Double-Lumen Needle versus Conventional Oocyte Retrieval in IVF-ET for Diminished Ovarian Reserve (DOR): A Comparative Analysis of Clinical Outcomes

Double-Lumen Needle versus Conventional Oocyte Retrieval in IVF-ET for Diminished Ovarian Reserve (DOR): A Comparative Analysis of Clinical Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Double-Lumen Needle versus Conventional Oocyte Retrieval in IVF-ET for Diminished Ovarian Reserve (DOR): A Comparative Analysis of Clinical Outcomes Xiaoxia Zhang, Li Sun, Shuqi Ge This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7018162/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This retrospective cohort study analyzed 1,165 IVF-ET cycles of diminished ovarian reserve (DOR) patients (≤ 5 follicles > 14 mm at trigger) comparing double- versus single-lumen oocyte retrieval (559 vs 606 cycles). The double-lumen group demonstrated superior oocyte retrieval efficiency (91.06% vs 85.15%, P < 0.05) despite comparable median oocyte yield (2 [IQR 1–3] in both groups). Fresh cycles revealed significantly reduced miscarriage rates (15.38% vs 55.56%, P = 0.002) and a non-significant trend toward higher live birth rates (21.00% vs 11.49%) with double-lumen retrieval. No between-group differences were observed in fertilization success (IVF: 66.52% vs 62.30%; ICSI: 75.27% vs 70.16%), embryo quality metrics, or frozen-thawed cycle outcomes (clinical pregnancy rate: 22.93% vs 29.09%; live birth rate: 13.66% vs 18.18%, all P > 0.05). Safety profiles were equivalent between groups. The findings suggest double-lumen needles optimize follicular flushing efficacy in DOR patients, significantly reducing oocyte retention risks and fresh-cycle pregnancy loss without compromising procedural safety. While cumulative live birth rates remained unaffected, the technique's value resides in maximizing retrieval attempts for poor responders-particularly those with recurrent failure or minimal follicles. This approach may serve as a strategic adjunct in ART protocols for advanced-age populations with limited ovarian response. double-lumen needle oocyte retrieval diminished ovarian reserve assisted reproductive technology oocyte retrieval rate Embryo Transfer‌ Background Transvaginal oocyte retrieval ( 1 , 2 ) is a conventional method for oocyte collection in assisted reproductive technology. With the continuous improvement and progress of production technology, the development of oocyte retrieval needles is becoming more and more close to clinical use ( 3 , 4 ). The phenomenon of late marriage and late childbearing in society has increased, and the fertility desire of young women has declined. Especially after the release of the three-child policy in China, the main force of fertility is mainly people over 35 years old. As the age increases, the ovarian reserve decreases, and the embryo euploid rate decreases ( 5 , 6 ) Even through Controlled Ovarian Hyperstimulation (COH)‌, the number of eggs obtained does not reach an ideal level. In order to improve the oocyte retrieval rate of this group of people, Double-Lumen Needle Aspiration with Follicular Flushing (DLN-AFF) was employed to optimize oocyte recovery. Follicular fluid is sucked through one cavity and follicles are washed through one cavity. We hope to improve the oocyte retrieval rate through this technical means. For patients, obtaining one more oocyte means that one more embryo may be used for transplantation, increasing the chance of pregnancy. Follicular fluid is sucked through one cavity and follicles are washed through one cavity. We hope to improve the oocyte retrieval rate through this technical means. For patients, obtaining one more oocyte means that one more embryo may be used for transfer and increase the chance of pregnancy. The double-lumen oocyte retrieval technique ( 7 , 8 ) initially used in patients with low ovarian reserve, and later gradually applied to patients with less follicles and worried about unsatisfactory oocyte retrieval rate. A large number of studies have confirmed that patients with low ovarian reserve ( 9 , 10 ) have an increased risk of cycle cancellation and a decreased pregnancy rate due to the decrease in the number of oocytes retrieved, which brings great psychological burden and economic pressure to patients. This study retrospectively analyzed the patients with Diminished Ovarian Reserve (DOR) and HCG trigger day follicle diameter > 14mm follicle number ≤ 5 who underwent single or double lumen needle oocyte retrieval, a total of 1165 oocyte retrieval cycles. By analyzing and comparing the number of oocytes retrieved, the rate of oocytes retrieved, the number of normal fertilization, the number of high-quality embryos and other indicators of the two groups of patients, the application value of double-lumen needle oocyte retrieval in assisted reproductive technology was discussed. Materials and methods Research object Patients with DOR and ≤ 5 follicles with follicle diameter > 14mm on HCG trigger day from January 2019 to December 2024 in the Reproductive Center of the Third Affiliated Hospital of Sun Yat-sen University were included in this study. Basic data of the included patients were collected. The basic data of the patients were collected, such as the age of both partners, the BMI of the woman, the basal antral follicle number, the number of follicles with a diameter of > 14mm on the day of HCG administration, the total amount of Gn, the days of Gn administration, etc. The laboratory data included the number of eggs obtained, the number of available embryos, and the number of high-quality embryos and comparing the live births of single transplantation. Our study was conducted in strict accordance with the ‌Declaration of Helsinki‌ (2013 revision). The study was approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University (Approval No. [II2025-155]). Written informed consent was obtained from all individual participants included in the study prior to data collection. Exclusion criteria: patients with premature ovulation; patients with normal ovarian reserve function; The fertilization method was late rescue ICSI patients. Special circumstances: When comparing the outcome of live births after fresh or frozen embryo transfer, due to the fact that some patients discard frozen embryos or accumulate embryos without thawing, the clinical outcome of some patients is lacking. In the superovulation cycle, when the diameter of the dominant follicle reached 18mm, human chorionic gonadotropin (HCG) 4000-10000IU or recombinant HCG 250ug was used for trigger, and eggs were taken 36–38 hours after injection. Single-Lumen Needle Oocyte Retrieval Group‌(SL-OR Group)(Wallace, cooper surgical, Denmark) : Remove the puncture guide line on the B-ultrasound screen, put the 17G single-lumen needle into the puncture guide device, and aspirated follicular fluid at a negative pressure of 100-120mmHg. Double-Lumen Needle Oocyte Retrieval Group‌༈DL-OR Group༉ (Wego, Shandong Wego Ruisheng Medical Device Co., Ltd‌): Under the guidance of B-ultrasound, the clinician used the 17G double-lumen needle to puncture the follicles, and pumped the follicular fluid with a negative pressure of 100-120mmHg. One channel pumped the follicular fluid, while the other channel was injected with PBS culture solution at the same time, and each follicle was washed multiple times. The obtained oocytes were selected according to the indications of in vitro fertilization embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI), combined with the concentration and viability of the man's semen after processing on the day of the operation. Embryo score: The cleavage stage embryo score standard refers to the Istanbul consensus, and the score is based on the number of cleavage stages, the degree of fragmentation, and the uniformity of the blastomeres. High quality cleavage stage embryos