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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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Larsson F, Strömbäck U, Rysst Gustafsson S, Engström Å. Perception of feeling safe perioperatively: a concept analysis. Int J Qual Stud Health Well-being 2023; 18:2216018. [PMID: 37210740 DOI: 10.1080/17482631.2023.2216018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/16/2023] [Indexed: 05/23/2023] Open
Abstract
PURPOSE The purpose of this study was to explore the concept of feeling safe, from the patient perspective, in a perioperative context. METHOD The eight-step concept analysis approach proposed by Walker and Avant was utilized to examine the attributes of feeling safe. Uses of the concept, defining attributes as well as antecedents, consequences and empirical referents are presented to describe the concept. Case examples are provided in order to assist the understanding of the defining attributes. RESULTS Feeling safe is defined as: a person that does not feel worried or threatened. Three attributes were identified: Participation, Control and Presence. Knowledge and Relationship are the antecedents of feeling safe, while Feeling Acknowledged and Trust are the consequences. Empirical referents are explored in order to find a way to measuring the perceived feeling of safety. CONCLUSION This concept analysis underscores the importance of including patients' perceptions in traditional patient safety work. Patients who feel safe perceive that they participate in their care, that they are in control, and that they feel the presence of both healthcare staff and relatives. The perceived feeling of security could, by extension, promote the postoperative recovery of patients undergoing surgery by positively affect the process of recovery.
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Affiliation(s)
- Fanny Larsson
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Ulrica Strömbäck
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Silje Rysst Gustafsson
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Åsa Engström
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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Buisman ETIA, Roest I, van der Steeg JW, Smeenk JMJ, Koks CAM. Pain scores during oocyte retrieval for IVF/ICSI: a retrospective cohort study comparing three different analgesia protocols. J Gynecol Obstet Hum Reprod 2022; 51:102394. [PMID: 35487403 DOI: 10.1016/j.jogoh.2022.102394] [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: 01/25/2022] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Oocyte retrieval is a painful, but essential element of IVF/ICSI. Evidence for the best method of analgesia is lacking. In the Netherlands, the three most common analgesia protocols entail administration of oral analgesics, intravenous opioids, and intramuscular opioids. The aim of this study was to compare these methods. METHODS A retrospective cohort study was conducted at three clinics. Clinic one provided oral analgesics (1000mg paracetamol and 500mg naproxen). The main component of analgesia at clinic two was opioids intravenously (50-100µg fentanyl), and at clinic three, this was opioids intramuscularly (0.01mg/kg alfentanil). Intraprocedural pain was registered on an 11-point scale. Univariate analyses were performed to identify factors significantly associated with pain scores. A mixed linear model was used to uncover mean pain scores per clinic. RESULTS In total, 2,127 oocyte retrievals were included. Pain scores were lower in older women; scores decreased 0.06 points per year (95%-confidence interval (CI): 0.04-0.08). Per extra follicle, scores were 0.05 points higher (95%-CI: 0.03-0.06). Endometriosis resulted in 0.45-point higher scores (95%-CI: 0.01-0.88). Primary subfertility resulted in a 0.36-point increase in scores (95%-CI: 0.15-0.56). Nulliparous women had a 0.41-point higher score than multiparous women (95%-CI: 0.19-0.63). These effects were mostly similar in all clinics. Mean pain scores were 5.6 at clinic number 1 (95%-CI: 5.3-5.8), 5.1 at clinic number 2 (95%-CI: 4.9-5.3), and 3.9 at clinic number 3 (95%-CI: 3.8-4.1). CONCLUSION The lowest pain scores were achieved in the clinic that used intramuscular administration of alfentanil, followed by intravenous fentanyl and, finally, non-sedative oral analgesics. Significant correlations between patient characteristics and pain scores were identified.
