Transvaginal Ultrasound-guided Oocyte Retrieval Research Articles

Transvajinal ultrason eşliğinde oosit toplama işleminde anestezi yönetimi: Mini derleme

Oosit toplama işlemlerinde anestezi/analjezi yönetimi, in vitro fertilizasyon tedavisinde hasta konforunun, güvenliğinin ve prosedürel başarının sağlanmasında çok önemli bir rol oynamaktadır. Bu mini derleme, transvajinal ultrason eşliğinde oosit toplanması planlanan hastalarda bilinçli sedasyon, rejyonal anestezi veya genel anestezi yoluyla bireysel hasta ihtiyaçlarına göre yeterli analjezi ve konfor sağlamak için işlem öncesi/işlem sırasındaki hususları, anestezi tekniklerinin ve anestezik ilaçların seçimini ele almaktadır. Klinisyenler anestezi tekniklerini seçerken hastanın komorbiditelerini, ilaç kullanımlarını ve prosedürel gereklilikleri göz önünde bulundurmalıdır.

Female with peritonitis and abdominal distention.

A G0 35-year-old female with a body mass index (BMI) of 21 and history of antibiotic allergies presented to the emergency department with diffuse abdominal pain. Two days prior, she had a transvaginal ultrasound-guided oocyte retrieval for mature oocyte cryopreservation and 36 hours before the procedure received a human chorionic gonadotropin (hCG) “trigger shot.” She was tachycardic, but otherwise hemodynamically stable. On abdominal examination, she had a distended abdomen with diffuse tenderness to percussion and rebound tenderness. A point-of-care ultrasound demonstrated free fluid and a computed tomography (CT) of the abdomen/pelvis with intravenous contrast was obtained after consultation with surgery and obstetrics (Figures 1-3). CT revealed bilateral enlarged ovaries with follicles, the largest at 17 × 15 × 10 cm, with ascites and bilateral pleural effusions. No free air or active hemorrhage was identified. She underwent paracentesis of 2.5 L with administration of albumin and anticoagulation. Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology, described as cystic enlargement of the ovaries and fluid shifts from the intravascular space to the third space.1, 2 It can occur in 1%–5% of cycles with risk factors of low BMI, polycystic ovarian syndrome, allergy history, high doses of hCG, and large number of follicles.2, 3 Peritonitis can occur because of the release of inflammatory mediators or rupture of follicular cysts.3 Severe OHSS is characterized by ascites, pleural effusions, and hemoconcentration. In addition to OHSS, complications of oocyte retrieval, albeit rare, must also be considered as intraperitoneal hemorrhage, bowel perforation, or infection.4

Transvaginal ultrasound-guided oocyte retrieval in cattle: State-of-the-art and its impact on the in vitro fertilization embryo production outcome.

Transvaginal ultrasound-guided oocyte retrieval (commonly called OPU) and in vitro embryo production (IVP) in cattle has shown significant progress in recent years, in part, as a result of a better understanding of the full potential of these tools by end users. The combination of OPU and IVP (OPU-IVP) has been successfully and widely commercially used worldwide. The main advantages are a greater number of embryos and pregnancies per unit of time, faster genetic progress due to donor quick turn around and more elite sires mating combinations, larger spectrum of female age (calves, prepuberal, heifer, cow) and condition (open, pregnant) from which to retrieve oocytes, a reduced number of sperm (even sexed) required to fertilize the oocytes, among other benefits. OPU-IVP requires significant less donor preparation in comparison to conventional embryo transfer (<50% of usual FSH injections needed) to the extent of no stimulating hormones (FSH) are necessary. Donor synchronization, stimulation, OPU technique, oocyte competence, embryo performance, and its impact on cryopreservation and pregnancy are discussed.

