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Oltedal A, Björkman S, Peltoniemi O, Gaustad AH, Oropeza-Moe M. Transvaginal Ovum Pick-Up in sows: Impacts on welfare and reproduction. Theriogenology 2024; 226:68-75. [PMID: 38865790 DOI: 10.1016/j.theriogenology.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 06/14/2024]
Abstract
There are few existing publications that describe transvaginal ultrasound-guided Ovum Pick-Up (OPU) in sows, and the impacts of the procedure for the welfare of the animals are unknown. In this study, we evaluated the effects of OPU, performed following restraint in a claw-trimming chute, on the animal welfare and reproductive health of second parity hybrid sows. The study utilized a generalized randomized block design at a commercial sow pool. We assessed salivary cortisol levels before, during, and after the procedure to compare the physiological stress response between OPU and restraint chute procedures (control group). We found a significant increase in salivary cortisol caused by the physical restraint procedure, and that the salivary cortisol level at the end of the procedure did not differ between OPU and control groups (p = 0.51). Furthermore, we conducted a novel approach-aversion test for sows, designed to assess if a feed reward would motivate the animals to willingly participate in the OPU-procedure. The animals were trained daily to enter the chute to access a feed reward. Ten animals in each group failed to complete the training period and did not voluntarily enter the restraint chute on the experimental day. This indicates that even the short daily restraint procedure during the four-day long training period was aversive to some animals. There was no difference in aversion towards the restraint chute between OPU and control groups one day after the procedure. The reproductive performance of the animals was subsequently evaluated through oestrus synchronization and insemination of the sows after the experiment. There was no observed difference in the farrowing rate (p = 0.72) and total number of born piglets (p = 0.84) between OPU and control sows. On average, we retrieved 9.0 ± 5.9 oocytes during the OPU-sessions (N = 26). Our results show that a majority of the sows prioritize the motivation for feed over their aversion to the OPU procedure. However, the physical restraint procedure is unpleasant for the animals and elicits a temporary stress response. We suggest that transvaginal OPU may be used for the recovery of oocytes from live sows, but refinements are needed to avoid stress during the lifting procedure. Such modifications could also potentially reduce the observed inter-individual variations in oocyte recovery outcomes.
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Affiliation(s)
- Aslak Oltedal
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Sandnes, Norway.
| | | | | | | | - Marianne Oropeza-Moe
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Sandnes, Norway
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Liu Y, Gao Y, Lu C, Chen J, Huang S. Effect of intravenous anesthetic drugs on fertilization rate in oocyte retrieval. BMC Anesthesiol 2024; 24:163. [PMID: 38684945 PMCID: PMC11057136 DOI: 10.1186/s12871-024-02542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effects of intravenous anesthetic drugs on fertilization rate in subjects receiving oocyte retrieval by assisted reproduction technology (ART). METHODS A retrospective cohort study was designed. The clinical information of subjects who received oocyte retrieval procedure was collected. The subjects were divided into two groups based on the type of anesthesia used: the no-anesthesia group and the intravenous anesthesia group. Propensity score matching (PSM) was performed and multiple linear regression analyses were conducted. Fertilization rate was compared between the two groups before and after PSM. RESULTS A total of 765 subjects were divided into two groups: the no-anesthesia group (n = 482) and the intravenous anesthesia group (n = 283). According to propensity scores, 258 pairs of subjects were well matched, and the baseline data between the two groups were not significantly different (P > 0.05). Fertilization rate was 77% in the intravenous anesthesia group, and 76% in the no-anesthesia group, without significant between-group difference (P = 0.685). Before matching, Poisson regression analysis showed no effect of intravenous anesthetic drugs on fertilization rate (RR = 0.859, 95%CI: 0.59 to 1.25, P = 0.422). After matching, no difference was found either (RR = 0.935, 95%CI: 0.67 to 1.29, P = 0.618). CONCLUSION Intravenous anesthetic drugs may exert no effects on fertilization rate in subjects receiving ART.