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Affiliation(s)
- Erato T I A Buisman
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Postbus 90153, 5200 ME, 's-Hertogenbosch, The Netherlands; Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Inez Roest
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Postbus 90052, 5600 PD, Eindhoven, The Netherlands
| | - Jan Willem van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Postbus 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
| | - Jesper M J Smeenk
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Postbus 90151, 5000 LC, Tilburg, The Netherlands
| | - Carolien A M Koks
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Postbus 90052, 5600 PD, Eindhoven, The Netherlands
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Baradwan S, Almalki NA, Alshahrani MS, Shodari A, AlSghan R, Miski NT, Labib K, Islam BA, Riad AAM, Alanwar A, Elhawary MAA, Saleh DM, Elsharkawy MRM, Daoud M, Abdelhakim AM, Abdou H. Effect of reduced needle versus standard needle on pain experience during oocyte retrieval procedure: a systematic review and meta-analysis of randomized controlled trials. Gynecol Endocrinol 2022; 38:296-302. [PMID: 34907828 DOI: 10.1080/09513590.2021.2015758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare reduced needle versus standard needle regarding pain experience among women undergoing oocyte retrieval procedures. METHODS A systematic search was done in Cochrane Library, PubMed, ISI web of science, and Scopus during April 2021. We selected randomized clinical trials (RCTs) compared reduced needle versus standard needle among women undergoing ultrasound-guided oocyte retrieval procedures. Revman software was utilized for performing our meta-analysis. Our primary outcomes were pain scores evaluated by the Visual Analog Scale (VAS) during the procedure, directly post-procedure, and 30 min post-procedure. Our secondary outcomes were the request for more analgesia, clinical pregnancy rate, and rate of vaginal bleeding less than expected. RESULTS Six RCTs met our inclusion criteria with a total number of 1063 patients. We found reduced needle was linked to a significant reduction in VAS pain score during and directly after the procedure, respectively (MD= -1.54, 95% CI [-2.38, -0.70], p = .003 and MD= -1.14, 95% CI [-1.38, -0.91], p < .001). After removal of the reported heterogeneity, the reduced needle had significantly reduced the pain score 30 min post-procedure and request for more analgesia in comparison with standard needle (p < .001). No significant difference was found between both groups regarding clinical pregnancy rate (p = .17). More patients in reduced needle group were reported to vaginally bleed less than expected compared to standard needle group (RR = 1.91, 95% CI [1.35, 2.70], p = .003). CONCLUSIONS Patient perceived pain, analgesic requirement, and vaginal bleeding are decreased with reduced needle administration versus standard needle without affecting the clinical pregnancy rate in oocyte retrieval procedure.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Norah Awadh Almalki
- Department of Obstetrics and Gynecology, Security Forces Hospital, Makkah, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Albraa Shodari
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children hospital, AlKharj, Saudi Arabia
| | - Najlaa Talat Miski
- Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Saudi Arabia
| | - Kareem Labib
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Bassem Aly Islam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr Ahmed Mahmoud Riad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Alanwar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Doaa M Saleh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | | | - Mohamed Daoud
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Hossam Abdou
- Department of Obstetrics and Gynecology, Faculty of Medicine, Helwan University, Cairo, Egypt
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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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Buisman ETIA, Grens H, Wang R, Bhattacharya S, Braat DDM, Huppelschoten AG, van der Steeg JW. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac006. [PMID: 35224230 PMCID: PMC8868119 DOI: 10.1093/hropen/hoac006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
STUDY QUESTION What is the methodological validity and usefulness of randomized controlled trials (RCTs) on pain relief during oocyte retrieval for IVF and ICSI? SUMMARY ANSWER Key methodological characteristics such as randomization, allocation concealment, primary outcome measure and sample size calculation were inadequately reported in 33–43% of the included RCTs, and a broad heterogeneity is revealed in the studied outcome measures. WHAT IS KNOWN ALREADY A Cochrane review on conscious sedation and analgesia for women undergoing oocyte retrieval concluded that the overall quality of evidence was low or very low, mainly owing to poor reporting. This, and heterogeneity of studied outcome measures, limits generalizability and eligibility of results for meta-analysis. STUDY DESIGN, SIZE, DURATION For this review, a systematic search for RCTs on pain relief during oocyte retrieval