Different Outcomes of Pelvic Inflammatory Disease after Transvaginal Oocyte Retrieval in Patients with and without Endometriosis and the Factors Influencing Its Treatment: A Retrospective Study of 66 Cases

Background: Even though endometriosis is an important risk factor for pelvic inflammatory disease (PID), it is still not clear whether endometriosis influences PID after ultrasound-guided transvaginal oocyte retrieval (TVOR). Therefore, this work was designed to explore whether endometriosis will influence PID after TVOR and study the influencing factors of receiving drainage treatment to improve the outcomes of patients with PID. Methods: A retrospective study was conducted between 2004 and 2017. Data were collected from Women’s Hospital, Zhejiang University School of Medicine, China. This study included 66 patients with acute PID symptoms after TVOR with or without endometriosis. The independent factors predicting drainage treatment were determined using univariate and multivariate logistic regression analyses, and their optimal cut-off points were ascertained using a receiver operating characteristic curve. Results: Among 66 cases, there were 53 women without endometriosis and 13 women with stage III or IV endometriosis. The significantly higher maximum body temperature (p = 0.047), longer days of fever (p = 0.043) and duration of intravenous (IV) antibiotic use (p = 0.001), and more receiving drainage treatment (p = 0.002) were found in the patients with endometriosis. In vitro fertilization (IVF) cycles (odds ratio [OR] = 6.055, 95% confidence interval [CI] = 1.360–26.961, p = 0.018), puncture cyst during TVOR (OR = 60.167, 95% CI = 2.477–1461.619, p = 0.012), and pre-treatment C-reactive protein (CRP; OR = 1.022, 95% CI = 1.003–1.041, p = 0.022) were significant independent risk factors for drainage treatment. The optimal cut-off for IVF cycles and pre-treatment CRP for patients receiving drainage treatment were 2 and 40.3 mg/L, respectively. Conclusions: Patients with endometriosis had more severe PID outcomes after TVOR, requiring more attention during treatment. Early drainage treatment is recommended for patients with pre-treatment CRP levels higher than 40.3 mg/L, puncture cyst during TVOR, and those receiving more than 2 IVF cycles.

P–794 Prevalence of positivity for SARS-CoV–2 RNA in follicular fluid in infertile patients

Abstract Study question Is Sars-Cov–2 present in the follicular fluid of infertile patients? Summary answer In the experience of the Infertility and IVF Unit, University Of Bologna, Italy, RNA of SARS-Cov–2 was not detected in the follicular fluid. What is known already Data on the risk of virus presence in reproductive cells and transmissibility in IVF procedures are very limited. In literature only one study reports the detection of SARS-Cov–2 viral RNA in oocytes of PCR positive women. Research of RNA in follicular fluid could be a marker able to indicate whether to continue IVF treatments in the case of swab-positive patients. Study design, size, duration Prospective study performed at Infertility and IVF Unit, Sant’Orsola University Hospital, University of Bologna, Italy, from March 2020 to January 2021. 451 IVF cycles were performed on 902 patients. In addition 59 cycles of oocyte cryopreservation were also performed to fertility preservation in oncological patients. In all positive swab patients was analyzed the follicular fluid for RNA virus detection. Participants/materials, setting, methods 961 patients underwent telephone triage before going to the IVF Center to identify subjects with suspected or confirmed infection. Body temperature was measured on all patients before entering the IVF Center. All patients were subjected to real-time analysis (RT PCR) of pharyngeal swab samples 48 hours before transvaginal ultrasound-guided oocyte retrieval. In case of positive swab, PCR was performed on follicular fluid. Main results and the role of chance In our population of infertile patients the incidence of SARS COV–2 infection positivity was 0.4% (4/961). No IVF treatments were suspended. The oocytes of the 4 women with positive swab were cryopreserved using closed devices stored in a special dedicated cryogenic container. No viral RNA was detected in the follicular fluid. Limitations, reasons for caution there are no limitations to the study. Wider implications of the findings: The absence of SARS-COV–2 RNA in the follicular fluid is a reassuring result in the storage and future use of oocytes. Trial registration number Not applicable

Lars Hamberger: in memory of a Nordic pioneer in IVF.