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Affiliation(s)
- Yanfang Liu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Nantong, Jiangsu Province, 226001, China
| | - Yongtao Gao
- Department of Anesthesiology, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Nantong, Jiangsu Province, 226001, China
| | - Cuie Lu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Nantong, Jiangsu Province, 226001, China
| | - Junjie Chen
- Department of Anesthesiology, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Nantong, Jiangsu Province, 226001, China.
| | - Saisai Huang
- Department of Anesthesiology, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Nantong, Jiangsu Province, 226001, China.
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Malard F, Moy L, Denoual V, Beloeil H, Leblong E. Variations of the Relative Parasympathetic Tone Assessed by ANI During Oocyte Retrieval Under Local Anaesthesia with Virtual Reality : A Randomized, Controlled, Monocentric, Open Study. J Med Syst 2024; 48:39. [PMID: 38578467 DOI: 10.1007/s10916-024-02057-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
Transvaginal oocyte retrieval is an outpatient procedure performed under local anaesthesia. Hypno-analgesia could be effective in managing comfort during this procedure. This study aimed to assess the effectiveness of a virtual reality headset as an adjunct to local anaesthesia in managing nociception during oocyte retrieval. This was a prospective, randomized single-centre study including patients undergoing oocyte retrieval under local anaesthesia. Patients were randomly assigned to the intervention group (virtual reality headset + local anaesthesia) or the control group (local anaesthesia). The primary outcome was the efficacy on the ANI®, which reflects the relative parasympathetic tone. Secondary outcomes included pain, anxiety, conversion to general anaesthesia rate, procedural duration, patient's and gynaecologist's satisfaction and virtual reality headset tolerance. ANI was significantly lower in the virtual reality group during the whole procedure (mean ANI: 79 95 CI [77; 81] vs 74 95 CI [72; 76]; p < 0.001; effect size Cohen's d -0.53 [-0.83, -0.23]), and during the two most painful moments: infiltration (mean ANI: 81 +/- 11 vs 74 +/- 13; p < 0.001; effect size Cohen's d -0.54[-0.85, -0.24]) and oocytes retrieval (mean ANI: 78 +/- 11 vs 74.40 +/- 11; p = 0.020; effect size Cohen's d -0.37 [-0.67, -0.07]).There was no significant difference in pain measured by VAS. No serious adverse events related were reported. The integration of virtual reality as an hypnotic tool during oocyte retrieval under local anaesthesia in assisted reproductive techniques could improve patient's comfort and experience.
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Affiliation(s)
- Florent Malard
- CHU Rennes, Anesthesia and Intensive Care Department, F-35000, Rennes, France
| | - Ludovic Moy
- Clinique Mutualiste La Sagesse Rennes, Medically Assisted Procreation Department, F-35000, Rennes, France
| | - Vincent Denoual
- Clinique Mutualiste La Sagesse Rennes, Anesthesia and Intensive Care Department, F-35000, Rennes, France
| | - Helene Beloeil
- Univ Rennes, CHU Rennes, Inserm, CIC-1414, OSS 1242, Anesthesia and Intensive Care Department, F-35000, Rennes, France.
- Pole Anesthésie-Réanimation Medecine Interne Geriatrie, CHU Rennes, 2 Avenue Henri Le Guillou, 35033, Rennes Cedex, France.
| | - Emilie Leblong
- Rehabilitation Center, Pole Saint Helier, Department of Clinical Research, Rennes, France
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Gadenne C, Miquel L, Faust C, Berbis J, Perrin J, Courbiere B. Impact of a positive Chlamydia trachomatis serology on cumulative IVF live birth rate. Reprod Biomed Online 2024; 48:103586. [PMID: 38113763 DOI: 10.1016/j.rbmo.2023.103586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 12/21/2023]
Abstract
RESEARCH QUESTION Does positive Chlamydia trachomatis serology have an impact on the cumulative live birth rate from IVF? DESIGN A retrospective matched cohort study compared women with positive Chlamydia trachomatis serology (group A) who underwent IVF treatment between January 2016 and December 2021 with a control group of women with negative Chlamydia trachomatis serology (group B). The main outcome measures were the cumulative live birth rate per IVF cycle and the live birth rate per embryo transfer. Secondary outcomes were the cumulative rates of clinical pregnancy, ectopic pregnancy and pregnancy loss calculated per IVF cycle and per embryo transfer. RESULTS A total of 151 women in group A were matched 1:2 to 302 women in group B, representing 220 and 440 IVF cycles, respectively. Women with a history of Chlamydia trachomatis infection had a significantly higher rate of tubal obstruction (P < 0.001), excluded or operated hydrosalpinx (P = 0.002) and/or history of chronic endometritis (P < 0.001). There were no statistically significant differences between the two groups in the mean number of mature oocytes retrieved, fertilization rate or implantation rate. The IVF cumulative live birth rate per cycle was similar in the two groups (36.7% in group A versus 34.9% in group B, P = 0.692). The cumulative rates of clinical pregnancy, pregnancy loss, biochemical pregnancy and ectopic pregnancy were comparable between the two groups. CONCLUSION Positive Chlamydia trachomatis serology has no impact on IVF pregnancy outcomes.