as cleavage ball number 7–10, cell size uniform, debris amount < 10%. According to the level of Gardner blastocyst scoring system for blastocyst, the transplantable blastocysts were scored as stage 3 or above, and the inner cell mass and trophoblast were not at the same time as C ; the high-quality blastocysts were scored as stage 3 or above, and the inner cell mass and trophoblast did not contain C. All embryos were frozen and thawed using a Japanese Kato commercial reagent kit. The obtained embryos were subjected to D3 or D5 fresh cycle transplantation according to individual conditions or thawed embryo transfer after cryopreservation due to endometrial factors and personal factors. Routine luteal support was started on the day of oocyte retrieval in the fresh cycle, the day of endometrial transformation in the artificial cycle of thawed embryo transfer, and routine luteal support was performed after ovulation was confirmed in the natural cycle. Serum β-HCG level was detected 14 days after embryo transfer. When serum β-HCG ≥ 10U/L, HCG was positive. Clinical pregnancy was defined when the gestational sac and fetal heart beats were detected by transvaginal ultrasound at 4–5 weeks after embryo transfer. Live birth was defined as the delivery of a live infant at or after 28 completed weeks‌. Statistical analysis SPSS 26.0 software was used for statistical analysis of the data. The measurement data obeying the normal distribution were expressed as mean ± standard deviation (x ± s). Non-normally distributed data were expressed as median and quartile M (P25, P75). The count data were expressed as rate (%), and the chi-square test or Fisher 's exact test was used for comparison between groups. P < 0.05 was considered statistically significant. Results 1. Comparison of basic data between the two groups: A total of 1165 oocyte retrieval cycles were included in this study. According to the oocyte retrieval puncture needle used on the day of oocyte retrieval, they were divided into two groups, including 606 cases in the SL-OR Group and 559 cases in the SL-OR Group.The basic data included the couple's age, the woman's BMI, infertility years, AMH level, basic FSH, PRL, basic antral follicles, and the number of follicles with follicle diameter > 14mm on HCG day. There was no statistically significant difference (P > 0.05). There were significant differences in the total amount of Gn and Gn days between the two groups (p < 0.001). Show in ‌ Table 1 ‌. Table 1 basic information in two groups Variable SL-OR Group DL-OR Group P -value Number of cases 606 559 Female age (years) 39.52 ± 4.68 39.12 ± 4.80 0.155 Male age (years) 40.94 ± 6.53 40.05 ± 5.77 0.015* Female's BMI (kg/m 2 ) 22.39 ± 2.81 22.31 ± 3.16 0.633 Infertility duration (years) 4.12 ± 3.49 3.94 ± 3.52 0.383 Protocol Antagonist protocol 200 239 < 0.001* Mild Stimulation Protocol 268 169 Natural Cycle Protocol‌ 69 68 PPOS Protocol‌ 7 45 ‌Luteal Phase Stimulation Protocol‌ Luteal Phase Short-Acting Long Protocol‌ Luteal Phase Long-Acting Long Protocol‌ Other Options 24 12 15 11 4 15 14 5 AMH (ng/ml) 0.60 (0.34, 0.95) 0.54 (0.30, 1.01) 0.080 Basal FSH (IU/L) 10.50 ± 6.45 11.33 ± 8.68 0.084 PRL (ug/L) 15.85 (12.13, 25.68) 15.54(10.79, 23.58) 0.382 Basal E2 (pg/ml) 51.04 (31.26, 75.73) 46.28(28.33, 73.11) 0.032* ‌Total Gn Dosage‌ (IU) 1787.48 ± 864.56 2057.65 ± 909.06 < 0.001* Duration of Gn Use(day) 8.13 ± 2.59 8.76 ± 2.86 14mm on HCG day 2 ( 1 , 3 ) 2 ( 1 , 3 ) 0.233 Values are presented as mean ± standard deviation, BMI body mass index, AMH anti-Müllerian hormone, FSH follicle stimulating hormone, PRL prolactin, E2 estrogen, Gn gonadotropin, AFC Antral Follicle Count, 2. Laboratory data on oocyte retrieval, fertilization and related Parameters in two groups: The ‌oocyte retrieval rate‌ of ‌double-lumen needle‌ was significantly higher than that that of single-lumen needle (91.06% VS 85.15%), the difference was statistically significant (P < 0.05). The proportion of primary infertility in patients with double-lumen needle was higher than that in patients with single-lumen needle (39.1% VS 26.6%), the difference was statistically significant (P < 0.001). But there were ‌no statistically significant differences‌ between the two groups in terms of infertility type, fertilization method, number of oocytes retrieved, number of high-quality embryos, normal fertilization rate of IVF and ICSI, number of available embryos and number of frozen embryos between the two groups ( P > 0.05). Show in ‌ Table 2 ‌. Table 2 Laboratory data in the two groups Variable SL-OR Group DL-OR Group P -value Number of cases 606 559 No oocyte retrieval cycles 90 50 Rate of oocyte-obtained (%) 85.15 (516/606) 91.06 (509/559) < 0.05* Type of infertility Primary infertility 26.68 (148/516) 39.10 (199/509) < 0.001* Secondary infertility 71.32 (368/516) 60.90 (310/509) Method of fertilization IVF 81.59 (421/516) 80.35 (409/509) 0.614 ICSI 18.41 (95/516) 19.65 (100/509) Number of retrieved oocytes 2 ( 1 , 3 ) 2 ( 1 , 3 ) 0.727 Normal fertilization rate in IVF (%) 66.52 (620/932) 62.30 (537/862) 0.062 Normal fertilization rate in ICSI (%) 75.27 (137/182) 70.16 (134/191) 0.268 Number of high-quality Day 3 Embryos‌ 1 (0, 1) 1 (0, 1) 0.544 Number of Usable Embryos‌ 1 ( 1 , 2 ) 1 ( 1 , 2 ) 0.068 Number of Frozen Embryos 1 ( 1 , 2 ) 1 ( 1 , 2 ) 0.938 Rate of oocyte-obtained oocyte-obtained cycles/ total oocyte retrieval cycles, normal fertilization rate IVF number of 2PN/number of oocyte obtained×100%, ICSI number of 2PN /number of mature oocyte injected×100%, IVF in vitro fertilization, ICSI intracytoplasmic sperm injection, high-quality embryo rate number of high-quality embryos /number of 2PN cleavage× 100%, median (25th centile, 75th centile) or % (n), Usable Embryos Number of transferred embryos plus number of frozen embryos ‌*P < 0.05 ( 3 ) Two groups of fresh cycle transplantation: 105 cases of fresh embryo transfer in single-lumen needle oocyte retrieval, 100 cases of fresh embryo transfer in double-lumen needle oocyte retrieval, the two groups were mainly transferred cleavage stage embryos and the number of fresh blastocyst transfer was relatively small. Both groups prioritized cleavage-stage embryo transfers, with minimal fresh blastocyst utilization. Embryo selection for D3 transfers required at least one high-quality embryo in most cases. The abortion rate of the SL-OR group was significantly higher than that of the DL-OR group (P = 0.002). There was no significant difference in the clinical pregnancy rate and ectopic pregnancy rate between the two groups (P = 0.963). The live birth rate of the single needle group was lower than that of the double needle group (11.49% VS 21.00%), but the difference was not statistically significant (P = 0.062). Show in ‌Table 3 . Table 3 Fresh cycle transplants in the two groups Variable SL-OR Group DL-OR Group χ 2 P -value Transplantation cycles 105 100 Type of embryo transfer Number of D3 embryos 98.10 (103/105) 100.00 (100/100) 1.924 0.165 Number of D5 embryos 1.90 (2/105) 0 (0/100) D3 Embryo Grading No high-quality embryos 30.10 (31/103) 33.00 (33/100) 0.198 0.656 At least one high-quality embryo 69.90 (72/103) 67.00 (67/100) Clinical pregnancy rate (%) 25.7 (27/105) 26.00 (26/100) 0.002 0.963 Miscarriage rate (%) 55.56 (15/27) 15.38 (4/26) 9.294 0.002* Ectopic pregnancy rate (%) 0/27 0/26 Live birth rate (%) 11.49 (12/105) 21.00 (21/100) 3.474 0.062 D3 embryos The cleavage stage embryos, D5 embryos blastocyst, *P < 0.05 ( 4 ) Transplantation of the thawing cycle in the two groups: A total of 370 thawed embryo transfer cycles were included, including 205 cases of single-chamber oocyte retrieval and 165 cases of double-chamber oocyte retrieval. The two groups of patients were mainly transplanted cleavage-stage embryos, and the transplanted embryos were mainly containing at least one high-quality embryo. The