Professor Emeritus Lars Hamberger, former Chief Editor of Acta Obstetricia et Gynecologica Scandinavica (AOGS), passed away at the age of 82 years on 2 June 2021. Lars Hamberger was an internationally renowned scientist in the field of assisted reproductive technology (ART) and was the initiator and team leader behind the first in vitro fertilization (IVF) baby within the Nordic countries. The birth, in 1982 at Sahlgrenska University Hospital in Gothenburg, occurred only 4 years after the world’s first IVF baby was born. This accomplishment cemented Sweden’s reputation within the international IVF scene as the 5th country in the world to successfully develop the revolutionary technique. Lars Hamberger continued his scientific and clinical work in ART throughout his career, inspiring many young colleagues in Sweden and around the world to pursue careers within this rapidly evolving field. Lars Hamberger studied medicine at the University of Gothenburg and worked at Sahlgrenska University Hospital for most of his career. His doctorate training was in reproductive physiology, specifically ovarian metabolism. His innovative mind led to the development of a micro-diver technique to measure the oxygen consumption of ovarian cells. He became Associate Professor in Physiology in 1968, some months after receiving his PhD. After completing residency training at Sahlgrenska, Hamberger became an Associate Professor in Obstetrics & Gynecology in 1974. He was active in conducting research on ovarian physiology and closely followed the international work carried out to develop a technique that would fertilize the human oocyte outside the body. The successful creation of this IVF technique was largely due to the scientific efforts of Robert Edwards in Cambridge. In 1978, the Cambridge group reported the birth of Louise Brown. Soon after, Hamberger formed a team of clinicians and scientists to set up IVF in close contact with the Cambridge team, proving successful in 1982 with their first live birth at Sahlgrenska. In 2010, Robert Edwards was awarded the Nobel prize in physiology/medicine for the scientific development of IVF. Lars Hamberger was appointed Professor of Obstetrics & Gynecology at Karolinska Institute in 1983 but returned to the University of Gothenburg the following year as a professor. IVF was soon established as a clinical treatment at Sahlgrenska and Hamberger created a large adjoining research laboratory, “Spec-lab”, for translational research in ART. This center attracted scientists from all over the world to work in developing IVF and ART even further. One major IVF invention from the Sahlgrenska center was the forming of transvaginal ultrasound-guided oocyte retrieval in 1987. With this technique it was possible to avoid laparoscopy surgery when obtaining oocytes. Another major invention in ART was intracytoplasmic sperm injection (ICSI), developed by the Brussels group in 1992. Lars Hamberger and his team quickly learned the technique and Sahlgrenska became the second center in the world with a live birth after ICSI. Several major research findings in ART came from the Sahlgrenska center, including the establishment of elective single embryo transfer as a routine, long-term follow-up of IVF children, and uterus transplantation. Alongside all the science in the laboratory, Hamberger also made space for the world-renowned photographer Lennart Nilsson, who created the book “A Child is Born”, with Lars Hamberger as co-author. The book has been translated into 18 languages. Lars Hamberger was not only a scientist and clinician but also an entrepreneur within the business field. He was co-founder of the second private IVF clinic in Sweden, the stem-cell company Cellartis, as well as Vitro Life, now a major global company within the area of Culture media and products for assisted reproduction. Lars Hamberger supervised several PhD students within the Departments of Physiology and Obstetrics & Gynecology and hosted a great number of international visiting scientists. The famous Spec-lab became an international hub for advanced research in ART, greatly aided by Hamberger’s scientific generosity and hospitality. Lars Hamberger became honorary member of the European Society of Human Reproduction (ESHRE) in 2011 and was the Chief Editor of AOGS from 1999 to 2000. On a personal level, Lars had many interests but was particularly passionate about the arts. Lars himself was a talented painter and as a young man dreamed of a future as a painter, despite the disapproval of his father, Professor Carl-Axel Hamberger. However, Hamberger pursued his painting in parallel with his scientific career and had several art exhibitions after retirement. Lars Hamberger will be remembered with warmth and gratitude for being instrumental in the establishment of ART in the Nordic countries and being essential to the development of AOGS.

The live birth in a woman with resistant ovary syndrome after in vitro oocyte maturation and preimplantation genetic testing for aneuploidy.

