Oxidative Stress Reduction by Midazolam Premedication during Oocyte Retrieval Procedure: Pilot Study.

Maja Pešić,Marinko Vučić,Katarina Kličan-Jaić,Krunoslav Kuna,Andro Košec,Ana Čipak Gašparović

doi:10.3390/jcm10040855

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.

Highlights

Today, infertility is recognized as a growing medical problem, affecting 9% to 15% of the world’s fertile population, with the number of affected couples in Europe reaching up to 25 million [1,2]
Numerous studies show that couples who opt for In Vitro Fertilization (IVF) face a great deal of psychological and emotional stress, which is confirmed by the fact that 30% of them withdraw from the procedure before its completion due to the psychological burden they face [3]
Taking into account the fear of not obtaining oocytes, the pain caused by the needle, and the fear of needles, it is not surprising that women experience higher levels of stress compared to other stages of the procedure, and this increased anxiety before the IVF procedure reduces the number of oocytes obtained by retrieval [5,6]

Summary

Introduction

Infertility is recognized as a growing medical problem, affecting 9% to 15% of the world’s fertile population, with the number of affected couples in Europe reaching up to 25 million [1,2]. Taking into account the fear of not obtaining (enough) oocytes, the pain caused by the needle, and the fear of needles, it is not surprising that women experience higher levels of stress compared to other stages of the procedure, and this increased anxiety before the IVF procedure reduces the number of oocytes obtained by retrieval [5,6]. The association of low levels of noradrenaline and cortisol at the time of TUGOR has been demonstrated with a successful fertilization outcome [6,12] This may be attributed to the uncertainty of the success of the retrieval procedure in terms of the number of oocytes obtained, and to the nature of the procedure itself, which is painful and uncomfortable and performed under intravenous general anesthesia [13]. Premedication with midazolam, which is one of the most commonly used benzodiazepines, is a good choice for short-term daily surgical procedures, because it reduces stress and tension without causing more serious disorders of consciousness [12]

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Conclusion