clinical pregnancy rate, abortion rate, ectopic pregnancy rate, and live birth rate of the two groups were comparable, and the difference was not statistically significant. Show in ‌ Table 4. Table 4 Thawing cycle transplants in the two groups Variable SL-OR Group DL-OR Group χ 2 P -value Transplantation cycles 205 165 Type of embryo transfer Number of D3 embryos 96.59 (198/205) 95.76(158/165) 0.172 0.678 Number of D5 embryos 3.41 (7/205) 4.24(7/165) D3 Embryo Grading No high-quality embryos 25.76 (51/198) 22.15 (35/158) 0.624 0.430 At least one high-quality embryo 74.24 (147/198) 77.85 (123/158) Clinical pregnancy rate (%) 22.93 (47/205) 29.09 (48/165) 1.820 0.177 Miscarriage rate (%) 34.04 (16/47) 35.42 (17/48) 0.020 0.888 Ectopic pregnancy rate (%) 2.13 (1/47) 2.08 (1/48) 0.000 0.988 Live birth rate (%) 13.66 (28/205) 18.18 (30/165) 1.145 0.234 Discussion The advantage of double-lumen needle oocyte retrieval is that one channel punctures the follicle, and the other channel can be perfused with the culture medium to ' flush ' the follicle, which can reduce the risk of oocyte retention, improve the patient 's oocyte retrieval rate, reduce the cycle cancellation rate, and increase the number of transplantation. However, some studies have suggested that washing follicles, with the increase of washing times, is bound to prolong the operation time, and the culture medium is injected into the follicles, which increases the risk of postoperative infection ( 11 , 12 ). In a single follicle retrieval study, the use of a double-lumen needle increased the number of mature oocytes, increasing the oocyte retrieval rate to 83% by the fifth flush of follicles. However, there was no difference in clinical pregnancy rate and live birth rate between the two groups ( 13 ). It has also been reported that there is no benefit of using double-lumen needle for poor ovarian response, not only prolonged the operation time, but also decreased the oocyte retrieval rate ( 14 ). Other studies have suggested that double-lumen oocyte retrieval does not improve clinical outcomes ( 15 ). A 2018 Cochrane review showed no improvement in oocyte retrieval rate or live birth rate for patients with normal or poor ovarian response ( 16 ). Previous studies mostly focused on the comparison of the results of single and double-needles used for single follicle, and there were few studies on the use of single and double-needles for more than one mature follicle or more. Our study focused on the comparison of the situation of oocyte retrieval with single and double needles when the follicle diameter was greater than 14mm and less than 5 follicles on HCG trigger day in IVF cycles of patients with DOR. A total of 1165 oocyte retrieval cycles were included in this study, including 606 cases in the SL-OR Group and 559 cases in the DL-OR group. The results showed that the oocyte retrieval rate of DL-OR group was significantly higher than that of SL-OR group (91.06% vs 85.15%, P < 0.05). For these patients, especially DOR or elderly patients, obtaining one more oocyte means that may be used for transplantation to increase pregnancy opportunities. A total of 205 fresh embryo transfer cycles were performed in our study (105 cases in the SL-OR group and 100 cases in the DL-OR group). There were 370 cycles of thawed embryos (205 cases in the SL-OR group and 165 cases in the DL-OR group). Both fresh embryo transfer and frozen embryo transfer were mainly performed with cleavage stage embryos and at least one high-quality embryo. This study found that the laboratory outcomes and clinical pregnancy rate were similar between the two groups. However, the abortion rate of fresh embryo transfer in the DL-OR group was lower than that in the SL-OR group. In this study, 559 cases of double-lumen needle oocyte retrieval group were not found to have postoperative infection after oocyte retrieval, suggesting that double-lumen needle oocyte retrieval does not increase the risk of postoperative infection under the condition of routine surgical operation. This study was a retrospective study focusing on patients with ‌poor ovarian reserve‌, characterized by ‌low oocyte yield‌ and ‌limited availability of viable embryos‌. Most patients underwent ‌fresh embryo transfer‌ (either cleavage-stage or blastocyst) infrequently, primarily due to strategies for ‌embryo accumulation‌ or concerns about the potential impact of ovarian stimulation medications on the endometrium. In analyzing ‌clinical live birth outcomes‌, we only included cases with ‌a single fresh embryo transfer‌ or ‌a single frozen-thawed embryo transfer‌ (in which the ‌highest-quality embryo available‌ was transferred). Therefore, this study did not discuss ‌cumulative pregnancy rates‌ or ‌cumulative live birth rates‌. Additionally, some patients still had remaining embryos that were either ‌cryopreserved‌ or ‌discarded‌, resulting in incomplete clinical outcome data for these cases. Conclusions In summary, by analyzing the DOR patients who used single-lumen needle oocyte retrieval and double-lumen needle oocyte retrieval in our center in recent years, it was found that double-lumen needle oocyte retrieval significantly improved the oocyte retrieval rate and reduced the cycle cancellation rate. By minimizing oocyte retention via follicular flushing, its core value lies in maximizing oocyte retrieval, offering additional opportunities for embryo transfer in patients with recurrent failure or minimal follicles. For DOR patients, oocytes are recovered to the greatest extent, the oocyte retrieval rate is increased, the great psychological pressure and economic burden caused by patients' failure to obtain oocytes are reduced, and more transplantation opportunities are brought to patients. This approach may serve as a supplementary strategy for advanced-age or poor-responder populations. Declarations Ethics approval and consent to participate ‌ This study was reviewed and approved by the ‌ Ethics Committee of The Third Affiliated Hospital of Sun Yat-sen University ‌ (Approval No. [II2025-155]). The Ethics Committee waived the need for written informed consent due to the retrospective nature of the study. Consent for publication This retrospective analysis utilized de-identified patient data approved by the ‌ Ethics Committee of The Third Affiliated Hospital of Sun Yat-sen University ‌ (Approval No. [II2025-155]) with waived individual consent, complying with: Helsinki Declaration §32 (2013) for retrospective studies HIPAA Privacy Rule §164.514(a) for data anonymization ICMJE recommendations on secondary data use Availability of data and materials The datasets are available from the corresponding author on reasonable request. Competing interests The authors declare no competing financial interests and manuscript is approved by all authors for publication. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions Conceptualization, Data curation, Writing-original draft: Xiaoxia Zhang; Data curation: Li Sun; Supervision, Writing-review & editing: Shuqi Ge; Writing-review & editing: all authors. Acknowledgements Not applicable Authors' information Xiaoxia Zhang and Li Sun are co-first authors. Shuqi Ge is the principal investigator (ORCID: https://orcid.org/0009-0004-2838-0786). References Ludwig AK, Glawatz M, Griesinger G, Diedrich K, Ludwig M. Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of > 1000 oocyte retrievals. Hum Reprod. 2006;21(12):3235–40. 10.1093/humrep/del284 . Ozaltın S, Kumbasar S, Savan K. Evaluation of complications developing during and after transvaginal ultrasound - guided oocyte retrieval. Ginekol Pol. 2018;89(1):1–6. 10.5603/GP.a2018.0001 . Miller KA, Elkind-Hirsch K, Benson M, Bergh P, Drews M, Scott RT. A new follicle aspiration needle set is equally effective and as well tolerated as the standard needle when used in a prospective randomized trial in a large in vitro fertilization program. Fertil Steril. 