was performed on 20 July 2020 in CENTRAL CRSO, MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, WHO ICTRP, Web of Science, Portal Regional da BVS and Open Grey. PARTICIPANTS/MATERIALS, SETTING, METHODS RCTs with pain or patient satisfaction as an outcome were included and analysed on a set of methodological and clinical characteristics, to determine their validity and usefulness. MAIN RESULTS AND THE ROLE OF CHANCE Screening of 2531 articles led to an inclusion of 51 RCTs. Randomization was described inadequately in 33% of the RCTs. A low-risk method of allocation concealment was reported in 55% of the RCTs. Forty-nine percent of the RCTs reported blinding of participants, 33% of blinding personnel and 43% of blinding the outcome assessor. In 63% of the RCTs, the primary outcome was stated, but a sample size calculation was described in only 57%. Data were analysed according to the intention-to-treat principle in 73%. Treatment groups were not treated identically other than the intervention of interest in 10% of the RCTs. The primary outcome was intraoperative pain in 28%, and postoperative pain in 2%. The visual analogue scale (VAS) was the most used pain scale, in 69% of the RCTs in which pain was measured. Overall, nine other scales were used. Patient satisfaction was measured in 49% of the RCTs, for which 12 different methods were used. Occurrence of side-effects and complications were assessed in 77% and 49% of the RCTs: a definition for these was lacking in 13% and 20% of the RCTs, respectively. Pregnancy rate was reported in 55% of the RCTs and, of these, 75% did not adequately define pregnancy. To improve the quality of future research, we provide recommendations for the design of future trials. These include use of the VAS for pain measurement, use of validated questionnaires for measurement of patient satisfaction and the minimal clinically relevant difference to use for sample size calculations. LIMITATIONS, REASONS FOR CAUTION Consensus has not been reached on some methodological characteristics, for which we formulated recommendations. To prevent further heterogeneity in research on this topic, recommendations were formulated based on expert opinion, or on the most used method thus far. Future research may provide evidence to base new recommendations on. WIDER IMPLICATIONS OF THE FINDINGS Use of the recommendations given for design of trials on this topic can increase the generalizability of future research, increasing eligibility for meta-analyses and preventing wastefulness. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was obtained for this study. S.B. reports being the editor-in-chief of Human Reproduction Open. For this manuscript, he was not involved with the handling process within Human Reproduction Open, or with the final decision. Furthermore, S.B. reports personal fees from Remuneration from Oxford University Press as editor-in-chief of Human Reproduction Open, personal fees from Editor and contributing author, Reproductive Medicine for the MRCOG, Cambridge University Press. The remaining authors declare no conflict of interest in relation to the work presented. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- E T I A Buisman
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The Netherlands
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Correspondence address. Centre of Reproductive Medicine, Jeroen Bosch Hospital, Postbus 90153, 5200 ME ‘s-Hertogenbosch, Netherlands. E-mail: https://orcid.org/0000-0001-7857-5742
| | - H Grens
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The Netherlands
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - S Bhattacharya
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK
| | - D D M Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A G Huppelschoten
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The Netherlands
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Oxidative Stress Reduction by Midazolam Premedication during Oocyte Retrieval Procedure: Pilot Study. J Clin Med 2021; 10:jcm10040855. [PMID: 33669707 PMCID: PMC7922791 DOI: 10.3390/jcm10040855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Infertility is one of the major medical problems nowadays. Couples who opt for In Vitro Fertilization (IVF) face a great deal of stress which certainly affects the outcome of the procedure. Therefore, we aimed to reduce the stress during the oocyte retrieval procedure by applying midazolam. Total oxidant (TOC) and antioxidant (TAC) capacities of serum, as well as glutathione (GSH) content and catalase activity, were measured in both control and midazolam groups. Follicular fluid was also tested for oxidant capacity and IL1β. Results implied that the midazolam group increased TAC at the end of the procedure. At the same time, the control group decreased GSH at the beginning of the procedure, and both groups decreased catalase activity at the end of the procedure. The results imply that stress during the procedure affects oxidative and antioxidative parameters of the patients, but did not affect the frequency of the pregnancy at the end of this pilot study. Yet, the results imply that oxidative and antioxidative mechanisms during IVF should be investigated in detail as they could affect the outcome of IVF.