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Affiliation(s)
- Clara Gadenne
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France.
| | - Laura Miquel
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France
| | - Cindy Faust
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Julie Berbis
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Jeanne Perrin
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
| | - Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
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Oltedal A, Gaustad AH, Peltoniemi O, Björkman S, Skaare A, Oropeza-Moe M. Experiences with transvaginal Ovum Pick-Up (OPU) in sows. Theriogenology 2024; 214:157-165. [PMID: 37879285 DOI: 10.1016/j.theriogenology.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/01/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023]
Abstract
Transvaginal ultrasound-guided Ovum Pick-Up (OPU) is an established technique in other species. Due to several challenges, there are few publications addressing the procedure in sows. An efficient OPU technique may allow for the collection of numerous oocytes from valuable sows for porcine in vitro embryo production, gene editing and cloning programmes, or cryopreservation. We aimed to improve transvaginal OPU and equipment for this technique in sows. In experiment 1, we conducted 13 OPU sessions on three Landrace x Large White hybrid sows under general anaesthesia, while the second experiment explored OPU in non-sedated animals (N = 6) physically restrained in a commercial claw trimming chute. The experiments resulted in 6.6 ± 5.6 (mean ± SD) and 7.7 ± 8.9 recovered cumulus-oocyte complexes per session, respectively. Post-mortem examination of the pelvic and abdominal cavities of the three sows subjected to repeated OPU sessions did not reveal major acute or chronic pathological lesions. The only sow which was inseminated after the experiment delivered 16 liveborn piglets at term. Salivary cortisol levels increased during the procedure in non-sedated and physically restrained sows but returned to baseline 1 h later (n = 5), indicating a short-term stress response. The described OPU technique and equipment have the potential to retrieve considerable numbers of oocytes by repeated procedures on valuable mature sows. Follow-up studies are needed to optimize the efficiency of the aspiration of high-quality oocytes and to describe the developmental competence of these OPU-derived oocytes. It is also essential to further investigate sow welfare during and after the procedure before recommending porcine transvaginal OPU as a sustainable and welfare-friendly procedure.
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Affiliation(s)
- Aslak Oltedal
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Sandnes, Norway.
| | | | | | | | | | - Marianne Oropeza-Moe
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Sandnes, Norway
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Bilgen S, Erdogan D, Ökten SB. Infusion of propofol with bispectral index monitoring does not reduce the amount of propofol used during transvaginal oocyte retrieval procedure. Sci Rep 2023; 13:21561. [PMID: 38057377 PMCID: PMC10700325 DOI: 10.1038/s41598-023-48611-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
In our study we aimed to investigate whether the use of bispectral index (BIS) monitoring would decrease total propofol consumption during the transvaginal oocyte retrieval procedure. This was a prospective, randomized, controlled, parallel-group clinical trial. The study was conducted in the operating room, and postoperative recovery room. One hundred and thirty, American Society of Anesthesiologists (ASA) I-II patients, over age 18, undergoing transvaginal oocyte retrieval were included in this study. All patients were administered 2 μg/kg fentanyl, and 2 mg/kg propofol for the induction of anesthesia. The patients were divided into two groups. Patients in the group bolus were given 0.5 mg/kg of propofol when necessary, according to the observer's range of motion. Patients in the group BIS were given 10 mg/kg/h propofol infusion adjusted to keep the BIS value between 40 and 60. The primary outcome was the total dose of propofol administered per patient. The secondary outcomes were the time to reach the value of 5 on the Modified Observer's Assessment of Alertness Sedation Scale (MOASs), the time to reach Post Anesthetic Discharge Scoring System (PADSS) ≥ 9 of the patients, satisfaction of the patient, and the gynecologist. The amount of total propofol was higher in the group BIS than in the group bolus administered according to the patient's clinic. There was no difference in the time to reach the value of 5 on the MOASs between the groups. The time to reach PADSS ≥ 9 was longer in the group BIS than in the group bolus. There was no difference between the two groups in terms of the satisfaction of the patient and the gynecologist. Administration of propofol as an infusion with BIS monitoring did not reduce the amount of propofol administered to patients during transvaginal oocyte retrieval.Clinical trial registration number: NCT05631925-30/11/2022.
