Deleterious impact of propofol on in vitro fertilization. a prospective randomized trial

Abstract

Propofol is widely used for anesthesia in oocyte transvaginal aspiration. In vitro studies on animal models have shown that propofol could be deleterious for fertilization and embryo development in a dose- and time-dependent manner. The purpose of this study was to analyse the potential negative effects of propofol on human in vitro fertilization outcomes. Prospective-double blind, randomized trial. 144 patients with more than four metaphase II oocytes retrieved were enrolled in this study and randomly separated. Two protocols of anesthesia were used. Group A: (GA, n=74) received intravenous (IV) propofol 2 mg/kg, midazolam 0.015 mg/kg and fentanyl 1 μg/kg. Group B: (GB, n=74) IV propofol 1.5 mg/kg, midazolam 0.05 mg/kg and fentanyl 1.5 μg/kg. Maintenance of anesthesia was achieved by intermittent IV bolus when required. Quantity of propofol, duration and quality of anesthesia, number of oocytes, embryo quality and pregnancy rate were evaluated. Mean doses of propofol were GA: 0.277 ± 0.080 mg/kg.min and GB: 0.195 ± 0.055 mg/kg.min (p< .01). No significant differences were found among anesthetics parameters, patient age, number of oocytes retrieved, fertilization rate and embryo quality in both groups. A significative difference was found in clinical pregnancy rate between groups (GA: 27.0% vs GB: 43.3%, p < .05). Our findings suggest that the administration of high doses of propofol produces a negative late effect on human embryo development. The use of lower doses of propofol and the consistent lower exposure of the oocytes to the drug, show an improvement in clinical pregnancy rate, maintaining quality of anesthesia and optimal postoperative recovery. According to our results, we postulate that the reduction of propofol could improve the results of in vitro fertilization treatments.