1. Oocyte retrieval at 140 mm Hg negative aspiration pressure – a promising alternative to flushing and aspiration in Assisted Reproduction
Dr.Aswathy Kumaran**
Dr.Amar Ramachandran***
Dr.Praveena Pai**
Dr Satish Adiga****
Dr.Pratap Kumar****
****Professor
***Assoc.Professor
**Senior Resident

2. Background
Standard oocyte aspiration pressure – Negative pressure of 120 mm of Hg ( mmHg)
When oocyte retrieval difficult  when antral follicle count < 5 in each ovary
flushing and oocyte retrieval
loss of granulosa cells
corpus luteal defects
Higher aspiration pressures
mechanical trauma to oocyte
poor oocyte quality

3. Aim
To compare oocyte retrieval using negative aspiration pressure of 140mm Hg with retrieval by flushing and aspiration at 120mm Hg in women with poor antral follicle counts.

4. Materials and methods Type of study- retrospective analytic study
Study group –all women undergoing IVF/ICSI following oocyte retrieval at
Manipal Assisted Reproduction Centre,
Dept.Of OBG,
Kasturba Medical College,
Manipal University, Manipal
Study period - 3years (May 2010-April 2013))

5. women whose total antral follicle counts were less than 10
Inclusion criteria
Exclusion Criteria
women whose total antral follicle counts were less than 10
Women who had oocyte retrieval with
Antral follicular count > 10
120 mm of Hg
A combination of two methods

6. Methods Data collection from IVF records In each patient
Oocyte pick up pressure
Women with antral follicle counts less than 10
n=76
Group A
140 mm Hg
n=41(54%)
Group B
Flushing
n=35(46%)
Number of Follicles tapped
Number of Oocytes retrieved
Number of Oocytes fertilized
Number and quality of Embryos obtained
In each
patient
Bhcg 2 weeks after embryo transfer

7. Flushing and aspiration
Analysis
Parameter
Group A
140 mm of Hg n=41
Group B
Flushing and aspiration
n=35
p-value
Mean
Follicles tapped 7
6.8
>0.05
Eggs retrieved 4
3.94
Fertilized
eggs
2.73
2.00
Embryos obtained
2.25
2.10
Chi-square test
The means of each parameter comparable in both groups

8. Comparison of number of oocytes retrieved
Parameter
Group A
140 mm of Hg
n=41
Group B
Flushing and aspiration
n=35
p-value
Mean
Eggs Retrieved/
follicles tapped
0.52
0.60
0.404
Independent sample test
Rate of oocyte retrieval in both groups comparable

9. Flushing and aspiration
Oocyte quality
Parameter
Group A
140 mm of Hg
n=41
Group B
Flushing and aspiration
n=35
p-value
Mean
Eggs fertilised/
eggs retrieved
0.74
0.29
0.016
Embryos developed/
0.66
0.32
0.004
Independent sample test
Functional oocyte quality significantly more in Group A
Loss of granulosa cells in aspirating fluid was 80% in group B versus 10 % group A

10. Comparison of Embryo Quality
Parameter
Group A
140 mm of Hg n=41
Group B
Flushing and aspiration
n=35
p-value
Mean
Gr1 embryos/eggs retrieved
0.68
0.54
0.089
Gr2 embryos/eggs retrieved
0.09
0.14
0.125
Gr3 embryos/eggs retrieved
0.04
0.165
Independent sample test
SD-standard deviation
Independent sample test
The number of high grade embryos per oocytes retrieved
more in Group A
Basak Balaban et al, The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting ;Alpha Scientists in Reproductive Medicine and ESHRE SpecialInterest Group of Embryology Human Reproduction, Vol.26, No.6 pp. 1270–1283, 2011 Advanced Access publication on April 18, 2011 doi: /humrep/der037

11. βHCG positive
Biochemical pregnancy rates significantly more in group A

12. Pregnancy outcomes
Favourable pregnancy outcomes more in group A

13. Merit
Limitation
Study model may used to conduct large multi-centric prospective trials to arrive at a definitive recommendation
Small study
Confounding factors
Retrospective study

14. Conclusion
The oocyte retrieval outcomes with aspiration pressure of 140 mm of Hg is better than that after flushing and aspiration
Oocyte retrieval at 140 mm of Hg in women is a promising alternative to flushing and aspiration in women with poor
antral follicle count
Message

15. Reference
Hans Peter Steiner,Follicular aspiration and flushing,Milder,mildest or back to nature-Textbook of minimal stimulation IVF,JP medical Ltd,Newdelhi,2011;Pages
Hashimoto S, Aisaku Fukudaet al,Effect of aspiration vacuum on the developmental competence of immature human oocytes retrieved using a 20-gauge needle,Reproductive BioMedicine Online ,2007;Vol14, Issue 4 , Pages
Antosik et al,Vaccum Pressure on quality and number of recovered oocytes aspirated from ovarian follicles of swine and cow,Arch.Tierz,Dummerstorf,Poland,2007;Vol.3,Pages

16. Thank you