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Affiliation(s)
- Sevgi Bilgen
- Department of Anesthesiology, Acibadem Kozyatagi Hospital, Ondokuz Mayıs Mah., Begonya Sokak., No:12 Kadıköy, Istanbul, Turkey.
| | - Dilek Erdogan
- Department of Anesthesiology, Acibadem Kozyatagi Hospital, Ondokuz Mayıs Mah., Begonya Sokak., No:12 Kadıköy, Istanbul, Turkey
| | - Sabri Berkem Ökten
- Department of Obstetrics and Gynecology, Acibadem Kozyatagi Hospital, Ondokuz Mayıs Mah., Begonya Sokak., No:12 Kadıköy, Istanbul, Turkey
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Hekimoğlu Şahin S, Çopuroğlu E, Yamak Altınpulluk E, Süt N, Karamanlıoğlu B, Elter K, Yaman Ö. Effect of Preoperative Anxiety on Depth of Anaesthesia and In Vitro Fertilization Success. Turk J Anaesthesiol Reanim 2023; 51:414-419. [PMID: 37876168 PMCID: PMC10606735 DOI: 10.4274/tjar.2023.22829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/08/2023] [Indexed: 10/26/2023] Open
Abstract
Objective Infertility anxiety may have a harmful effect on embryo quality and fertilization during in vitro fertilization (IVF). Monitoring brain function gives real-time information about the depth of anaesthesia of a patient. This study examined the effect of preoperative anxiety on the depth of anaesthesia and IVF success. Methods One hundred thirty-one patients who had undergone oocyte retrieval were divided into two groups according to the Beck Anxiety Inventory (BAI): the low-anxious Group L (n = 71) and high-anxious Group H (n = 60). Hemodynamic stability, intraoperative total propofol and fentanyl consumption, good quality embryo (GQE) rate, and fertilization rate were recorded. Results Fertilization and GQE rates were not significant between groups L and H. Total propofol consumption was significantly higher in group H than in group L. Heart rate (HR) preoperatively and postoperatively and systolic arterial pressure (SAP) preoperatively and diastolic arterial pressure (DAP) postoperatively were significantly increased in group H than in group L. The time for the modified Aldrete score to reach 9 (MAS 9) in group H was significantly higher than that in group L. The effect of variables that were found significantly in the univariate analysis (Propofol, HRpreop, HRpostop, SAPpreop, DAPpostop, and MAS 9) on BAI score. Conclusion Total propofol consumption was higher in patients with high anxiety levels, but it did not have a negative effect on IVF success.
