Follicular flushing versus direct aspiration in poor responder IVF patients: a randomized prospective study

To compare follicular flushing with a double-lumen needle with direct aspiration on the number of oocytes collected in a poor responder population in IVF.

We conducted a randomized controlled prospective single-center study between March 2011 and June 2016 at the ART center in the Medico-Surgical and Obstetric Center in Schiltigheim, France. Patients undergoing IVF who had ≤ 4 follicles ≥ 14 mm on the day of HCG administration were recruited and then randomized to one of two groups : simple aspiration group (= NO FLUSH) with a single-lumen 17-gauge needle or follicular flushing group (= FLUSH) which underwent oocyte puncture with aspiration and follicular flushing with a double-lumen 17-gauge needle. The primary end-point was the number of oocytes collected. Secondary assessment criteria were the fertilization rate, the number of transferable embryos, the number of clinical pregnancies and their outcome.

252 patients were included: 127 in the Flush group and 125 in the No flush The number of oocytes retrieved per patient was significantly lower in the FLUSH group: 2.41 than in the NO FLUSH group: 3.42 (p < 0.001). The number of transferable embryos, fertilization rate (68.8 % in the FLUSH group versus 75 % p = 0.682), or pregnancy rate weren't different but (15 versus 13). However the number of failed punctures was significantly higher in the FLUSH group (11 % versus 3.2 % p = 0.016) and the duration of oocyte retrieval was significantly longer in the FLUSH group where the median time was 10 min whereas it was only 7 min in the NO FLUSH group, p < 0.001 CONCLUSION: Follicular flushing in poor responders is not beneficial and could be detrimental with an increasing procedure time and less oocytes retrieved.