Advertisement

Journal of Assisted Reproduction and Genetics

, Volume 34, Issue 11, pp 1523–1528 | Cite as

IVF oocyte retrieval: prospective evaluation of the type of anesthesia on live birth rate, pain, and patient satisfaction

  • Lucie RollandEmail author
  • Jeanne Perrin
  • Virginie Villes
  • Valérie Pellegrin
  • Léon Boubli
  • Blandine Courbiere
Assisted Reproduction Technologies

Abstract

Purpose

Does the type of anesthesia (paracervical block (PCB) or general anesthesia (GA)) impact live birth rate, pain, and patient satisfaction?

Methods

A non-randomized prospective cohort study was conducted in women treated for IVF. Two groups of patients were prospectively included: the PCB group (n = 234) and the GA group (n = 247). The type of anesthesia was determined by the patients. The primary endpoint was cumulative live birth rate by OR. Secondary endpoints were self-assessment of the patients’ peri-operative abdominal and vaginal pain vs the doctors’ evaluations during PCB, post-operative abdominal and vaginal pain level, and patient satisfaction in both groups. Pain levels were assessed with a numerical rating scale (NRS).

Results

The live birth rate was similar in both groups (19.8% in the GA group vs 20.9% in the PCB group, P = 0.764). During oocyte retrieval in the PCB group, the physicians significantly under-estimated the vaginal pain experienced by the patients (3.04 ± 0.173 for patients vs 2.59 ± 0.113 for surgeons, P = 0.014). Post-operative vaginal and abdominal pain were significantly greater in the PCB group compared to the GA group (2.26 ± 0.159 vs 1.66 ± 0.123, respectively, P = 0.005, and 3.80 ± 0.165 vs 3.00 ± 0.148, respectively, P < 0.001). Patients were more significantly satisfied with GA than with PBC (P < 0.001).

Conclusion

Because the LBR was similar in both groups and patient satisfaction was high, the choice of anesthesia should be decided by the patients.

Keywords

IVF Pain relief Paracervical block General anesthesia Live birth rate 

Notes

Compliance with ethical standards

The French Ethical Committee of Research in Obstetrics and Gynecology (CEROG 2014-GYN-1105) approved this study. Each patient gave written informed consent prior to participating in the study.

Funding

None declared.