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Affiliation(s)
- Sevtap Hekimoğlu Şahin
- Department of Anaesthesiology and Reanimation, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Elif Çopuroğlu
- Department of Anaesthesiology and Reanimation, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Ece Yamak Altınpulluk
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain EchoTraining School, Madrid, Spain; Outcomes Research Consortium, Cleveland, Ohio, USA; Anaesthesiology Clinical Research Office, Atatürk University, Erzurum, Turkey
| | - Necdet Süt
- Department of Bioistatistics, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Beyhan Karamanlıoğlu
- Department of Anaesthesiology and Reanimation, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Koray Elter
- Department of Obstetrics and Gynecology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Özge Yaman
- Department of Obstetrics and Gynecology, Trakya University Faculty of Medicine, Edirne, Turkey
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Thanikachalam P, Govindan DK. Pain Management during Ultrasound Guided Transvaginal Oocyte Retrieval - A Narrative Review. J Hum Reprod Sci 2023; 16:2-15. [PMID: 37305768 PMCID: PMC10256939 DOI: 10.4103/jhrs.jhrs_141_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 06/13/2023] Open
Abstract
Transvaginal oocyte retrieval (TVOR), done for the purpose of assisted reproduction can instigate enormous pain and therefore requires adequate analgesia with the least adverse effects. As the procedure involves retrieving oocytes for in vitro fertilisation, the effect of the anaesthetic drugs on the oocyte quality should also be considered. This review focuses on the various modes of anaesthesia and the anaesthetic drugs which can be administered safely to provide effective analgesia in normal and in special conditions such as women with pre-existing comorbidities. Medline, Embase, PubMed and Cochrane electronic databases were searched according to modified Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. According to this review, conscious sedation appears to be the most preferred mode of anaesthesia in women undergoing TVOR owing to fewer adverse effects, faster recovery, better patient and specialist comfort and the least effect on oocyte quality and embryo development. Combining it with paracervical block resulted in lesser consumption of the anaesthetic drug, which may have a beneficial effect on the oocyte quality.
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Affiliation(s)
- Puvithra Thanikachalam
- Department of Obstetrics and Gynaecology, Chettinad Fertility Services, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Dilip Kumar Govindan
- Department of Anaesthesiology, Sri Sathya Sai Medical College and Research Institute, Balaji Vidyapeeth University, Kanchipuram, Tamil Nadu, India
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Sallam HN, Gelbaya TA, Rosas IM, Anagnostopoulou C, Sallam N, Agarwal A. Clinical aspects of oocyte retrieval and embryo transfer. Tips and tricks for the novice and experts. Panminerva Med 2022; 64:185-199. [PMID: 35179015 DOI: 10.23736/s0031-0808.22.04679-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oocyte retrieval (ovum pick-up) and embryo transfer (ET) are essential steps in IVF and ICSI and over the years, the two procedures were developed in order to improve the clinical outcome. Many suggestions were proposed and applied before, during and after oocyte retrieval such as timing of HCG trigger, pre-operative pelvic scan, vaginal cleansing, type of anesthesia, type and gauge of aspiration needles, aspiration pressure, follicle flushing, and the need for prophylactic antibiotics. Similarly, many steps were suggested and implemented before, during and after ET including patient's position, type of anesthesia/analgesia, dummy (mock) ET, ultrasound-guidance, HCG injection in the uterine cavity, use of relaxing agents, full bladder, removal of the cervical mucus, flushing the cervix with culture medium, type of ET catheter, embryo loading techniques, site of embryo deposition, the use of adherence compounds, as well as bed rest after ET. Complications were also reported with oocyte retrieval and ET. The aim of this review is to evaluate the current practice of these two procedures in the light of available evidence.
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Affiliation(s)
- Hassan N Sallam
- Department of Obsterics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt -
| | - Tarek A Gelbaya
- Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester, UK
| | - Israel M Rosas
- Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico
| | | | - Nooman Sallam
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Trust, London, UK
| | - Ashok Agarwal
- Andrology Center and American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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Rosas IM, Anagnostopoulou C, Singh N, Gugnani N, Singh K, Desai D, Darbandi M, Manoharan M, Darbandi S, Chockalingam A, Leonardi Diaz SI, Gupta S, Kuroda S, Finelli R, Sallam HN, Wirka KA, Boitrelle F, Agarwal A. Optimizing embryological aspects of oocyte retrieval, oocyte denudation, and embryo loading for transfer: a state of the art review. Panminerva Med 2022; 64:156-170. [PMID: 35146991 DOI: 10.23736/s0031-0808.22.04675-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oocyte retrieval, oocyte denudation, and embryo transfer are crucial processes during assisted reproduction (ART). Air quality in the ART laboratory, temperature, pH of the media used and the time interval between oocyte retrieval and insemination are all critical factors. Anesthesia is required for oocyte retrieval, however evidence regarding the potential impact of different methods (general anesthesia, conscious sedation, and local anesthesia) on the clinical outcomes is unclear. The optimal timing of oocyte denudation following retrieval has not been established. Regarding the mechanical denudation process, there is a lack of evidence to demonstrate the safest minimum inner diameter of denuding pipettes used to complete the removal of granulosa cells surrounding the oocytes. During embryo transfer, many clinics worldwide flush the catheter before embryo loading, in an attempt to potentially rinse off any toxic agents; however, there is insufficient evidence to show that flushing the embryo transfer catheter before loading increases the success of ART outcome. Considering the serious gaps in knowledge in ART practice, the aim of this review is to provide an updated overview of the current knowledge regarding the various steps and techniques involved in oocyte retrieval, oocyte denudation, and embryo loading for transfer.
