An evaluation of the effect of anesthetic technique on reproductive success after laparoscopic pronuclear stage transfer. Propofol/nitrous oxide versus isoflurane/nitrous oxide.
BACKGROUND
Laparoscopic pronuclear stage transfer (PROST) is the preferred method of embryo transfer after in vitro fertilization in many infertility programs. There are scant data to recommend the use or avoidance of any particular anesthetic agent for use in women undergoing this procedure. The authors hypothesized that propofol would be an ideal anesthetic for laparoscopic PROST because of its characteristic favorable recovery profile that includes minimal sedation and a low incidence of postoperative nausea and vomiting. The purpose of the study was to compare propofol and isoflurance with respect to postanesthetic recovery and pregnancy outcomes after laparoscopic PROST.


METHODS
One hundred twelve women scheduled for laparoscopic PROST were randomized to receive either propofol/nitrous oxide or isoflurane/nitrous oxide for maintenance of anesthesia.


RESULTS
Visual analog scale scores for sedation were lower in the propofol group than in the isoflurance group at all measurements between 30 min and 3 h after surgery. More women experienced emesis and were given an antiemetic during recovery in the isoflurance group than in the propofol group. However, the percentage of pregnancies with evidence of fetal cardiac activity was 54% in the isoflurane group compared with only 30% in the propofol group (P = 0.023). Also, the ongoing pregnancy rate was greater in the isoflurane group than in the propofol group (54% vs. 29%, P = 0.014).


CONCLUSIONS
Propofol/nitrous oxide anesthesia was associated with lower clinical and ongoing pregnancy rates compared with isoflurane/nitrous oxide anesthesia.
Department of Anesthesia, University of Iowa College of Medicine, Iowa City 52242.
R D
RD
Vincent
C H
CH
Syrop
B J
BJ
Van Voorhis
D H
DH
Chestnut
A E
AE
Sparks
J M
JM
McGrath
W W
WW
Choi
J N
JN
Bates
D H
DH
Penning
D000328:Adult; D010064:Embryo Implantation; D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007530:Isoflurane / Q000627:therapeutic use*; D009325:Nausea / Q000209:etiology; D017060:Patient Satisfaction; D011247:Pregnancy; D015742:Propofol / Q000627:therapeutic use*; D017388:Zygote Intrafallopian Transfer / Q000379:methods*
D007530:Isoflurane; D015742:Propofol