2004;81(1):191–3. 10.1016/j.fertnstert.2003.06.010 . Ronchetti C, Cirillo F, Immediata V, et al. A Monocentric Randomized Controlled Clinical Trial to Compare Single- and Double-Lumen Needles in Oocyte Retrieval Procedure in Assisted Reproductive Technologies. Reprod Sci. 2023;30(9):2866–75. 10.1007/s43032-023-01238-4 . Predheepan D, Salian SR, Uppangala S, Kalthur G, Kovačič B, Adiga SK. Advanced maternal age affects their frozen-thawed embryo susceptibility to high oxygen environment. Sci Rep. 2024;14(1):23008. 10.1038/s41598-024-53038-8 . La Marca A, Capuzzo M, Imbrogno MG et al. The complex relationship between female age and embryo euploidy. Minerva Obstet Gyneco l. 2021; 73 (1): 103–10. ‌DOI‌: 10.23736/S2724-606X.20.04735-5 Georgiou EX, Melo P, Cheong YC, Granne IE. Follicular flushing during oocyte retrieval in assisted reproductive techniques. Cochrane Database Syst Rev. 2022;11(11):CD004634. 10.1002/14651858.CD004634.pub4 . Lainas G, Lainas T, Kolibianakis E. The importance of follicular flushing in optimizing oocyte retrieval. Curr Opin Obstet Gynecol. 2023;35(3):238–45. 10.1097/GCO.0000000000000860 . Wang Y, Liu S, Gan F, Xiong D, Zhang X, Zheng Z. Melatonin levels and embryo quality in IVF patients with diminished ovarian reserve: a comparative study. Reprod Biol Endocrinol. 2024;22(1):127. 10.1186/s12958-024-01204-y . Shahine LK, Marshall L, Lamb JD, Hickok LR. Higher rates of aneuploidy in blastocysts and higher risk of no embryo transfer in recurrent pregnancy loss patients with diminished ovarian reserve undergoing in vitro fertilization. Fertil Steril. 2016;106(5):1124–8. 10.1016/j.fertnstert.2016.06.028 . Malhotra N, Vignarajan CP, Dolkar D, Mahey R, Vanamail P. Follicular Flushing Versus Direct Aspiration at Oocyte Retrieval in Poor Responders Undergoing in vitro Fertilization: A Randomized Controlled Tria l . J Hum Reprod Sci. 2020;13(2):150–4. 10.4103/jhrs.JHRS_157_19 . Kara M, Aydin T, Turktekin N. Is follicular flushing really effective? A clinical study. Arch Gynecol Obste t. 2012; 286 (4): 1061–1064. DOI‌: 10.1007/s00404-012-2417-0 Kohl Schwartz AS, Calzaferri I, Roumet M, et al. Follicular flushing leads to higher oocyte yield in monofollicular IVF: a randomized controlled trial. Hum Reprod. 2020;35(10):2253–61. 10.1093/humrep/deaa183 . Calabre C, Schuller E, Goltzene MA, et al. Follicular flushing versus direct aspiration in poor responder IVF patients: a randomized prospective study. Eur J Obstet Gynecol Reprod Biol. 2020;248:118–22. 10.1016/j.ejogrb.2020.03.027 . Neumann K, Griesinger G. Follicular flushing in patients with poor ovarian response: a systematic review and meta-analysis. Reprod Biomed Online. 2018;36(4):408–15. 10.1016/j.rbmo.2017.12.012 . Georgiou EX, Melo P, Brown J, Granne IE. Follicular flushing during oocyte retrieval in assisted reproductive techniques. Cochrane Database Syst Rev. 2018;4(4):CD004634. 10.1002/14651858.CD004634.pub3 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7018162","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488367559,"identity":"dc1de0c2-08c0-4c5f-983d-b191e967871c","order_by":0,"name":"Xiaoxia Zhang","email":"","orcid":"","institution":"Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoxia","middleName":"","lastName":"Zhang","suffix":""},{"id":488367560,"identity":"4defd847-34e3-4497-8e0d-75ed5b128114","order_by":1,"name":"Li Sun","email":"","orcid":"","institution":"Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Sun","suffix":""},{"id":488367561,"identity":"c072ce97-af9e-4e5a-bfca-282a8184ea00","order_by":2,"name":"Shuqi Ge","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYLCCBAZmOTb29gOkaTHm4zmTQJI9zInzJBwMiFMr7394m8TDHdbpbRJAy35UbCOsxfBGWplE4pn03DbpxgOMPWduE6FlBo/ZjcS2w7ltMgcSmBnbiNHSfwasJZ1NIsGAOC3yDDlgLQnEazGQSCv/kdiWbtgGDOSDRPlFvv/wZsOfbdby8u3tBx/8qCDGlgMMiOg4QFg9yJYGBiJjcBSMglEwCkYuAAB35zyHNUzdJgAAAABJRU5ErkJggg==","orcid":"","institution":"Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Shuqi","middleName":"","lastName":"Ge","suffix":""}],"badges":[],"createdAt":"2025-07-01 08:53:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7018162/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7018162/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90769646,"identity":"bc9f9d47-4348-4f2f-a1b4-3659a71cd6fa","added_by":"auto","created_at":"2025-09-07 23:31:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":825285,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7018162/v1/2838475a-5ed1-452d-b69a-7c9c7877f564.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e Double-Lumen Needle versus Conventional Oocyte Retrieval in IVF-ET for Diminished Ovarian Reserve (DOR): A Comparative Analysis of Clinical Outcomes\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eTransvaginal oocyte retrieval (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) is a conventional method for oocyte collection in assisted reproductive technology. With the continuous improvement and progress of production technology, the development of oocyte retrieval needles is becoming more and more close to clinical use (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The phenomenon of late marriage and late childbearing in society has increased, and the fertility desire of young women has declined. Especially after the release of the three-child policy in China, the main force of fertility is mainly people over 35 years old. As the age increases, the ovarian reserve decreases, and the embryo euploid rate decreases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Even through Controlled Ovarian Hyperstimulation (COH)\u0026zwnj;, the number of eggs obtained does not reach an ideal level.\u003c/p\u003e\u003cp\u003eIn order to improve the oocyte retrieval rate of this group of people, Double-Lumen Needle Aspiration with Follicular Flushing (DLN-AFF) was employed to optimize oocyte recovery. Follicular fluid is sucked through one cavity and follicles are washed through one cavity. We hope to improve the oocyte retrieval rate through this technical means. For patients, obtaining one more oocyte means that one more embryo may be used for transplantation, increasing the chance of pregnancy. Follicular fluid is sucked through one cavity and follicles are washed through one cavity. We hope to improve the oocyte retrieval rate through this technical means. For patients, obtaining one more oocyte means that one more embryo may be used for transfer and increase the chance of pregnancy.\u003c/p\u003e\u003cp\u003eThe double-lumen oocyte retrieval technique (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) initially used in patients with low ovarian reserve, and later gradually applied to patients with less follicles and worried about unsatisfactory oocyte retrieval rate. A large number of studies have confirmed that patients with low ovarian reserve (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) have an increased risk of cycle cancellation and a decreased pregnancy rate due to the decrease in the number of oocytes retrieved, which brings great psychological burden and economic pressure to patients.\u003c/p\u003e\u003cp\u003eThis study retrospectively analyzed the patients with Diminished Ovarian Reserve (DOR) and HCG trigger day follicle diameter\u0026thinsp;\u0026gt;\u0026thinsp;14mm follicle number\u0026thinsp;\u0026le;\u0026thinsp;5 who underwent single or double lumen needle oocyte retrieval, a total of 1165 oocyte retrieval cycles. By analyzing and comparing the number of oocytes retrieved, the rate of oocytes retrieved, the number of normal fertilization, the number of high-quality embryos and other indicators of the two groups of patients, the application value of double-lumen needle oocyte retrieval in assisted reproductive technology was discussed.