Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Hum Reprod. 2012 Aug;27(8):2373-9. doi: 10.1093/humrep/des174. Epub 2012 May 30.
Does follicular flushing during assisted reproductive technologies (ART) improve the number of oocytes retrieved?
Follicular flushing during ART does not result in a greater number of oocytes in normal responders.
Despite limited evidence supporting the use of follicular flushing, it continues to be a common procedure in many ART clinics. Prior studies have provided conflicting results regarding the routine use of flushing during oocyte retrieval.
STUDY DESIGN, SIZE, DURATION: Systematic review and meta-analysis of 518 patients who participated in 6 randomized trials over 20 years.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Literature searches were conducted to retrieve randomized controlled trials on follicle or ovarian flushing in ART. Databases searched included PubMed, EMBASE, Web of Science and the Cochrane Database of Clinical Trials (CENTRAL). Six trials that included 518 subjects matched the inclusion criteria. Studies included were limited to trials that were published, randomized trials comparing oocyte retrieval with a single-lumen pick-up needle versus follicle flushing after direct aspiration with a multi-channel oocyte pick-up needle in ART patients.
In each of the trials, measures of the oocyte yield (oocytes retrieved divided by follicles aspirated), total oocytes retrieved, fertilization or pregnancy were not different when comparing direct aspiration with follicle flushing. Four trials reported a higher operative time with follicle flushing. Results of the meta-analysis indicated no significant differences in the oocytes retrieved [weighted mean difference: 0.07, 95% confidence interval (CI): -0.13 to 0.29] or the oocyte yield (odds ratio: 1.06, 95% CI: 0.95-1.18) between the non-flushing and flushing groups.
LIMITATIONS, REASONS FOR CAUTION: All trials featured an open label design and the majority of patients in this meta-analysis were normal responders. The applications of these results to poor responders, patients undergoing natural cycle ART or minimal stimulation ART should be made with caution.
Follicle flushing does not improve ART outcomes in normal-responding patients and should not be performed. This meta-analysis should solidify this recommendation as it includes the largest trial published on the subject and is consistent with a recently published Cochrane review.
STUDY FUNDING/COMPETING INTEREST(S): This work was supported, in part, by the Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD. The authors have no competing interests to declare.
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辅助生殖技术（ART）中卵泡冲洗是否会增加获卵数？
ART 中卵泡冲洗不会增加正常反应者的获卵数。
尽管有有限的证据支持卵泡冲洗的使用，但它在许多 ART 诊所仍然是一种常见的程序。先前的研究对于在取卵过程中常规冲洗的结果提供了相互矛盾的结果。
研究设计、大小、持续时间：对 20 年来参与 6 项随机试验的 518 名患者进行系统评价和荟萃分析。
参与者/材料、设置、方法：检索了关于 ART 中卵泡或卵巢冲洗的随机对照试验的文献。搜索的数据库包括 PubMed、EMBASE、Web of Science 和 Cochrane 临床试验数据库（CENTRAL）。纳入了符合纳入标准的 6 项试验，共 518 例患者。研究仅限于已发表的试验，这些试验比较了在 ART 患者中使用单腔取卵针与直接抽吸后使用多通道取卵针进行卵泡冲洗时的取卵数（吸出的卵泡数除以吸出的卵泡数）、总获卵数、受精或妊娠。
在每个试验中，当比较直接抽吸与卵泡冲洗时，卵母细胞产量（每吸出卵泡数的获卵数）、总获卵数、受精或妊娠率均无差异。四项试验报告卵泡冲洗的手术时间较长。荟萃分析结果表明，非冲洗组与冲洗组的获卵数[加权均数差：0.07，95%置信区间（CI）：-0.13 至 0.29]或卵母细胞产量（比值比：1.06，95%CI：0.95-1.18）无显著差异。
局限性、谨慎的原因：所有试验均采用开放标签设计，本荟萃分析中的大多数患者为正常反应者。在将这些结果应用于反应不良者、接受自然周期 ART 或微刺激 ART 的患者时应谨慎。
卵泡冲洗不能改善正常反应患者的 ART 结局，不应进行。由于本荟萃分析包括了关于该主题的最大规模试验，并且与最近发表的 Cochrane 综述一致，因此它应该巩固这一建议。
研究资金/利益冲突：这项工作得到了美国国立卫生研究院（NIH）国家儿童健康与人类发育研究所（NICHD）生殖和成人内分泌学项目的部分支持，位于马里兰州贝塞斯达。作者没有利益冲突需要申报。
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