Flushing follicles or not has been debated for years. The rationale is that flushing of the follicle offers an advantage to the patient, with a larger number of oocytes being collected and therefore a higher potential for pregnancy. Kingsland et al. were the first to perform a randomized trial. They demonstrated that when performing transvaginal ultrasonically guided oocyte recovery, there were no significant differences in number of oocytes retrieved, fertilization rate, or pregnancy rate between those where flushing had been used as compared to no flushing. However, they could show that the operating time was significantly shortened in the non-flushing group (33). Similar results were later demonstrated in another prospective randomized study (34). In a recent publication, a study by Bagtharia and Haloob found that 40% of the oocytes were retrieved in the primary aspirate, whereas up to 82% of oocytes were retrieved with two flushes and 97% of oocytes were retrieved in up to four flushes. Based on this study, they concluded that the optimum number of follicular flushings was four times (35). It could be argued that in this particular study it is not known if the oocytes were trapped in the needle or the tubing after the first aspiration. In our IVF program, we do not flush follicles and have had a recovery rate of 70% per punctured follicle over the last 10 years. Based on our own experience and of published prospective randomized studies, in our opinion routine flushing would seem superfluous in ART.
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