieval for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). However, there is controversy over whether flushing yields a larger number of oocytes and a higher potential for pregnancy than aspiration only. OBJECTIVES To determine whether follicular aspiration and flushing increases live birth or ongoing pregnancy rates and the number of oocytes over aspiration alone in women undergoing IVF and ICSI. SEARCH STRATEGY We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO and the citation lists of relevant publications (to April 2010). SELECTION CRITERIA Randomised controlled trials that compared follicular aspiration and flushing with aspiration alone were included. Trials were excluded if the flushing method comparison was confounded by comparisons of other methods. DATA COLLECTION AND ANALYSIS Eligible studies were assessed for methodological quality. For dichotomous data, odds ratios (OR) and 95% confidence intervals (CI) were calculated. For continuous data, mean differences were reported. The heterogeneity of the studies was examined by using statistical tests of homogeneity and the I(2) statistic. MAIN RESULTS No studies reported on the primary outcome of live birth. There was no evidence (3 studies, 164 patients) to suggest an association between follicular aspiration and flushing and ongoing or clinical pregnancy per woman randomised (OR 1.17, 95% CI 0.57 to 2.38). There was no evidence of a difference in adverse events reported between follicular aspiration and flushing and aspiration only. There was no evidence of significant differences in increased oocyte yield per woman randomised (1 study, 44 patients). Without flushing the operative time was significantly shorter, by 3 to 15 minutes (3 studies, P < 0.001) and the dose of pethidine required was significantly less (50 mg versus 100 mg, P < 0.00001). AUTHORS' CONCLUSIONS There is no evidence that follicular aspiration and flushing is associated with improved clinical or ongoing pregnancy rates, nor an increase in oocyte yield. The operative time is significantly longer and more opiate analgesia is required for pain relief during oocyte retrieval. There is a lack of evidence regarding the effect of follicular aspiration and flushing on live birth rates in the identified data.
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Affiliation(s)
- Supreeya Wongtra-Ngan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 50200
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