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cb\u003eResearch object\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients with DOR and \u0026le;\u0026thinsp;5 follicles with follicle diameter\u0026thinsp;\u0026gt;\u0026thinsp;14mm on HCG trigger day from January 2019 to December 2024 in the Reproductive Center of the Third Affiliated Hospital of Sun Yat-sen University were included in this study. Basic data of the included patients were collected. The basic data of the patients were collected, such as the age of both partners, the BMI of the woman, the basal antral follicle number, the number of follicles with a diameter of \u0026gt;\u0026thinsp;14mm on the day of HCG administration, the total amount of Gn, the days of Gn administration, etc. The laboratory data included the number of eggs obtained, the number of available embryos, and the number of high-quality embryos and comparing the live births of single transplantation. Our study was conducted in strict accordance with the \u0026zwnj;Declaration of Helsinki\u0026zwnj; (2013 revision). \u003cb\u003e The study was approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University (Approval No. [II2025-155]). Written informed consent was obtained from all individual participants included in the study prior to data collection.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eExclusion criteria: patients with premature ovulation; patients with normal ovarian reserve function; The fertilization method was late rescue ICSI patients. Special circumstances: When comparing the outcome of live births after fresh or frozen embryo transfer, due to the fact that some patients discard frozen embryos or accumulate embryos without thawing, the clinical outcome of some patients is lacking.\u003c/p\u003e\u003cp\u003eIn the superovulation cycle, when the diameter of the dominant follicle reached 18mm, human chorionic gonadotropin (HCG) 4000-10000IU or recombinant HCG 250ug was used for trigger, and eggs were taken 36\u0026ndash;38 hours after injection.\u003c/p\u003e\u003cp\u003eSingle-Lumen Needle Oocyte Retrieval Group\u0026zwnj;(SL-OR Group)(Wallace, cooper surgical, Denmark) : Remove the puncture guide line on the B-ultrasound screen, put the 17G single-lumen needle into the puncture guide device, and aspirated follicular fluid at a negative pressure of 100-120mmHg. Double-Lumen Needle Oocyte Retrieval Group\u0026zwnj;༈DL-OR Group༉\u003c/p\u003e\u003cp\u003e(Wego, Shandong Wego Ruisheng Medical Device Co., Ltd\u0026zwnj;): Under the guidance of B-ultrasound, the clinician used the 17G double-lumen needle to puncture the follicles, and pumped the follicular fluid with a negative pressure of 100-120mmHg. One channel pumped the follicular fluid, while the other channel was injected with PBS culture solution at the same time, and each follicle was washed multiple times.\u003c/p\u003e\u003cp\u003eThe obtained oocytes were selected according to the indications of in vitro fertilization embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI), combined with the concentration and viability of the man's semen after processing on the day of the operation.\u003c/p\u003e\u003cp\u003eEmbryo score: The cleavage stage embryo score standard refers to the Istanbul consensus, and the score is based on the number of cleavage stages, the degree of fragmentation, and the uniformity of the blastomeres. High quality cleavage stage embryos as cleavage ball number 7\u0026ndash;10, cell size uniform, debris amount\u0026thinsp;\u0026lt;\u0026thinsp;10%. According to the level of Gardner blastocyst scoring system for blastocyst, the transplantable blastocysts were scored as stage 3 or above, and the inner cell mass and trophoblast were not at the same time as C ; the high-quality blastocysts were scored as stage 3 or above, and the inner cell mass and trophoblast did not contain C. All embryos were frozen and thawed using a Japanese Kato commercial reagent kit.\u003c/p\u003e\u003cp\u003eThe obtained embryos were subjected to D3 or D5 fresh cycle transplantation according to individual conditions or thawed embryo transfer after cryopreservation due to endometrial factors and personal factors. Routine luteal support was started on the day of oocyte retrieval in the fresh cycle, the day of endometrial transformation in the artificial cycle of thawed embryo transfer, and routine luteal support was performed after ovulation was confirmed in the natural cycle.\u003c/p\u003e\u003cp\u003eSerum β-HCG level was detected 14 days after embryo transfer. When serum β-HCG\u0026thinsp;\u0026ge;\u0026thinsp;10U/L, HCG was positive. Clinical pregnancy was defined when the gestational sac and fetal heart beats were detected by transvaginal ultrasound at 4\u0026ndash;5 weeks after embryo transfer. Live birth was defined as the delivery of a live infant at or after 28 completed weeks\u0026zwnj;.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eSPSS 26.0 software was used for statistical analysis of the data. The measurement data obeying the normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s). Non-normally distributed data were expressed as median and quartile M (P25, P75). The count data were expressed as rate (%), and the chi-square test or Fisher 's exact test was used for comparison between groups. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e1. Comparison of basic data between the two groups: A total of 1165 oocyte retrieval cycles were included in this study. According to the oocyte retrieval\u003c/p\u003e\u003cp\u003epuncture needle used on the day of oocyte retrieval, they were divided into two groups, including 606 cases in the SL-OR Group and 559 cases in the SL-OR Group.The basic data included the couple's age, the woman's BMI, infertility years, AMH level, basic FSH, PRL, basic antral follicles, and the number of follicles with follicle diameter\u0026thinsp;\u0026gt;\u0026thinsp;14mm on HCG day. There was no statistically significant difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There were significant differences in the total amount of Gn and Gn days between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Show in \u0026zwnj;\u003cb\u003eTable 1\u003c/b\u003e\u0026zwnj;.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ebasic information in two groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSL-OR Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDL-OR Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e606\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e559\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFemale age (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.12\u0026thinsp;\u0026plusmn;\u0026thinsp;4.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.155\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMale age (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.05\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.015*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFemale's BMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.633\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eInfertility duration (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.12\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.383\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eProtocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAntagonist protocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild Stimulation Protocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNatural Cycle Protocol\u0026zwnj;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePPOS Protocol\u0026zwnj;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026zwnj;Luteal Phase Stimulation Protocol\u0026zwnj;\u003c/p\u003e\u003cp\u003eLuteal Phase Short-Acting Long Protocol\u0026zwnj;\u003c/p\u003e\u003cp\u003eLuteal Phase Long-Acting Long Protocol\u0026zwnj;\u003c/p\u003e\u003cp\u003eOther Options\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e12\u003c/p\u003e\u003cp\u003e15\u003c/p\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e15\u003c/p\u003e\u003cp\u003e14\u003c/p\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAMH (ng/ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.60 (0.34, 0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.54 (0.30, 1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBasal FSH (IU/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.50\u0026thinsp;\u0026plusmn;\u0026thinsp;6.