We report the pregnancy and live birth achieved after in vitro maturation (IVM) of oocytes and PGT-A in a 23-year-old patient suffering from ovarian gonadotropin resistance. A woman with resistant ovary syndrome (ROS) had secondary amenorrhea, high FSH levels (25.34 mIU/mL) and LH (29.6 mIU/mL), low estradiol levels (15.2 pg/mL), and high serum AMH levels (38.0 ng/mL), associated with an increased antral follicle count (AFC) of 45. Without gonadotropin priming and HCG trigger, ultrasound-guided transvaginal oocyte retrieval was performed. Aspiration of antral-stage follicles allowed the retrieval of 15 immature oocytes. After oocyte collection, immature oocytes were cultured in the IVM medium. Following IVM, six of them reached metaphase II stage. Resultant matured oocytes were fertilized by intracytoplasmic sperm injection (ICSI). Embryos obtained were cultured to the blastocyst stage. On day 5, three embryos reached blastocyst stage. Trophectoderm biopsy and PGT-A were performed on two better quality embryos on day 5 after fertilization. Two biopsied embryos were reported to be euploid. PGT-A was performed utilizing next-generation sequencing (NGS\MPS). One embryo was transferred in an artificial thaw cycle and resulted in a viable intrauterine pregnancy and live birth. Our experience indicates that there is no requirement for gonadotropin stimulation and use of b-hCG trigger prior to IVM in patients with ROS. The results suggest that oocytes obtained with IVM in patients with ROS are capable of meiotic and mitotic division, fertilization, and generation of euploid embryos. IVM appears to be a valuable approach in patients with ROS, allowing them to have genetically connected offspring.

Paracervical Block for Oocyte Retrieval: Experience at a Public Health Facility in Nigeria

Background: Transvaginal Ultrasound Guided Oocyte Retrieval(TUGOR) for in vitro fertilization is one of the most common minorsurgical procedures. Despite this, it is stressful and painful for thepatient and thus requires some form of analgesia with or without sedation. The effects of various anesthetic techniques used for TUGORon reproductive outcomes remain controversial.Aims: This study assessed patients’ perception of pain using paracervical block and its effect on IVF outcomes.Methods: A cross sectional study of 66 eligible patients that underwent assisted reproduction program in our facility. All clients weretreated with antagonist protocol for Controlled Ovarian Hyperstimulation. Self- administered questionnaires was used as the research instrument. Pain was assessed using a 10cm Visual Analogue Scale whileclients’ overall satisfaction was rated using Likert scoring system.Results: Client’s aged 32.8 ±3.4. More than half had primary infertility with mean duration of 4.6 ± 2.4. Female factor infertility wasthe commonest cause of infertility. The pregnancy rate per embryotransfer was 36.4%, miscarriage rate was 9.1%, while the live ratewas 27.3%. The mean VAS scores at 1hour, 6 hours, 24 hours andat embryo transfer were 7.1 ± 2.8, 4.6 ±1.4, 2.8 ±1.2 and 1.0 ± 0.9respectively. The mean Likert score was 2.4 ± 0.9.Conclusion:Paracervical block is a safe and effective anaesthesia/analgesia option for TUGOR.However a multimodal approach of analgesia/anaesthesia for TUGOR is recommended to further improve on clients’ satisfaction andacceptance.

Follicular Fluid Aspiration and Oocyte Retrieval Techniques, Several Flushing, Difficulty Situations Damage Risk to the Cumulus Complex and Complications

In Assisted Reproductive Technology (ART), oocyte retrieval is a vital step. It was initially performed through laparoscopy, which was complex and difficult and of low efficiency. Ultrasound-guided transvaginal oocyte retrieval was safer and more effective; it is presently the standard operation for in vitro fertilization (IVF) treatment. Theoretically, oocyte retention is achievable after the initial aspirate due to abnormal development of the follicle or oocyte and human technical factors, and such retention could be overcome by recurrent follicular flushing. Follicular flushing is considered to maximize the number of oocytes retrieved and thereafter to improve the rate of IVF pregnancy. There are a number of factors that can affect egg collection and/or egg damage. These involve variables like pump vacuum flow, velocity, needle bore size and length, follicle pressure and size, and collection techniques. Cook Medical Technology, Brisbane, has developed appropriate equipment to study the factors influencing the success of egg collection and the cause of egg trauma.

