Follicular Flushing
Follicular Flushing
Patients with infertility often undergo in vitro fertilization (IVF) to achieve a pregnancy,
 which involves ovarian stimulation, monitoring of follicular growth, oocyte retrieval, sperm
 insemination, embryo culture and embryo transfer.

 The oocytes are removed during surgery by aspirating the follicles using a single lumen
 needle with an ultrasound to guide the procedure. There is some data that flushing the
 follicles with embryo culture media before aspiration using a double lumen needle increases
 the number of oocytes retrieved, particularly among poor responding patients for whom each
 additional oocyte recovered may substantially alter the outcome of that IVF cycle.

 The objective of the research is to evaluate the effect of follicular flushing in poor
 responders on IVF cycle outcomes.
Patients with infertility often undergo in vitro fertilization (IVF) to achieve a pregnancy,
 which involves ovarian stimulation, monitoring of follicular growth, oocyte retrieval, sperm
 insemination, embryo culture and embryo transfer. The number of embryos obtained is dependent
 on the number of oocytes retrieved.

 The objective of the research is to evaluate the effect of follicular flushing in poor
 responders on IVF cycle outcomes, including the number of oocytes retrieved, number of mature
 oocytes, fertilization rate, number of embryos transferred, implantation rate, miscarriage
 rate, live birth rate, operating room time, and luteal estradiol and progesterone levels.

 The research entails a prospective, randomized, controlled trial of poor-responder patients
 who are undergoing IVF treatment at The Ronald O. Perelman and Claudia Cohen Center for
 Reproductive Medicine, defined as patients who have ≤ 4 follicles that are ≥ 12mm on the day
 of hCG trigger.

 Patients identified as poor responders will be consented and randomized to follicular
 flushing versus aspiration without flushing. A 2-5mL flush using embryo culture media
 followed by aspiration of the follicle will be performed in the patients randomized to the
 flushing group, with subsequent flushes until an oocyte is identified or up to 4 flushes
 maximum.

 Patients being enrolled in this research study will undergo IVF regardless of participation
 in this research study.

 Randomization:

 A series of randomized blocks of 2 will be generated for the study. This will provide
 assurance that after two patients are enrolled, there will be one patient assigned to each
 group- follicular flushing versus aspiration without flushing. This process of blocked
 randomization ensures an equal distribution between the two study arms of patients.
Inclusion Criteria:

 -  Pts ages 18-45 undergoing IVF

 -  Pts with ≤ 4 follicles that are ≥ 12mm on day of HCG

 Exclusion Criteria:

 -  Pts undergoing natural cycles (i.e. those with intentionally low # of follicles)