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8
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Effect of needle diameter on pain during oocyte retrieval-a randomized controlled trial. Fertil Steril 2020; 115:683-691. [PMID: 33077240 PMCID: PMC7563574 DOI: 10.1016/j.fertnstert.2020.06.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
Objective To study pain in women undergoing oocyte retrieval with a reduced needle (20/17 gauge) compared to a standard needle (16 gauge). Design Single-center randomized controlled trial. Setting Fertility clinic. Patients Women undergoing their first oocyte retrieval for in vitro fertilization or intracytoplasmic sperm injection. Interventions Oocyte retrieval with a reduced needle (20/17 gauge) or with a standard needle (16 gauge). Main Outcome Measures The primary outcome measure was intraoperative pain on an 11-point visual analogue scale (VAS). Secondary outcome measures included the following: dosage of fentanyl requested; pain at 5, 15 and 30 minutes after retrieval; and pain and analgesia until 4 days after retrieval. Results A total of 47 women were randomized for the reduced needle (RN) and 48 for the standard needle (SN). Pain scores were significantly lower during and after retrieval with the RN. During retrieval, mean VAS scores in the RN group were 4.3 versus 6.3 in the SN group. Pain remained significantly lower in the RN group after retrieval, with VAS-scores of 1.2 vs. 2.1 directly after retrieval, 0.0 versus 2.0 5 minutes after retrieval, and 0.0 versus 1.0 30 minutes after retrieval. In the RN group, three patients (6.4%) requested more fentanyl during the procedure, versus 16 (33.3%) in the SN group. A total of 79 patients submitted their follow-up questionnaire (response rate 83%). Pain on the first 2 days following retrieval was significantly less in the RN group, with VAS scores of 1.6 versus 2.4 in the SN group, and 1.2 versus 2.5. In line with this finding, fewer patients in the RN group took analgesia on the days after the procedure. This difference was statistically significant only on day 3. Conclusion Use of a thinner needle results in significantly and clinically relevant lower pain scores during oocyte retrieval, and patients in the reduced needle group requested significantly less analgesia during oocyte retrieval than patients in the standard needle group. Pain scores remained significantly lower up until 2 days after the procedure. Dutch Trial Registration Number NTR6064 (www.trialregister.nl).
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9
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Guo XL, Li X, Wei W, Wang RR, Xiao F, Liu LY, Xu J. Acupuncture for pain relief of women undergoing transvaginal oocyte retrieval: A meta analysis and systematic review protocol. Medicine (Baltimore) 2020; 99:e22383. [PMID: 32991459 PMCID: PMC7523850 DOI: 10.1097/md.0000000000022383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pain during oocyte retrieval, which can make the in-vitro fertilization process an unpleasant experience, is becoming a common problem. Although there are many analgesic methods available in the clinical setting, they are not therapeutically equivalent, and some are associated with varying adverse reactions. In recent years, acupuncture analgesia has been used in the perioperative period of oocyte retrieval because of its perceived efficacy and safety. The purpose of this systematic review and meta-analysis is to provide evidence that acupuncture is effective in the treatment of vaginal oocyte retrieval pain. METHODS Electronic searches of the following six databases will be conducted by two qualified reviewers: MEDLINE, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Medicine database, VIP database and Wanfang database. Three clinical trial registries will also be searched: World Health Organization International Clinical Trial Registry Platform, Chinese Clinical Trial Registry, Cochrane Central Register of Controlled Trials and ClinicalTrials.Gov. All searches will cover the period from inception of the database/registry to March 2020 and will be limited to publications in English and Chinese. Data identification, data selection, data extraction, and bias risk assessment will be conducted independently by3ν two or more qualified reviewers, including those who selected the studies. Visual analogue scale scores will be calculated as the primary outcome. Secondary outcomes will include results of other subjective pain rating scales, including Likert scales or other defined numerical or non-numerical scales, self-assessed by patients before, during, and after oocyte retrieval. We will use STATA software (Version 16) to perform meta-analyses, and the Grading of Recommendations, Assessment, Development and Evaluations framework to grade the quality of evidence. If quantitative analysis is not available, a systematic narrative synthesis will be provided. PROSPERO REGISTRATION NUMBER CRD42020170095.