Conflicts of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Wikland M, Enk L, Hamberger L. Transvesical and transvaginal approaches for the aspiration of follicles by use of ultrasound. Ann N Y Acad Sci. 1985;442:182–94.CrossRefPubMedGoogle Scholar
  2. 2.
    Vlahos NF, Giannakikou I, Vlachos A, Vitoratos N. Analgesia and anesthesia for assisted reproductive technologies. Int J Gynecol Obstet. 2009;105:201–5.CrossRefGoogle Scholar
  3. 3.
    Kim WO, Kil HK, Koh SO, Kim JI. Effects of general and locoregional anesthesia on reproductive outcome for in vitro fertilization: a meta-analysis. J Korean Med Sci. 2000;15:68.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Koninckx PR, Renaer M. Pain sensitivity of and pain radiation from the internal female genital organs. Hum Reprod. 1997;12:1785–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Ng EHY, Tang OS, Chui DKC, Ho PC. A prospective, randomized, double-blind and placebo-controlled study to assess the efficacy of paracervical block in the pain relief during egg collection in IVF. Hum Reprod. 1999;14:2783–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Rodriguez CS. Pain measurement in the elderly: a review. Pain Manag Nurs. 2001;2:38–46.CrossRefPubMedGoogle Scholar
  7. 7.
    Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res. 2011;63:S240–52.CrossRefGoogle Scholar
  8. 8.
    Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update. 2015;21:136–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Bümen S, Günüşen İ, Firat V, Karaman S, Akdoğan A, Göker ENT. A comparison of intravenous general anesthesia and paracervical block for in vitro fertilization: effects on oocytes using the transvaginal technique. Turk J Med Sci. 2011;41:801–8.Google Scholar
  10. 10.
    Christiaens F, Janssenswillen C, Steirteghem ACV, Devroey P, Verborgh C, Camu F. Comparison of assisted reproductive technology performance after oocyte retrieval under general anaesthesia (propofol) versus paracervical local anaesthetic block: a case-controlled study. Hum Reprod. 1998;13:2456–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Hammadeh ME, Wilhelm W, Huppert A, Rosenbaum P, Schmidt W. Effects of general anaesthesia vs. sedation on fertilization, cleavage and pregnancy rates in an IVF program. Arch Gynecol Obstet. 1999;263:56–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Tummon I, Newton C, Lee C, Martin J. Lidocaine vaginal gel versus lidocaine paracervical block for analgesia during oocyte retrieval. Hum Reprod. 2004;19:1116–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Egan B, Racowsky C, Hornstein MD, Martin R, Tsen LC. Anesthetic impact of body mass index in patients undergoing assisted reproductive technologies. J Clin Anesth. 2008;20:356–63.CrossRefPubMedGoogle Scholar
  14. 14.
    Ng EHY, Miao B, Ho PC. Anxiolytic premedication reduces preoperative anxiety and pain during oocyte retrieval. A randomized double-blinded placebo-controlled trial. Hum Reprod. 2002;17:1233–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Cerne A, Bergh C, Borg K, Ek I, Gejervall A-L, Hillensjö T, et al. Pre-ovarian block versus paracervical block for oocyte retrieval. Hum Reprod. 2006;21:2916–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Frederiksen Y, Mehlsen MY, Matthiesen SMS, Zachariae R, Ingerslev HJ. Predictors of pain during oocyte retrieval. J Psychosom Obstet Gynaecol. 2017;38:21–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Ng EHY, Chui DKC, Tang OS, Ho PC. Paracervical block with and without conscious sedation: a comparison of the pain levels during egg collection and the postoperative side effects. Fertil Steril. 2001;75:711–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Ben-Shlomo I, Moskovich R, Katz Y, Shalev E. Midazolam/ketamine sedative combination compared with fentanyl/propofol/isoflurane anaesthesia for oocyte retrieval. Hum Reprod. 1999;14:1757–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Casati A, Valentini G, Zangrillo A, Senatore R, Mello A, Airaghi B, et al. Anaesthesia for ultrasound guided oocyte retrieval: midazolam/remifentanil versus propofol/fentanyl regimens. Eur J Anaesthesiol. 1999;16:773–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Guasch E, Ardoy M, Cuadrado C, González Gancedo P, González A, Gilsanz F. Comparison of 4 anesthetic techniques for in vitro fertilization. Rev Esp Anestesiol Reanim. 2005;52:9–18.PubMedGoogle Scholar
  21. 21.
    Trout SW, Hazard VA, Kemmann E. Conscious sedation for in vitro fertilization. Fertil Steril. 1998;69:799–808.CrossRefPubMedGoogle Scholar
  22. 22.
    Gohar J, Lunenfeld E, Potashnik G, Glezerman M. The use of sedation only during oocyte retrieval for in vitro fertilization: patients’ pain self-assessments versus doctors’ evaluations. J Assist Reprod Genet. 1993;10:476–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Lucie Rolland
    • 1
    • 2
    Email author
  • Jeanne Perrin
    • 1
    • 2
    • 3
  • Virginie Villes
    • 4
  • Valérie Pellegrin
    • 1
  • Léon Boubli
    • 5
  • Blandine Courbiere
    • 1
    • 2
  1. 1.Department of Gynecology, Obstetrics and Reproductive Medicine, Pôle femmes parents enfantsAP-HM La Conception University HospitalMarseilleFrance
  2. 2.Aix Marseille Université, CNRS, IRD, Avignon UniversitéMarseilleFrance
  3. 3.Department of Gynecology, Obstetric and Reproductive Medicine, Laboratory of Medical ReproductionCECOSMarseilleFrance
  4. 4.Research Unit EA3279, Department of Public HealthAix Marseille UniversitéMarseilleFrance
  5. 5.Department of Gynecology, Obstetrics and Reproductive Medicine, Pôle femmes parents enfantsAP-HM Hopital NordMarseilleFrance

Personalised recommendations