Follicular flushing increases the number of oocytes retrieved in women with diminished ovarian reserve and serum progesterone levels of ≤ 5.0 ng/ml post surge Follicular flushing increases the number of oocytes retrieved

Abstract

Objective
To evaluate the utility of follicular flushing increase the number of oocytes retrieved in women with diminished ovarian reserve (DOR) and serum progesterone of ≤ 5.0 ng/ml the day after final oocyte maturation induction.
Design
Retrospective study.
Subjects
Women <4O years, with DOR, underwent controlled ovarian stimulation for an invitro fertilization cycle (IVF) were separated into two groups: Group 1: follicular flushing (n=35) Group 2: direct aspiration (n=33).
Main outcomes measured
Our primary outcome was the number of retrieved oocytes. Secondary outcome measures included the total procedure time, mean oocyte/follicle retrieval rate, mean number of metaphase II (MII) oocytes, MII rate, mean number of fertilized oocytes, and blastulation rate.
Results
A total of 288 oocytes were retrieved: 59.0% from the flushing group and 41.0% from the direct aspiration group. The mean number of oocytes retrieved by aspiration and subsequent flushes was significantly higher than the number retrieved from direct aspiration (4.4 ± 0.96 versus 2.64 ± 1.00, P = 0.003). The oocyte/follicle rate was also significantly higher in women in Group 1 vs Group 2 (68.3% vs 48.7%, p=0.001). No significant differences were observed in the total number of MII, oocyte maturation rate, fertilization rate nor blastulation rate. The retrieval procedure time was higher among those who underwent follicular flushing, with an estimated increase of 6.5 minutes (14.0 ± 2.5 versus 7.5 ±1.7, P = 0.003).

Conclusions
The results of this analysis in the poor responders found that women with DOR and post surge P4 levels of ≤ 5.0 ng/ml may benefit from follicular flushing on the number of oocytes retrieved.