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Affiliation(s)
- Israel M Rosas
- Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico
| | | | | | - Nivita Gugnani
- BabySoon Fertility and IVF Center, India Institute of Medical Sciences, New Delhi, India
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
| | - Dimple Desai
- DPU IVF & ENDOSCOPY CENTER, Dr. D. Y. Patil Hospital & Research Centre, Pune, India
| | - Masha Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.,Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | | | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.,Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | | | | | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | | | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Kelly A Wirka
- Fertility & Endocrinology, Medical Affairs, EMD Serono, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland, OH, USA -
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11
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Gilboa D, Seidman L, Kimiagarov P, Noni A, Doron R, Seidman DS. Why do women choose to undergo oocyte aspiration without sedation or analgesia? REPRODUCTION AND FERTILITY 2022; 2:89-94. [PMID: 35128445 PMCID: PMC8812437 DOI: 10.1530/raf-20-0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
Objective Oocyte pick-up (OPU) is a painful but essential part of in-vitro fertilization (IVF) that is usually performed under sedation and analgesia (SaA). Our aim was to study that why some women decide to undergo OPU without SaA? Methods This was a prospective study using patient questionnaires and the standardized 7-item generalized anxiety disorder (GAD-7) score. The patients were asked to assess the pain experienced during OPU using a visual analog scale (VAS). The study sample was a convenience sample of 100 healthy women undergoing OPU at our unit with or without SaA. Results Women who chose to undergo OPU without SaA were significantly more likely to express the fear of anesthesia. A high pain score (VAS ≥ 6) was reported by significantly more patients who underwent OPU without SaA than with SaA. Yet, 98% of the patients who underwent OPU without SaA stated that in future IVF cycles, they would still choose to undergo OPU without SaA. More patients had high anxiety scores among those who underwent OPU with than without SaA. Conclusions Women who chose to undergo OPU without SaA reported more often fear of anesthesia. Although these women experienced significantly more pain during OPU, almost all of them suggested that they would still choose to undergo OPU without SaA. Increased anxiety, as expressed by higher GAD-7 scores, was not associated with a tendency to choose SaA during OPU. The option of OPU without SaA seems to be an acceptable option for selected women. Lay summary Egg retrieval from the ovaries is a painful part of in vitro fertilization (IVF). It is, therefore, usually performed under sedation and pain relief (analgesia). The aim of this study was to investigate: Why some women decide to undergo egg retrieval without sedation? We prospectively studied 100 women using patient questionnaires and standardized scores in order to measure patient's pain and anxiety levels. We found that women who chose to undergo egg retrieval without sedation were significantly more likely to express fear of anesthesia. As expected, women who decided to forgo sedation experienced more pain during egg retrieval, yet, 98% of them decided that in future IVF cycles, they would still choose to undergo egg retrieval without sedation. Surprisingly, women who had high anxiety scores were not more likely to ask for sedation during egg retrieval. The option to undergo egg retrieval without sedation during IVF seems to be acceptable for some women.