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePRL (ug/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.85 (12.13, 25.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.54(10.79, 23.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.382\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBasal E2 (pg/ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.04 (31.26, 75.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.28(28.33, 73.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.032*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026zwnj;Total Gn Dosage\u0026zwnj;\u0026nbsp;(IU)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1787.48\u0026thinsp;\u0026plusmn;\u0026thinsp;864.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2057.65\u0026thinsp;\u0026plusmn;\u0026thinsp;909.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDuration of Gn Use(day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAFC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of follicles\u0026thinsp;\u0026gt;\u0026thinsp;14mm on HCG day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.233\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eAMH\u003c/em\u003e anti-M\u0026uuml;llerian hormone, \u003cem\u003eFSH\u003c/em\u003e follicle stimulating hormone, \u003cem\u003ePRL\u003c/em\u003e prolactin, \u003cem\u003eE2\u003c/em\u003e estrogen, \u003cem\u003eGn\u003c/em\u003e gonadotropin, \u003cem\u003eAFC\u003c/em\u003e Antral Follicle Count,\u003c/p\u003e\u003cp\u003e2. Laboratory data on oocyte retrieval, fertilization and related Parameters in two groups: The \u0026zwnj;oocyte retrieval rate\u0026zwnj; of \u0026zwnj;double-lumen needle\u0026zwnj; was significantly higher than that that of single-lumen needle (91.06% VS 85.15%), the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The proportion of primary infertility in patients with double-lumen needle was higher than that in patients with single-lumen needle (39.1% VS 26.6%), the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). But there were \u0026zwnj;no statistically significant differences\u0026zwnj; between the two groups in terms of infertility type, fertilization method, number of oocytes retrieved, number of high-quality embryos, normal fertilization rate of IVF and ICSI, number of available embryos and number of frozen embryos between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Show in \u0026zwnj;\u003cb\u003eTable 2\u003c/b\u003e\u0026zwnj;.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLaboratory data in the two groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSL-OR Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDL-OR Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e606\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e559\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNo oocyte retrieval cycles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRate of oocyte-obtained (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.15 (516/606)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91.06 (509/559)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of infertility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary infertility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.68 (148/516)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.10 (199/509)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary infertility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.32 (368/516)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.90 (310/509)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMethod of fertilization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIVF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.59 (421/516)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.35 (409/509)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.614\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eICSI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.41 (95/516)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.65 (100/509)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of retrieved oocytes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.727\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNormal fertilization rate in IVF (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.52 (620/932)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.30 (537/862)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNormal fertilization rate in ICSI (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75.27 (137/182)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.16 (134/191)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.268\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of high-quality Day 3 Embryos\u0026zwnj;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0, 1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0, 1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.544\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of Usable Embryos\u0026zwnj;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of Frozen Embryos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.938\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eRate of oocyte-obtained\u003c/em\u003e oocyte-obtained cycles/ total oocyte retrieval cycles, \u003cem\u003enormal fertilization rate\u003c/em\u003e IVF number of 2PN/number of oocyte obtained\u0026times;100%, ICSI number of 2PN /number of mature oocyte injected\u0026times;100%, \u003cem\u003eIVF\u003c/em\u003e in vitro fertilization, \u003cem\u003eICSI\u003c/em\u003e intracytoplasmic sperm injection, \u003cem\u003ehigh-quality embryo rate\u003c/em\u003e number of high-quality embryos /number of 2PN cleavage\u0026times; 100%, median (25th centile, 75th centile) or % (n), \u003cem\u003eUsable Embryos\u003c/em\u003e Number of transferred embryos plus number of frozen embryos \u0026zwnj;*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Two groups of fresh cycle transplantation: 105 cases of fresh embryo transfer in single-lumen needle oocyte retrieval, 100 cases of fresh embryo transfer in double-lumen needle oocyte retrieval, the two groups were mainly transferred cleavage stage embryos and the number of fresh blastocyst transfer was relatively small. Both groups prioritized cleavage-stage embryo transfers, with minimal fresh blastocyst utilization. Embryo selection for D3 transfers required at least one high-quality embryo in most cases. The abortion rate of the SL-OR group was significantly higher than that of the DL-OR group (P\u0026thinsp;=\u0026thinsp;0.002). There was no significant difference in the clinical pregnancy rate and ectopic pregnancy rate between the two groups (P\u0026thinsp;=\u0026thinsp;0.963). The live birth rate of the single needle group was lower than that of the double needle group (11.49% VS 21.00%), but the difference was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.062). Show in \u003cb\u003e\u0026zwnj;Table 3\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFresh cycle transplants in the two groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSL-OR Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDL-OR Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTransplantation cycles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eType of embryo transfer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of