OUTCOMES OF FOLLICULAR FLUSHING VERSUS NONFLUSHING ASPIRATION IN POOR OVARIAN RESPONDERS WOMEN UNDERGOING INTRACYTOPLASMIC SPER INJECTION - EMBRYO TRANSFER: A RANDOMIZED CLINICAL TRIAL

Aim: The main objective of this trial was to compare three - times follicular flushing aspiration (FFA) during ovum pick up (OPU) via modified single lumen needle (MSLN) to conventional direct non -flushing follicular aspiration (NFA) via single lumen needle (SLN) regards number of retrieved cumulus-oocyte complex (COCs), as well as other outcomes of assisted reproductive technology ? embryo transfer cycles (ARF-ET) in women, had poor ovarian response (POR) after controlled ovarian hyperstimulation (COH). Patients and Methods: This prospective, randomized, concealed allocation, double-blinded, controlled, superiority trial was performed at Hawa specialized IVF center, Benha, El- Qulobia, Egypt, between May 2017 and September 2018. One hundred women with POR after COH undergoing ART ? ET cycles were allocated to OPU via MSLN/FFA (interventional group) or SLN/NFA (control group). Outcomes were number of retrieved COCs, Metaphase II (MII) oocytes, oocyte recovery rate (ORR), as well as outcomes of intracytoplasmic sperm injection (ICSI) procedures including fertilization rate (FR), implantation rate (IR), total cleavage embryo (ICE), number of women with positive B-HCG, clinical and ongoing pregnancy rate (CPR) (OPR) and live birth rate (LBR) per cycle as well as per ET. Results: The outcomes in both interventional as well as control groups was similar with no statistical significant differences regards number of retrieved oocytes (2.81  1.36 vs 2.62  1.82, p = 0.48), FR (68.36  12.36 vs 70.38  15.37, p = 0.47), IR (25.62  9.36 vs 24.82  10.36, p = 0.68), TCE (2.26  1.28 vs 2.36  1.36, p = 0.70), positive B-HCG (36% vs 38%, p = 0.83), CPR/ cycle (22% vs 20%, p = 0.80) and LBR / cycle (16% vs 14%, p = 6.78). While both groups were significantly differs in procedures time (7.81  3.61 vs 14.61  8.61, p < 0.0001) as well as total anaesthesia time (10.21  4.61 vs 16.81  8.72, p = 0.001). Conclusion: In women with POR undergoing ART ? ET cycles after COH, follicular flushing OPU is time-consuming despite similar outcomes including the number of retrieved mature oocytes to live birth rate.