Ege Nazan GÖKER TAVMERGEN, Ayşin AKDOĞAN, Semra KARAMAN, Sevil BÜMEN, Vicdan FIRAT, İlkben GÜNÜŞEN

A comparison of intravenous general anesthesia and paracervical block for in vitro fertilization: effects on oocytes using the transvaginal technique

To compare the effects of 2 different anesthetic techniques used for oocyte retrieval. Comparison was made based on the number of retrieved and fertilized oocytes, metaphase 2 (M2, mature) oocytes, and transferred embryos, as well as fertilization, pregnancy, and live birth rates. Ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization is one of the most common minor surgical procedures. Despite this, it is stressful and painful for the patient; most patients request sedation and/or pain relief. Propofol, which is frequently used for general anesthesia in such procedures, has been suspected to damage oocytes. Materials and methods: Results from 70 patients without premedication were compared in this randomized prospective study. Patients were divided into 2 groups based on treatment. Those in Group G received intravenous general anesthesia with atropine (10 mg kg-1), remifentanil (1 mg kg-1), and propofol (2.5 mg kg-1), while patients in Group P received a paracervical block with 100 mg of prilocaine (2%) and 0.75 mg kg-1 of intramuscular meperidine. Results: Our results revealed no statistically significant difference between the 2 groups in terms of the fertilization rate. The numbers of retrieved and mature oocytes and transferred embryos and the pregnancy rate were greater in the general anesthesia group, although only the number of transferred embryos showed a statistically significant difference (P = 0.045). Conclusion: According to our data, both anesthesia techniques can be used for oocyte retrieval since there were no differences in fertilization, pregnancy, or live birth rates between the 2 groups.

Anahtar Kelimeler:

Key words: General anesthesia, paracervical block, oocyte, fertilization rate, pregnancy

A comparison of intravenous general anesthesia and paracervical block for in vitro fertilization: effects on oocytes using the transvaginal technique

Keywords:

Key words: General anesthesia, paracervical block, oocyte, fertilization rate, pregnancy,