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Affiliation(s)
- Xiao-Li Guo
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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10
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Frederiksen Y, Mehlsen MY, Matthiesen SMS, Zachariae R, Ingerslev HJ. Predictors of pain during oocyte retrieval. J Psychosom Obstet Gynaecol 2017; 38:21-29. [PMID: 27670651 DOI: 10.1080/0167482x.2016.1235558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Pain during oocyte retrieval remains prevalent despite detailed and specific pain management protocols. Exploring the role of psychosocial risk factors of pain during the oocyte retrieval could identify possible targets for prevention. The present study assessed pain prevalence and possible risk factors for experiencing extreme pain levels in a large cohort of women receiving assisted reproductive technologies (ART) treatment. METHODS Participants were 810 first attendees about to begin treatment with ART. The participants completed questionnaires at three time points: at their 21st day of the cycle, during the waiting time before the oocyte retrieval surgery and after the oocyte retrieval. RESULTS Fifty-one (6.9%) of the women reported the oocyte retrieval to be very or extremely painful. The results of a multiple logistic regression indicated that the significant predictors of high pain intensity, measured before the oocyte retrieval, were negative gynecological experiences and side effects of hormonal treatment. Variables measured after the oocyte retrieval associated with pain intensity were higher levels of anxiety during the oocyte retrieval, lower levels of perceived control and longer duration of the procedure. DISCUSSION The findings of the present study may help to identify those women who are at increased risk of experiencing unacceptable pain levels during oocyte retrieval procedures and the medical staff is advised to take psychological factors into account.
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Affiliation(s)
- Yoon Frederiksen
- a Department of Psychology , Aarhus University , Aarhus , Denmark
| | - Mimi Y Mehlsen
- a Department of Psychology , Aarhus University , Aarhus , Denmark
| | - Signe M S Matthiesen
- a Department of Psychology , Aarhus University , Aarhus , Denmark.,b Aarhus Municipality, Family, Children and Youth, Department of Projects and Development, Interventions for Children and Families , Risskov , Denmark
| | - Robert Zachariae
- a Department of Psychology , Aarhus University , Aarhus , Denmark.,c Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
| | - Hans Jakob Ingerslev
- d Centre for Preimplantation Genetic Diagnosis/The Fertility Clinic, Aarhus University Hospital , Aarhus N , Denmark.,e Faculty of Health , Aarhus University , Aarhus C, Denmark
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Bourdon M, Santulli P, de Ziegler D, Gayet V, Maignien C, Marcellin L, Chapron C. Does GnRH Agonist Triggering Control Painful Symptom Scores During Assisted Reproductive Technology? A Retrospective Study. Reprod Sci 2017; 24:1325-1333. [DOI: 10.1177/1933719116687659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mathilde Bourdon
- Faculté de Médecine, Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pietro Santulli
- Faculté de Médecine, Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Laboratoire d’immunologie, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Dominique de Ziegler
- Faculté de Médecine, Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Vanessa Gayet
- Faculté de Médecine, Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Chloé Maignien
- Faculté de Médecine, Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Louis Marcellin
- Faculté de Médecine, Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Laboratoire d’immunologie, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charles Chapron
- Faculté de Médecine, Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Département de “Génetique, Développement et Cancer,” Institut Cochin, Inserm, U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Guillaume A, Schuller-Dufour E, Faitot V, Pirrello O, Rongières C, Ohl J, Nisand I, Bettahar K. [Patient's experience of topical anesthesia by lidocaine vaginal gel for oocyte retrieval]. ACTA ACUST UNITED AC 2016; 45:942-947. [PMID: 27318637 DOI: 10.1016/j.jgyn.2016.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/08/2016] [Accepted: 05/13/2016] [Indexed: 11/19/2022]