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Affiliation(s)
| | - Liron Seidman
- The Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Polina Kimiagarov
- Department of Nursing, The Academic College of Tel-Aviv - Yaffo, Tel-Aviv, Israel
| | - Avia Noni
- Department of Nursing, The Academic College of Tel-Aviv - Yaffo, Tel-Aviv, Israel
| | - Ravid Doron
- Department of Nursing, The Academic College of Tel-Aviv - Yaffo, Tel-Aviv, Israel.,Department of Education and Psychology, The Open University, Raanana, Israel
| | - Daniel S Seidman
- IVF Unit, Assuta Medical Center, Tel Aviv, Tel-Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
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Khetarpal R, Chatrath V, Kaur P, Trikha A. Anaesthesia for assisted reproductive technology (ART): A narrative review. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_63_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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High satisfaction among women undergoing oocyte retrieval without anesthesia in a well-selected patient population. Fertil Steril 2020; 114:271-272. [PMID: 32654818 DOI: 10.1016/j.fertnstert.2020.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/22/2022]
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D’Angelo A, Panayotidis C, Amso N, Marci R, Matorras R, Onofriescu M, Turp AB, Vandekerckhove F, Veleva Z, Vermeulen N, Vlaisavljevic V. Recommendations for good practice in ultrasound: oocyte pick up †. Hum Reprod Open 2019; 2019:hoz025. [PMID: 31844683 PMCID: PMC6903452 DOI: 10.1093/hropen/hoz025] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 06/22/2019] [Accepted: 07/29/2019] [Indexed: 01/13/2023] Open
Abstract
STUDY QUESTION What is good practice in ultrasound (US), and more specifically during the different stages of transvaginal oocyte retrieval, based on evidence in the literature and expert opinion on US practice in ART? SUMMARY ANSWER This document provides good practice recommendations covering technical aspects of US-guided transvaginal oocyte retrieval (oocyte pick up: OPU) formulated by a group of experts after considering the published data, and including the preparatory stage of OPU, the actual procedure and post-procedure care. WHAT IS KNOWN ALREADY US-guided transvaginal OPU is a widely performed procedure, but standards for best practice are not available. STUDY DESIGN SIZE DURATION A working group (WG) collaborated on writing recommendations on the practical aspects of transvaginal OPU. A literature search for evidence of the key aspects of the procedure was carried out. Selected papers (n = 190) relevant to the topic were analyzed by the WG. PARTICIPANTS/MATERIALS SETTING METHODS The WG members considered the following key points in the papers: whether US practice standards were explained; to what extent the OPU technique was described and whether complications or incidents and how to prevent such events were reported. In the end, only 108 papers could be used to support the recommendations in this document, which focused on transvaginal OPU. Laparoscopic OPU, transabdominal OPU and OPU for IVM were outside the scope of the study. MAIN RESULTS AND THE ROLE OF CHANCE There was a scarcity of studies on the actual procedural OPU technique. The document presents general recommendations for transvaginal OPU, and specific recommendations for its different stages, including prior to, during and after the procedure. Most evidence focussed on comparing different equipment (needles) and on complications and risks, including the risk of infection. For these topics, the recommendations were largely based on the results of the studies. Recommendations are provided on equipment and materials, possible risks and complications, audit and training. One of the major research gaps was training and competence. This paper has also outlined a list of research priorities (including clarification on the value or full blood count, antibiotic prophylaxis and flushing, and the need for training and proficiency). LIMITATIONS REASONS FOR CAUTION The recommendations of this paper were mostly based on clinical expertise, as at present, only a few clinical trials have focused on the oocyte retrieval techniques, and almost all available data are observational. In addition, studies focusing on OPU were heterogeneous with significant difference in techniques used, which made drafting conclusions and recommendations based on these studies even more challenging. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on the management of good laboratory practice in ART. Some useful troubleshooting/checklist recommendations are given for easy implementation in clinical practice. These recommendations aim to contribute to the standardization of a rather common procedure that is still performed with great heterogeneity. STUDY FUNDING/COMPETING INTERESTS The meetings of the WG were funded by ESHRE. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER NA.ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Arianna D’Angelo
- Wales Fertility Institute, University Hospital of Wales, Cardiff University, Cardiff, UK
| | | | - Nazar Amso
- Cardiff University, Cardiff, South Glamorgan, UK
| | - Roberto Marci
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Roberto Matorras