D3 embryos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98.10 (103/105)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100.00 (100/100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.924\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.165\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of D5 embryos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.90 (2/105)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0/100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eD3 Embryo Grading\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo high-quality embryos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.10 (31/103)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.00 (33/100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.656\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAt least one high-quality embryo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.90 (72/103)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.00 (67/100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eClinical pregnancy rate (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.7 (27/105)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.00 (26/100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.963\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMiscarriage rate (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.56 (15/27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.38 (4/26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEctopic pregnancy rate (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0/27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0/26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLive birth rate (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.49 (12/105)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.00 (21/100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eD3 embryos\u003c/em\u003e The cleavage stage embryos, \u003cem\u003eD5 embryos\u003c/em\u003e blastocyst, *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Transplantation of the thawing cycle in the two groups: A total of 370 thawed embryo transfer cycles were included, including 205 cases of single-chamber oocyte retrieval and 165 cases of double-chamber oocyte retrieval. The two groups of patients were mainly transplanted cleavage-stage embryos, and the transplanted embryos were mainly containing at least one high-quality embryo. The clinical pregnancy rate, abortion rate, ectopic pregnancy rate, and live birth rate of the two groups were comparable, and the difference was not statistically significant. Show in \u0026zwnj;\u003cb\u003eTable\u003c/b\u003e 4.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThawing cycle transplants in the two groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSL-OR Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDL-OR Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTransplantation cycles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eType of embryo transfer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of D3 embryos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96.59 (198/205)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95.76(158/165)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.678\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of D5 embryos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.41 (7/205)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.24(7/165)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eD3 Embryo Grading\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo high-quality embryos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.76 (51/198)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.15 (35/158)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.624\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.430\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAt least one high-quality embryo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.24 (147/198)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77.85 (123/158)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eClinical pregnancy rate (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.93 (47/205)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.09 (48/165)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.820\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMiscarriage rate (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.04 (16/47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.42 (17/48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.888\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEctopic pregnancy rate (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.13 (1/47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.08 (1/48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.988\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLive birth rate (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.66 (28/205)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.18 (30/165)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.234\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe advantage of double-lumen needle oocyte retrieval is that one channel punctures the follicle, and the other channel can be perfused with the culture medium to ' flush ' the follicle, which can reduce the risk of oocyte retention, improve the patient 's oocyte retrieval rate, reduce the cycle cancellation rate, and increase the number of transplantation. However, some studies have suggested that washing follicles, with the increase of washing times, is bound to prolong the operation time, and the culture medium is injected into the follicles, which increases the risk of postoperative infection (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a single follicle retrieval study, the use of a double-lumen needle increased the number of mature oocytes, increasing the oocyte retrieval rate to 83% by the fifth flush of follicles. However, there was no difference in clinical pregnancy rate and live birth rate between the two groups (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). It has also been reported that there is no benefit of using double-lumen needle for poor ovarian response, not only prolonged the operation time, but also decreased the oocyte retrieval rate (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Other studies have suggested that double-lumen oocyte retrieval does not improve clinical outcomes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). A 2018 Cochrane review showed no improvement in oocyte retrieval rate or live birth rate for patients with normal or poor ovarian response (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Previous studies mostly focused on the comparison of the results of single and double-needles used for single follicle, and there were few studies on the use of single and double-needles for more than one mature follicle or more. Our study focused on the comparison of the situation of oocyte retrieval with single and double needles when the follicle diameter was greater than 14mm and less than 5 follicles on HCG trigger day in IVF cycles of patients with DOR.\u003c/p\u003e\u003cp\u003eA total of 1165 oocyte retrieval cycles were included in this study, including 606 cases in the SL-OR Group and 559 cases in the DL-OR group. The results showed that the oocyte retrieval rate of DL-OR group was significantly higher than that of SL-OR group (91.06% vs 85.15%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For these patients, especially DOR or elderly patients, obtaining one more oocyte means that may be used for transplantation to increase pregnancy opportunities.