Spinal mepivacaine versus bupivacaine for ultrasound guided transvaginal oocyte retrieval. A comparative study

Study objectiveThe most important limitation for spinal anesthesia in the ambulatory setting is the prolonged motor blockade and delayed postoperative ambulation. The current study was conducted to compare spinal mepivacaine–fentanyl combination versus conventional combination of spinal bupivacaine with fentanyl for surgical anesthesia of ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization (IVF).Patients and methodsSixty female patients undergoing ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization on ambulatory basis were enrolled in the current study. Patients were randomly distributed in to one of two equal groups: mepivacaine group (group M) and bupivacaine group (group B). Patients in group M received intrathecal 37.5 mg of isobaric mepivacaine 1.5% plus 10 μg fentanyl while patients in group B received intrathecal 12.5 mg of hyperbaric bupivacaine 0.5% plus 10 μg fentanyl. Primary outcome measure was the time to complete motor block regression. Secondary outcome measures included the peak sensory blockade level achieved, the times for sensory block regression to S1 dermatome, post-anesthesia stable ambulation, 1st voiding, and hospital discharge. The incidence of perioperative adverse events was also recorded.ResultsTwo patients (one in each group) were excluded from the study due to failed block and conversion to general anesthesia. The peak sensory blockade levels (T6–T10) were satisfactory for procedural anesthesia in the remaining patients of both groups. Patients in group M had significantly faster sensory block regression to S1 and motor block resolution when compared with group B (P < 0.05). Times to steady ambulation, voiding and hospital discharge were significantly shorter in group M when compared with group B (P < 0.05). There was no intergroup significant difference as regards the incidence of perioperative adverse events, and none of the patients reported transient neurological symptoms (TNS) or postdural puncture headache in both groups.ConclusionThe mepivacaine–fentanyl combination was superior to bupivacaine–fentanyl combination for spinal anesthesia of ultrasound-guided transvaginal oocyte retrieval on ambulatory basis because of faster sensory and motor block resolution and the shorter time to ambulation and hospital discharge with reliability of surgical anesthesia and no difference in the incidence of perioperative adverse events between both groups.

Comparison of chemical pregnancy rates according to the anesthetic method during ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization: a retrospective study.

BackgroundOocyte retrieval is the most important procedure in in vitro fertilization (IVF). Various anesthetic methods are used to control a patient’s anxiety and pain during IVF; however, there are no recommended anesthetic methods at present. In this study, we retrospectively investigated chemical pregnancy rates according to the anesthetic method used for oocyte retrieval.MethodsWe reviewed records of patients who underwent oocyte retrieval between January 1, 2012 and December 31, 2017. Patients were divided into the spinal anesthesia (SA) and monitored anesthesia care (MAC) groups. The primary outcome was chemical pregnancy rate after IVF.ResultsThe study included 95 patients. SA was administered in 77 (81%) and MAC in 18 (19%). The overall chemical pregnancy rate was 32.6% (31/95). According to the anesthetic method, the pregnancy rate was 32.5% (25/77) in the SA group and 33.3% (6/18) in the MAC group. There was no statistical difference in the pregnancy rate between the groups (P = 0.575). The procedural time was significantly shorter in the SA group than in the MAC group (P < 0.001).ConclusionsChemical pregnancy rates were not significantly different between the SA and MAC groups. However, the procedure duration was shorter in the SA group than in the MAC group.

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

ObjectiveAnesthesia 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 methodsThis 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. ResultsThree 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. ConclusionsThe 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 numberIRCT201410258677N4.

Effects of a n-3 polyunsaturated fatty acid-enriched diet on embryo production in dairy cows