- Instituto Valenciano de Infertilidad, IVI Bilbao, Bilbao, Spain; Human Reproduction Unit, Cruces University Hospital, Bilbao, Spain; Department of Obstetrics and Gynecology, Basque Country University, Spain; BioCruces Research Center Bilbao, Bilbao, Spain
| | - Mircea Onofriescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr.T.Popa”, Iasie, Romania
| | - Ahmet Berkiz Turp
- Department of Obstetrics and Gynecology, IVF Unit, Harran University, Sanliurfa 63300, Turkey
| | | | - Zdravka Veleva
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
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Anesthesia and analgesia for transvaginal oocyte retrieval. Should we recommend or avoid any anesthetic drug or technique? Curr Opin Anaesthesiol 2019; 32:285-290. [PMID: 31045635 DOI: 10.1097/aco.0000000000000715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The objective of this review is to analyze and summarize the current anesthetic methods used to alleviate pain and discomfort during transvaginal oocyte retrieval procedures (TORP), to try to reach practical recommendations, based on the evidence, which will translate into daily practice, the knowledge on the anesthetic management of patients scheduled for TORP. RECENT FINDINGS There is no strong evidence to recommend the avoidance of any technique or drug for TORP, including nitrous oxide or halogenated agents. Women should be offered any available technique. The evidence available up to date is not convincing enough to recommend avoiding any anesthetic technique in terms of pregnancy and birth rates. SUMMARY TORP is painful for women and different techniques may be used for pain relief in day case surgery. The other important outcome to consider is the pregnancy rate, and any anesthetic technique or drug which would improve this pregnancy rate should be recommended. Conscious sedation and general anesthesia proved to be well tolerated for woman and the oocytes, despite the use of propofol, opioids, benzodiacepines, nitrous oxide, or other drugs. Spinal anesthesia and paracervical block are also acceptable options, and can be combined with conscious sedation. Nevertheless, more studies are needed to find out the ideal drug or technique combination for the woman and the oocyte.
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Farzi F, Mehrafza M, Mirmansouri A, Sorouri ZZ, Roushan ZA, Raoufi A, Shalkohi R, Samadnia S, Hosseini A. Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil - A randomized clinical trial. Taiwan J Obstet Gynecol 2019; 58:536-540. [PMID: 31307747 DOI: 10.1016/j.tjog.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Anesthesia for assisted reproductive technology is very important to provide less stressful and painful environment for patients, with minimal side effects on oocytes. In the present study, we aimed to evaluate hemodynamic parameters, recovery time and intracytoplasmic sperm injection (ICSI) outcome among patients underwent anesthesia with fentanyl, remifentanil or alfentanil. MATERIAL AND METHODS This randomized double-blinded clinical trial was conducted in patients undergoing anesthesia for transvaginal ultrasound guided oocyte retrieval (TUGOR). Patients were randomly allocated to alfentanil (A; 15 μg/kg), fentanyl (F; 1.5 μg/kg) or remifentanil (R; 1.5 μg/kg) groups. RESULTS Three hundred forty patients were assessed for eligibility and randomized for transvaginal oocyte retrieval following general anesthesia and 105 were lost to follow up. No statistically significant differences were noted among groups regarding basic characteristics. Although, time to respond to verbal command was significantly different among groups (A: 1.99 ± 1.64, F: 2.56 ± 1.72, R: 1.78 ± 1.34, P = 0.014). There were no significant differences among groups with respect to the first and second postoperative pain intensity, patient satisfaction, pre-induction and post-induction systolic and diastolic blood pressure (BP). Terminal systolic (A: 101.61 ± 9.15, F: 105.29 ± 12.61, R: 102 ± 12.91, P = 0.01) and diastolic (A: 59.97 ± 9, F: 65.63 ± 9.13, R: 63.69 ± 11.01, P = 0.003) BP was significantly different among groups. The fertilization rate was significantly different among groups (A: 51.6%, F: 54.4%, R: 62.2%, P = 0.018). Implantation rate, biochemical and clinical pregnancy rate was similar among groups. CONCLUSIONS The results of present study demonstrated that all three opioids have the same efficiency, in regards to patient satisfaction and pregnancy outcome. However, Anesthesia with alfentanil compared with fentanyl and remifentanil, seems to be inferior for TUGOR due to higher effect on fertilization rate and less hemodynamic stability. REGISTRATION NUMBER IRCT201410258677N4.
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Affiliation(s)
- Farnoush Farzi
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Marzieh Mehrafza
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Ali Mirmansouri
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Ziba Zahiri Sorouri
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Zahra Atrkar Roushan
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Azadeh Raoufi
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Reyhane Shalkohi
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Sajedeh Samadnia
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Ahmad Hosseini
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
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