Effect of Follicular Flushing During Oocyte Retrievalon Clinical Outcome of Assisted Reproductive Technology

Objective:is to determine whether follicular aspiration and flushing increase the number of oocytes yield and pregnancy outcome over aspiration alone in women undergoing ICSI. Study design: prospective randomized controlled trial. One hundred eighty five infertile women who underwent ICSI were included in the study. They were randomized into two groups 92 cases in (aspiration and flushing group) and 93 cases in (aspiration only group),during the period from September 2011 to September 2013. Intervention(S):Controlled ovarian hyperstimulation using long GnRH agonist was the standard protocol, hCGadministrated 10000 iu when three or more follicles were at least 18 mm in largest diameter, Trans-vaginal follicular aspiration performed 34-36 hours after hCG trigger.In the aspiration alone group, a 16 gauge single lumen needle used, with suction continue until a small amount of blood stained fluid appeared in the tubing or flow stop, When flushing accompany aspiration of follicular fluid in the study group, the same needle used with a double-way tap allowing flushing of (2 ml) of embty follicleby Earl's medium till oocyte retrieved or maximum two times. Results:The study observed 60.5 % oocyte recovery rate with aspiration only compared with 80.9 % with follicular aspiration and flushing.Operative time (minutes) was significantly longer among flushing group,the retrieval time was 1.3 fold higher among those undergoing follicular flushing. Pregnancy was non-significantly more frequent among flushing. Implantation rates non-significantly more frequent among flushing group than non-flushing group (31.6% versus 26.3%, P= 0.424) and ongoing clinical pregnancy non-significantly more frequent among flushing group (27.4% versus 21.1% , P= 0.31). Conclusion, flushing non-significantly increase implantation and clinical pregnancy outcome and associated with a significant increase in the procedure time for oocyte retrieval, so patient groups where a small number of oocytes are available for retrieval may represent patients most likely to benefit from follicle flushing as only one extra oocyte may affect the outcome.