Beneficial effects of n-3 polyunsaturated fatty acid (PUFA) supplementation on dairy cow reproduction have been previously reported. The objectives of the present study were to assess whether n-3 PUFA supplementation would affect in vitro embryo production (IVP) after ovarian stimulation. Holstein cows received a diet with 1% dry matter supplementation of either n-3 PUFA (n = 18, microencapsulated fish oil) or a control, n-6 PUFA (n = 19, microencapsulated soy oil). Both plasma and follicular fluid FA composition showed integration of total PUFA through the diet. All cows underwent an IVP protocol consisting of ovarian stimulation, ultrasound-guided transvaginal oocyte retrieval (ovum pick-up, OPU, five per cow) followed by in vitro maturation, fertilisation and 7 days of embryo development. A tendency toward an increase in the blastocyst rate (diet effect, P = 0.0865) was observed in n-3 cows, with 49.6 ± 5.5% vs 42.3 ± 5.5% in control n-6 cows. A significant increase (diet effect, P = 0.0217) in the good-quality blastocyst rate (freezable blastocysts) was reported in n-3 cows (42.2 ± 7.7%) compared to control n-6 cows (32.7 ± 7.7%). A significant difference in lipid composition was shown in the oocytes recovered by OPU from n-3 and n-6 treated cows, by intact single-oocyte MALDI-TOF mass spectrometry. The 42 differentially abundant identified lipids were mainly involved in cell membrane structure. In conclusion, n-3 PUFA supplementation enhanced oocyte quality and modified their lipid composition. Further studies are necessary to investigate the potential link of these lipid modifications with enhanced oocyte quality.

Altered expression of the kisspeptin/KISS1R and neurokinin B/NK3R systems in mural granulosa and cumulus cells of patients with polycystic ovarian syndrome

The neurokinin B (NKB)/NK3 receptor (NK3R) and kisspeptin (KISS1)/kisspeptin receptor (KISS1R), two systems essential for reproduction, are present in human granulosa cells (GCs) of healthy women and contribute to the control of fertility, at least partially, by acting on the gonads. However, little is known about the expression of these systems in GCs of women with polycystic ovarian syndrome (PCOS). The aim of this study was to analyze the expression of NKB/NK3R and KISS1/KISS1R in mural granulosa (MGCs) and cumulus cells (CCs) of PCOS women. A cross-sectional study was performed in 46 healthy women and 43 PCOS women undergoing controlled ovarian stimulation. MGCs and CCs were collected from pre-ovulatory follicles after transvaginal ultrasound-guided oocyte retrieval and the expression of the genes encoding NKB (TAC3), NK3R (TACR3), KISS1, and its receptor (KISS1R) was analyzed using real-time quantitative RT-PCR. TAC3, TACR3, and KISS1 mRNA levels were decreased in MGCs and CCs of PCOS women. TAC3 positively correlated with KISS1 in MGCs of healthy women and TACR3 was positively associated with KISS1R in CCs from healthy women. These associations were not observed in PCOS women. The NKB/NK3R and KISS1/KISS1R systems are dysregulated in MGCs and CCs of PCOS women. The lower expression of these systems in GCs could contribute to the abnormal follicle development and defective ovulation that characterize the pathogenesis of PCOS.

The impact of music therapy on pain and stress reduction during oocyte retrieval - a randomized controlled trial.

Does music therapy help in reducing pain and anxiety in women undergoing transvaginal ultrasound-guided oocyte retrieval (TUGOR)? In this randomized controlled open label study, 209 participants were recruited and randomized into three groups (music group, n = 70; headphone group, n = 70; control group, n = 69). Patients' psychological status was assessed using the visual analogue scale of pain (VAS-P), satisfaction of pain control, state-trait anxiety inventory (STAI), Beck depression inventory (BDI), and general health questionnaire (GHQ). Stress biomarkers, including salivary alpha amylase (sAA) and salivary cortisol (sCort), were measured before and after TUGOR. No significant differences were found in psychological scoring of STAI, BDI, GHQ and the stress biomarkers. Although neither the anxiety scores nor the analgesic requirements differed among the three groups, the visual measure of vaginal pain (median, range) showed music group (20,0-70) was significantly (P = 0.005) lower than headphone group (30,0-90) and control group (30,0-100). The degree of satisfaction with pain control (median, range) in the music group (80,30-100), was significantly (P = 0.001) higher than the headphone group (80,10-100) and control group (70,0-100). Music is a simple, inexpensive and effective way to reduce pain score and increase satisfaction with pain control during TUGOR procedure, which may justify its routine use.

Effect of Body Mass Index on the Efficacy of Paracervical Block for Ultrasound-Guided Transvaginal Oocyte Retrieval as assessed by Requirement of Rescue Propofol.

