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Proof is pending if follicular flushing increases oocyte number in poor responders: an update of a systematic review

  • Kay Neumann
    Correspondence
    Correspondence; Kay Neumann, Kinderwunsch Praxisklinik Fleetinsel Hamburg, Admiralitätstraße 4, 20459 Hamburg, Germany
    Affiliations
    Department of Gynaecological Endocrinology and Reproductive Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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  • Georg Griesinger
    Affiliations
    Department of Gynaecological Endocrinology and Reproductive Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany

    Kinderwunsch Praxisklinik Fleetinsel Hamburg, Admiralitätstraße 4, 20459 Hamburg, Germany
    Search for articles by this author
Published:November 21, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.11.011

      Abstract

      Research Question

      ; Does flushing of follicles at ovum-pick increase the number of retrieved oocytes in poor response IVF-patients?

      Design

      ; An update of an electronic literature search was performed to identify RCTs investigating follicular flushing versus no flushing in patients with poor response in IVF treatment. No exclusion criteria for type of needle, stimulation or protocol were applied. A meta-analysis using the software RevMan 5.4 was conducted.

      Results

      ; Six RCTs were identified which all had the primary objective of testing for an increase in mean COC or/and mean metaphase-II oocytes between flushing and no flushing. A double-lumen needle was utilized in five trials, one study investigated a pseudo-double lumen needle whereas a conventional single lumen needle was used in the control groups. Main risk of all included studies is a lack of blinding of physicians performing the puncture and incomplete data in four trials.Heterogeneity of direction and size of effect of follicular flushing on mean oocyte number retrieved was detected (I2=80, p=0.0001), which precludes synthesis of the aggregated data. Two studies showed a decrease or tendency towards a decrease in oocyte numbers, respectively, one study showed similar oocyte numbers and one study showed a strong tendency towards increased oocyte numbers with flushing, respectively. A similar picture was seen for metaphase-II oocytes (I2=73, p=0.002).

      Conclusion

      ; It is uncertain whether follicular flushing in poor response IVF patients impacts the number of retrieved oocytes. Larger pragmatic trials are warranted to clarify the effect of flushing on oocyte numbers and clinical outcomes in poor responders and monofollicular patients.

      Key Words

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      Biography

      Kay Neumann is a physician and was undergoing subspeciality training in reproductive medicine at the Department of Gynaecological Endocrinology and Reproductive Medicine of the University of Luebeck, Germany. In 2020 he completed his Phd thesis ("Habilitation") at the University of Luebeck. In 02/2021 he has started to work at the Kinderwunsch Praxisklinik Fleetinsel in Hamburg, Germany.