Abstract
Oocyte retrieval is a routine procedure during the application of assisted reproduction technology. However, technical difficulties experienced during oocyte retrieval and the subsequent unsatisfactory number of oocytes obtained are rarely reported. The current study included 10,624 oocyte retrieval cycles from April 2015 to June 2018, and patients were followed up until February 2019. Patients were divided into two groups depending on whether the oocyte number obtained reached the >14-mm follicle number on the day of hCG administration. In the oocyte retrieval not satisfactory (ORNS) group, there were 1,294 cycles, and in the oocyte retrieval satisfactory (ORS) group, there were 9,330 cycles. ORNS patients were older, had a longer duration of infertility, had higher follicle-stimulating hormone, and were more likely to have endometriosis. The ORS group had a higher rate of the use of a follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long ovarian stimulation protocol and a lower rate of the use of a luteal phase short-acting GnRH agonist long protocol. The ORNS group had fewer total number of days of FSH stimulation. On human chorionic gonadotropin day, the ORNS group had higher luteinizing hormone (LH), lower estradiol, and lower progesterone levels. After oocyte retrieval, the oocyte quality and fresh cycle transplantation rate were higher in the ORNS group. An unsatisfactory oocyte retrieval number did not influence the clinical pregnancy rate, miscarriage rate, or live birth rate during the fresh cycles. The cumulative pregnancy rate and the live birth rate were lower in the ORNS group. In conclusion, with a similar number of matured follicles, ORNS was more likely to occur in ovarian dysfunction patients. The follicular phase long-acting GnRH agonist long protocol had lower oocyte retrieval difficulty during IVF/ICSI. ORNS does not affect embryo quality or the fresh cycle pregnancy rate, but it significantly reduces the cumulative pregnancy rate and the live birth rate.
Highlights
Transvaginal oocyte retrieval is a regular procedure in each in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle
Oocyte retrieval is a routine procedure during assisted reproduction technology (ART), but technical difficulties associated with oocyte retrieval and subsequent unsatisfactory numbers of oocytes obtained have rarely been reported
Data showed oocyte retrieval not satisfactory (ORNS) patients tended to be older, have a longer duration of infertility, and have higher follicle-stimulating hormone (FSH), indicating worse ovarian reserve and a higher incidence of infertility caused by endometriosis
Summary
Transvaginal oocyte retrieval is a regular procedure in each in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle. Despite the operator trying to obtain oocytes from each >14mm follicle, an unsatisfactory number of oocytes is retrieved. Follicular flushing has been used in attempts to negate unsatisfactory oocyte retrieval. In a survey of Australian assisted reproduction technology (ART) units, >50% of operators used follicular flushing in addition to direct aspiration during oocyte retrieval [1]. Follicular flushing increased the number of oocytes retrieved [2], but in randomized controlled IVF/ICSI trials, direct aspiration and follicular flushing were associated with similar outcomes, including the numbers of oocytes retrieved, fertilization rates, embryo quality, and pregnancy rates in both normal and poor ovarian responders [3,4,5,6,7,8,9,10]. Follicular flushing has become a safe and efficient way to increase the number of oocytes obtained
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