Background and Aims:Oocyte retrieval is the only vital aspect of in vitro fertilization requiring anesthesia. Previous studies have shown the inconclusive role of paracervical block (PCB) in transvaginal oocyte retrieval (TVOR) under ultrasound guidance. This study was planned to observe the role and efficacy of PCB as measured by the amount of propofol used as rescue in patients undergoing TVOR and grading it on the basis of body mass index (BMI).Methods:This prospective, comparative study, conducted over 1 year, recruited 140 American Society of Anesthesiologists I and II patients and divided into two groups as follows: Group A received PCB with 20 ml of 1% lignocaine and Group B received no PCB. Total propofol consumed, BMI, time taken, oocytes retrieved, postprocedure visual analog scale score, and complications were noted. In both the groups, patients were then divided into underweight, normal, overweight, and obese according to BMI. Statistical analysis was done using Statistical Package Mini Tab Version 17.0. The primary objective was to study the efficacy of PCB as estimated by amount of propofol required during the procedure. The secondary aim was to assess the effect of BMI on the efficacy of PCB.Results:Propofol requirement was found to be significantly more (P < 0.05) in Group B patients (172.14 ± 64.15) in comparison to Group A (132.14 ± 66.11). Amount of propofol required in normal BMI and overweight patients was significantly higher in Group B. No significant difference was observed in underweight, and obese patients in both the groups.Conclusion:PCB reduces the consumption of propofol in normal BMI patients. Underweight and obese population do not benefit from PCB.

Flurbiprofen Axetil Provides Effective Analgesia Without Changing the Pregnancy Rate in Ultrasound-Guided Transvaginal Oocyte Retrieval: A Double-Blind Randomized Controlled Trial.

In this prospective double-blind randomized study, we evaluated the analgesic effect and potential effect on pregnancy rate of the nonsteroidal anti-inflammatory drug flurbiprofen axetil in patients undergoing ultrasound-guided transvaginal oocyte retrieval under propofol-remifentanil anesthesia. A total of 200 patients scheduled to undergo ultrasound-guided transvaginal oocyte retrieval were randomly allocated to receive 1.5 mg/kg of flurbiprofen axetil (FA group) or placebo (control group) 30 minutes before the procedure. Postoperative pain scores, embryo implantation rate, and pregnancy rate were recorded. Neuroendocrine biomarkers and prostaglandin E2 levels in follicular fluid were tested after oocyte retrieval. Patients in the FA group awakened earlier after surgery than patients in the control group (3.3 ± 2.6 vs 5.3 ± 3.4 minutes, P < .05) and had lower pain scores than patients in the control group (2.0 [0.0, 2.8] vs 5.0 [3.0, 5.0], P< .001). The difference in pregnancy rates between the 2 groups (44%-44%) was 0% (conventional 2-sided 95% confidence interval, -13.8% to 13.8%). The lower limit of the 90% 1-sided confidence interval for this difference was -9.0%, which was within the predefined noninferiority margin of -15.0%. The concentration of prostaglandin E2 in follicular fluid was decreased in the FA group (24.51 ± 1.52 vs 25.15 ± 1.49 pg/mL, P = .039), although the difference does not appear to be clinically important. Flurbiprofen axetil given before ultrasound-guided transvaginal oocyte retrieval for patients under propofol-remifentanil general anesthesia relieves pain without any detrimental effect on clinical pregnancy rate.

Midluteal Serum Estrogen and Progesterone Levels predict Pregnancy Rate in in vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: A Prospective Study