Abstract
A recent adverse effect of a paracervical block (cardiac arrest) occurred during an oocyte retrieval (OR), forcing us to reconsider our pain management during OR. Since then, we decided to use intravaginal lidocaine gel as analgesia during OR. OBJECTIVES To evaluate the pain during OR after intravaginal lidocaine gel analgesia and to evaluate the motivations of women choosing this technique. METHODS A monocentric observational study was performed on 200 patients. Pain was measured using a numeric pain scale during and after oocyte retrieval. The tolerance of the procedure was evaluated through a patient questionnaire. RESULTS Median maximal pain was 5±2.3 (0-10) per-retrieval and 3±2.2 (0-10) post-retrieval. The procedure was considered bearable by 85.5% of the patients and 81.5% of them would choose this method in case of new oocyte retrieval. No adverse effect occurred during the study. CONCLUSION The use of intravaginal lidocaine gel seems an acceptable analgesia alternative during oocyte retrieval.
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Affiliation(s)
- A Guillaume
- Service d'aide médicale à la procréation, hôpitaux universitaires de Strasbourg CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
| | - E Schuller-Dufour
- Service d'aide médicale à la procréation, hôpitaux universitaires de Strasbourg CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - V Faitot
- Service d'anesthésie, hôpitaux universitaires de Strasbourg CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - O Pirrello
- Service d'aide médicale à la procréation, hôpitaux universitaires de Strasbourg CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - C Rongières
- Service d'aide médicale à la procréation, hôpitaux universitaires de Strasbourg CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - J Ohl
- Service d'aide médicale à la procréation, hôpitaux universitaires de Strasbourg CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - I Nisand
- Service d'aide médicale à la procréation, hôpitaux universitaires de Strasbourg CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - K Bettahar
- Service d'aide médicale à la procréation, hôpitaux universitaires de Strasbourg CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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13
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Hormonal and Clinical Predictors for Post–egg Retrieval Pain in Women Undergoing Assisted Reproductive Technology Procedures. Clin J Pain 2016; 32:313-20. [DOI: 10.1097/ajp.0000000000000251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holter H, Sandin-Bojö AK, Gejervall AL, Wikland M, Wilde-Larsson B, Bergh C. Quality of care in an IVF programme from a patient's perspective: development of a validated instrument. Hum Reprod 2013; 29:534-47. [PMID: 24287821 DOI: 10.1093/humrep/det421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is it possible to develop a trustworthy instrument to evaluate the patient's perspective on fertility care and to document fully all methodological steps, including validation? SUMMARY ANSWER A validated instrument has been developed for both women and men undergoing assisted reproduction to monitor the quality of care on a regular basis, similar to live birth rates and other effectiveness data. WHAT IS KNOWN ALREADY?: Within fertility care, several instruments have been developed, but many have significant methodological problems and few have been validated. Most instruments focus exclusively on women and no questionnaires have been directed at women and men separately. STUDY DESIGN, SIZE AND DURATION The questionnaire specific to IVF treatments (QPP-IVF) is based on the theoretical foundation of the validated general instrument, quality of care from patients perspective (QPP), for both women and men. The QPP-IVF was developed and validated by quantitative methods. A two-centre study ran between September 2011 and May 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS In all, 655 women and men participated. The measurements consisted of two kinds of evaluations: the rating of perceived reality of care and the rating of the subjective importance of various aspects of treatment. The questionnaire consisted of 43 items for women and 42 items for men. An exploratory factor analysis was performed for women for all items of subjective importance. Eigenvalue, explained variance and factor loading are given