\u003c/p\u003e\u003cp\u003eA total of 205 fresh embryo transfer cycles were performed in our study (105 cases in the SL-OR group and 100 cases in the DL-OR group). There were 370 cycles of thawed embryos (205 cases in the SL-OR group and 165 cases in the DL-OR group). Both fresh embryo transfer and frozen embryo transfer were mainly performed with cleavage stage embryos and at least one high-quality embryo. This study found that the laboratory outcomes and clinical pregnancy rate were similar between the two groups. However, the abortion rate of fresh embryo transfer in the DL-OR group was lower than that in the SL-OR group. In this study, 559 cases of double-lumen needle oocyte retrieval group were not found to have postoperative infection after oocyte retrieval, suggesting that double-lumen needle oocyte retrieval does not increase the risk of postoperative infection under the condition of routine surgical operation.\u003c/p\u003e\u003cp\u003eThis study was a retrospective study focusing on patients with \u0026zwnj;poor ovarian reserve\u0026zwnj;, characterized by \u0026zwnj;low oocyte yield\u0026zwnj; and \u0026zwnj;limited availability of viable embryos\u0026zwnj;. Most patients underwent \u0026zwnj;fresh embryo transfer\u0026zwnj; (either cleavage-stage or blastocyst) infrequently, primarily due to strategies for \u0026zwnj;embryo accumulation\u0026zwnj; or concerns about the potential impact of ovarian stimulation medications on the endometrium. In analyzing \u0026zwnj;clinical live birth outcomes\u0026zwnj;, we only included cases with \u0026zwnj;a single fresh embryo transfer\u0026zwnj; or \u0026zwnj;a single frozen-thawed embryo transfer\u0026zwnj; (in which the \u0026zwnj;highest-quality embryo available\u0026zwnj; was transferred). Therefore, this study did not discuss \u0026zwnj;cumulative pregnancy rates\u0026zwnj; or \u0026zwnj;cumulative live birth rates\u0026zwnj;. Additionally, some patients still had remaining embryos that were either \u0026zwnj;cryopreserved\u0026zwnj; or \u0026zwnj;discarded\u0026zwnj;, resulting in incomplete clinical outcome data for these cases.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, by analyzing the DOR patients who used single-lumen needle oocyte retrieval and double-lumen needle oocyte retrieval in our center in recent years, it was found that double-lumen needle oocyte retrieval significantly improved the oocyte retrieval rate and reduced the cycle cancellation rate. By minimizing oocyte retention via follicular flushing, its core value lies in maximizing oocyte retrieval, offering additional opportunities for embryo transfer in patients with recurrent failure or minimal follicles. For DOR patients, oocytes are recovered to the greatest extent, the oocyte retrieval rate is increased, the great psychological pressure and economic burden caused by patients' failure to obtain oocytes are reduced, and more transplantation opportunities are brought to patients. This approach may serve as a supplementary strategy for advanced-age or poor-responder populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e‌\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the ‌\u003cstrong\u003eEthics Committee of The Third Affiliated Hospital of Sun Yat-sen University\u003c/strong\u003e‌ (Approval No. [II2025-155]).\u003cstrong\u003eThe Ethics Committee waived the need for written informed consent due to the retrospective nature of the study.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective analysis utilized de-identified patient data approved by the ‌\u003cstrong\u003eEthics Committee of The Third Affiliated Hospital of Sun Yat-sen University\u003c/strong\u003e‌ (Approval No. [II2025-155]) with waived individual consent, complying with:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eHelsinki Declaration §32 (2013) for retrospective studies\u003c/li\u003e\n \u003cli\u003eHIPAA Privacy Rule §164.514(a) for data anonymization\u003c/li\u003e\n \u003cli\u003eICMJE recommendations on secondary data use\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing financial interests\u0026nbsp;and manuscript is approved by all authors for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, Data curation, Writing-original draft: Xiaoxia Zhang; Data curation: Li Sun; Supervision, Writing-review \u0026amp; editing: Shuqi Ge; Writing-review \u0026amp; editing: all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiaoxia Zhang and Li Sun are co-first authors. Shuqi Ge is the principal investigator (ORCID: https://orcid.org/0009-0004-2838-0786).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLudwig AK, Glawatz M, Griesinger G, Diedrich K, Ludwig M. Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of \u0026gt;\u0026thinsp;1000 oocyte retrievals. Hum Reprod. 2006;21(12):3235\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/del284\u003c/span\u003e\u003cspan address=\"10.1093/humrep/del284\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzaltın S, Kumbasar S, Savan K. Evaluation of complications developing during and after transvaginal ultrasound - guided oocyte retrieval. 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Cochrane Database Syst Rev. 2018;4(4):CD004634. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD004634.pub3\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD004634.pub3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"double-lumen needle oocyte retrieval, diminished ovarian reserve, assisted reproductive technology, oocyte retrieval rate, Embryo Transfer‌","lastPublishedDoi":"10.21203/rs.3.rs-7018162/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7018162/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis retrospective cohort study analyzed 1,165 IVF-ET cycles of diminished ovarian reserve (DOR) patients (\u0026le;\u0026thinsp;5 follicles\u0026thinsp;\u0026gt;\u0026thinsp;14 mm at trigger) comparing double- versus single-lumen oocyte retrieval (559 vs 606 cycles). The double-lumen group demonstrated superior oocyte retrieval efficiency (91.06% vs 85.15%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) despite comparable median oocyte yield (2 [IQR 1\u0026ndash;3] in both groups). Fresh cycles revealed significantly reduced miscarriage rates (15.38% vs 55.56%, P\u0026thinsp;=\u0026thinsp;0.002) and a non-significant trend toward higher live birth rates (21.00% vs 11.49%) with double-lumen retrieval. No between-group differences were observed in fertilization success (IVF: 66.52% vs 62.30%; ICSI: 75.27% vs 70.16%), embryo quality metrics, or frozen-thawed cycle outcomes (clinical pregnancy rate: 22.93% vs 29.09%; live birth rate: 13.66% vs 18.18%, all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Safety profiles were equivalent between groups.\u003c/p\u003e\u003cp\u003eThe findings suggest double-lumen needles optimize follicular flushing efficacy in DOR patients, significantly reducing oocyte retention risks and fresh-cycle pregnancy loss without compromising procedural safety. While cumulative live birth rates remained unaffected, the technique's value resides in maximizing retrieval attempts for poor responders-particularly those with recurrent failure or minimal follicles. This approach may serve as a strategic adjunct in ART protocols for advanced-age populations with limited ovarian response.\u003c/p\u003e","manuscriptTitle":"Double-Lumen Needle versus Conventional Oocyte Retrieval in IVF-ET for Diminished Ovarian Reserve (DOR): A Comparative Analysis of Clinical Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 07:40:05","doi":"10.21203/rs.3.rs-7018162/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8de1a81a-d30d-472e-8c41-8e88c2625d18","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-07T23:23:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 07:40:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7018162","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7018162","identity":"rs-7018162","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}