ABSTRACTIntroductionIn assisted reproduction technique cycles, controlled ovarian stimulation (COS) leads to supraphysiological levels of steroid hormone secretion and the subsequent need for luteal phase support (LPS). Therefore, existing data on the steroid secretion profile in the luteal phase of spontaneous conception cycles and its predictive value for pregnancy outcome need to be discussed against the background of preceding COS. The clinical significance of luteal phase hormones, such as estrogen (E2) and progesterone (P4), in predicting pregnancy after controlled ovarian hyperstimulation protocols forin vitrofertilization (IVF) or intracytoplasmic sperm injection (ICSI) is still poorly understood. The aim of the present study was to investigate the role of midluteal serum E2 and P4 level in predicting successful pregnancy in patients undergoing IVF/ICSI.Materials and methodsOne hundred fifteen women were recruited for the study. They were given gonadotropin-releasing hormone antagonist protocol and human chorionic gonadotropin (hCG) was administered if at least three follicles were more than 18 mm in size. Transvaginal ultrasound-guided oocyte retrieval followed by ICSI and embryo transfer (ET) was done. Post-ET, all women had same LPS. The E2 and P4 measurements were done at day of ET (day 0) and 9 days post-ET (day 9). Levels of E2 and P4 were compared between those who subsequently became pregnant and those who could not achieve pregnancy. Statistical analysis was performed using Statistical Package for the Social Sciences.ResultsForty-six (40%) achieved pregnancy. The E2 and P4 levels on day 9 were significantly higher in those who achieved pregnancy (p &lt; 0.01). Out of 46 pregnancies, 38 were ongoing viable pregnancies.ConclusionLuteal phase E2 and P4 can be used as prognostic marker to predict pregnancy in IVF/ICSI cycles.How to cite this articleNigam S, Joy I, Shankar K, Varma TR. Midluteal Serum Estrogen and Progesterone Levels predict Pregnancy Rate inin vitroFertilization/Intracytoplasmic Sperm Injection Cycles: A Prospective Study. Int J Infertil Fetal Med 2017;8(2):50-53.

Assisted reproduction technology: Comparison of anesthetic techniques for oocyte retrieval in a tertiary health facility in Ilorin, Nigeria

Background: Transvaginal ultrasound-guided oocyte retrieval (TUGOR) technique is minimally invasive and requires shorter time compared to previous techniques. Yet, it is a potentially stressful and painful procedure and thus requires some form of analgesia with or without sedation. The effects of various anesthetic techniques used for TUGOR on reproductive outcomes remain controversial. Aims and Objectives: This study aimed at comparing the efficacy of paracervical block (PCB) and conscious sedation for pain relief and pregnancy outcomes during TUGOR. Materials and Methods: This is a cross-sectional comparative study of 137 eligible clients that underwent assisted reproduction program in our facility. All clients were treated with antagonist protocol for controlled ovarian hyperstimulation. The choice of analgesia for TUGOR was influenced by clients' and/or clinicians' preference. PCB and conscious sedation were administered for TUGOR in 66 and 71 clients, respectively. Pain was assessed using a 10-cm Visual Analog Scale (VAS), while clients' overall satisfaction was rated using Likert scoring system. Results: There was no statistically significant difference in the clinical pregnancy, miscarriage, and live birth rates between the two groups. The mean VAS 10-point scores at 1, 6, and 24 h postretrieval and on the day of embryo transfer were significantly higher for paracervical group. The mean Likert score for conscious sedation group was significantly higher than that of paracervical group. Conclusion: Conscious sedation is superior to PCB as anesthetic/analgesic agent for pain relief and clients' satisfaction for TUGOR. However, a multimodal approach to anesthesia/analgesia for TUGOR is suggested to further improve overall clients' satisfaction.

Immediate ureterovaginal fistula following oocyte retrieval: A case and systematic review of the literature.

The aim of this study is to report a case of acute ureterovaginal fistula (UVF) formation with immediate symptomatic presentation after transvaginal ultrasound-guided oocyte retrieval (TVOR) for in vitro fertilization (IVF) and to perform a systematic literature review of ureteral injuries during TVOR. A 33-year-old woman with a history of anovulatory infertility presented with severe abdominal pain and vaginal leakage immediately following TVOR for IVF. We systematically reviewed the current literature regarding ureteral injury resulting from TVOR and present a case of timely identification and management of a UVF followed by a successful pregnancy. Computed tomography cystogram with intravenous contrast and left retrograde pyelogram confirmed the diagnosis of UVF which was managed by placement of the left ureteral stent. The IVF cycle was converted to a freeze-all cycle. The ureteral stent was removed 4 weeks later, and a subsequent frozen embryo transfer cycle resulted in pregnancy. We present the 13th case of ureteral injury and the fourth case of UVF following TVOR. UVF formation is a rare complication after TVOR and may result in serious long-term morbidity if it is not identified and treated promptly. Clinicians must exercise a high degree of suspicion and prompt evaluation for potential ureteral injuries in women presenting with abdominal pain, urinary symptoms, or vaginal leakage following TVOR.