for each factor. Internal consistency of subscales was assessed by Cronbach's alpha, item discriminant validity and percentage scaling success. For external validity, a correlation with fertility quality of life (FertiQoL) was performed and for reliability, a test-retest analysis was carried out. Sensitivity analyses were performed by known-group analyses. All significance tests were two sided and conducted at the 5% significance level. MAIN RESULTS AND THE ROLE OF CHANCE The QPP-IVF instrument, divided into four dimensions, seemed a valid and reliable way of measuring the quality of care from a patient's perspective, for both women and men. The item-scaling test confirmed 10 underlying factors, with scaling success in all subscales and Cronbach's alpha >0.70 for women in almost all subscales. It was somewhat lower for men but still acceptable. The external validity was acceptable, with significant correlation between QPP-IVF and FertiQoL. The test-retest analysis confirmed that QPP-IVF was a stable instrument, with intra-class correlation coefficients from 0.74 to 0.89 for women. Sensitivity analyses indicated a sensitive instrument. LIMITATIONS, REASON FOR CAUTION The response rate to the questionnaire was 67.5%. Although considered acceptable in questionnaire studies, this response level might introduce a certain risk of selection bias. The questionnaire was developed and validated only in Sweden. WIDER IMPLICATIONS OF THE FINDINGS The QPP-IVF may be of use for purposes of quality improvement and national comparisons. Future studies should focus on establishing the QPP-IVF as a valuable instrument for measuring the quality of care outside Sweden. STUDY FUNDING/COMPETING INTEREST The study was supported by the LUA/ALF agreement at Sahlgrenska University Hospital, Gothenburg, Sweden and by Hjalmar Svensson's Research Foundation. None of the authors declared any conflict of interests.
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Affiliation(s)
- Herborg Holter
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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Dancet EAF, Nelen WLDM, Sermeus W, De Leeuw L, Kremer JAM, D'Hooghe TM. The patients' perspective on fertility care: a systematic review. Hum Reprod Update 2010; 16:467-87. [PMID: 20223789 DOI: 10.1093/humupd/dmq004] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient-centered reproductive medicine (PCRM) is important for quality of care, and this is increasingly being recognized. However, its scientific basis is unclear. The main research questions addressed in this review are: 'How has the patients' perspective on fertility care been examined (method and quality)?' and 'What is the perspective of patients in developed countries on fertility care?'. METHODS A systematic search of electronic databases was conducted and inclusion criteria with respect to eligibility and quality were applied. The methodology of the studies was critically appraised; the findings of the studies were synthesized and organized according to: patients' value clarification and assessment of service quality and dimensions of patient-centeredness. Additionally data on patient preferences and determinants of patients' perspective on care were collected. RESULTS In 51 selected studies, patients' perspective on fertility care was examined with (few or many item) questionnaires and/or qualitative interviews. Significant methodological problems were observed. Fertility patients attached importance to seven out of eight dimensions of patient-centeredness (Picker institute) and two new dimensions 'fertility clinic staff' and 'skills' were developed. Overall, fertility patients want to be treated like human beings with a need for: medical skills, respect, coordination, accessibility, information, comfort, support, partner involvement and a good attitude of and relationship with fertility clinic staff. Patients' preferences between procedures and demographic, medical and psychological determinants of their perspective were defined. CONCLUSIONS Fertility patients have 'human needs' besides their need for medical care. Evidence on PCRM is available but significant methodological limitations call for the development and validation of a European questionnaire.
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Affiliation(s)
- E A F Dancet
- Leuven University Hospital, Leuven University Fertility Centre, Leuven, Belgium
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