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Yasmin E, Dresner M, Balen A. Sedation and anaesthesia for transvaginal oocyte collection: an evaluation of practice in the UK. Hum Reprod 2004; 19; 2942-5. 2. Vlahos NF, Giannakikou I, Vlachos A, Vitoratos N. Analgesia and anesthesia for reproductive technologies. Int J Gynaecol Obstet 2009; 105: 201-5.
Kim WO, Kil HK, Koh SO, Kim JI. Eff ects of general and locoregional anesthesia on reproductive outcome for in vitro fertilization: a meta-analysis. J Korean Med Sci 2000; 15: 68-72.
Martin R, Tsen LC, Tzeng G, Hornstein MD, Datta S. Anesthesia for in vitro fertilization: Th e addition of fentanyl to 1.5% lidocaine. Anesth Analg 1999; 88: 523-6. 5. Ben-Shlomo I, Moskovich R, Golan J, Eyali V, Tabak A, Shalev E. Th e eff ect of propofol anaesthesia on oocyte fertilization and early embryo quality. Hum Reprod 2000; 15: 2197-9.
Chetkowski RJ, Nass TE. Isofl urane inhibits early mouse embryo development in vitro. Fertil Steril 1988; 49: 171-3.
Vincent RD Jr, Syrop CH, Van Voorhis BJ, Chestnut DH, Sparks AE, McGrath JM et al. An evaluation of the eff ect of anesthetic technique on reproductive success aft er laparoscopic pronuclear stage transfer. Propofol/nitrous oxide versus isofl urane/nitrous oxide. Anesthesiology 1995; 82: 352-8.
Imoedemhe DA, Sigue AB, Abdul Ghani I, Abozeid MA, Abdel Halim MS. An evaluation of the eff ect of the anesthetic agent profofol (Diprivan) on the outcome of human in vitro fertilization. J Assist Reprod Genet 1992; 9: 488-91. 9. Christiaens F, Janssenswillen C, Van Steirteghem AC, Devroey P, Verborgh C, Camu F. Comparison of assisted reproductive technology performance aft er oocyte retrieval under general anaesthesia (propofol) versus paracervical local anaesthetic block: a case-controlled study. Hum Reprod 1998; 13: 2456-60.
Wikland M, Evers H, Jakobsson AH, Sandqvist U, Sjöblom P. Th e concentration of lidocaine in follicular fl uid when used for paracervical block in a human IVF-ET programme. Hum Reprod 1990; 5: 920-3.
Soussis I, Boyd O, Paraschos T, Duff y S, Bower S, Troughton P et al. Follicular fl uid levels of midazolam, fentanyl, and alfentanil during transvaginal oocyte retrieval. Fertil Steril 1995; 64: 1003-7.
Bürkle H, Dunbar S, Van Aken H. Remifentanil: a novel, short- acting, mu-opioid. Anesth Analg 1996; 83: 646-51.
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924-34.
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.
Rosenblatt MA, Bradford CN, Bodian CA, Grunfeld L. Th e eff ect of a propofol-based sedation technique on cumulative embryo scores, clinical pregnancy rates, and implantation rates in patients undergoing embryo transfers with donor oocytes. J Clin Anesth 1997; 9: 614-7.
Christiaens F, Janssenswillen C, Verborgh C, Moerman I, Devroey P, Van Steirteghem A et al. Propofol concentrations in follicular fl uid during general anaesthesia for transvaginal oocyte retrieval. Hum Reprod 1999; 14: 345-8.
Janssenswillen C, Christiaens F, Camu F, Van Steirteghem A. Th e eff ect of propofol on parthenogenetic activation, in vitro fertilization and early development of mouse oocytes. Fertil Steril 1997; 67: 769-74.
Alsalili M, Th ornton S, Fleming S. Th e eff ect of the anaesthetic, Propofol, on in-vitro oocyte maturation, fertilization and cleavage in mice. Hum Reprod 1997; 12: 1271-4.
Hammadeh ME, Wilhelm W, Huppert A, Rosenbaum P, Schmidt W. Eff ects of general anaesthesia vs. sedation on fertilization, cleavage and pregnancy rates in an IVF program. Arch Gynecol Obstet 1999; 263: 56-9.
Wilhelm W, Hammadeh ME, White PF, Georg T, Fleser R, Biedler A. General anesthesia versus monitored anesthesia care with remifentanil for assisted reproductive technologies: eff ect on pregnancy rate. J Clin Anesth 2002; 14: 1-5.
Öztürk E, Günaydın B, Karabacak O, Tuncer B, Erdem M, Erdem A et al. Remifentanil infusion and Paracervical block combination versus remifentanil infusion alone during in vitro fertilization. Turk J Med Sci 2006; 36: 105-11.
Kaya K, Öztürk E, Tuncer B, Günaydın B. Remifentanil infusion and paracervical block combination for transvaginal ultrasound guided oocyte retrieval. Turk J Med Sci 2005; 35: 99-105.
Godoy H, Erard P, De Munck L, Camus M, Gepts E, Van Steirteghem AC et al. Comparison of two local anaesthetics in transvaginal ultrasound-guided oocyte retrieval. Hum Reprod 1993; 8: 1093-7.
Hildebrandt NB, Hİst E, Mikkelsen AL. Pain experience during transvaginal aspiration of immature oocytes. Acta Obstet Gynecol Scand 2001; 80: 1043-5.
Schnell VL, Sacco AG, Savoy-Moore RT, Ataya KM, Moghissi KS. Eff ects of oocyte exposure to local anesthetics on in vitro fertilization and embryo development in the mouse. Reprod Toxicol 1992; 6: 323-7.
Del Valle LJ, Orihuela PA. Cleavage and development and cultured preimplantation mouse embryos exposed to lidocaine. Reprod Toxicol 1996; 10: 491-6.
Jennings JC, Moreland K, Peterson CM. In vitro fertilization. A review of drug therapy and clinical management. Drugs 1996; 52: 313-43.