Analgesia and anesthesia for assisted reproductive technologies.
BACKGROUND
Oocyte retrieval for in vitro fertilization (IVF) is one of the most common minor surgical procedures.


OBJECTIVE
To give an update on anesthesia practices used currently in the United States and Europe in assisted reproductive technology, and discuss the safety or the potential risks for oocyte and embryo quality.


METHODS
Electronic search of MEDLINE for literature published between 1972 and 2008.


METHODS
Relevant studies on the types of anesthesia used for oocyte retrieval and the impact on oocyte and embryo quality.


METHODS
Relevant studies were reviewed by the authors and the ones of significant scientific merit, based on methodology, were included.


RESULTS
Types of anesthesia that may be used for transvaginal follicular aspiration and oocyte retrieval include: general anesthesia, neuraxial anesthesia, conscious sedation, injection of local anesthetic agents into the cervix or the vaginal wall, or any combination of the above. Conscious sedation is most commonly used in IVF because it is relatively safe and does not require the presence of an anesthesiologist when opioids or benzodiazepines are used. Propofol is the preferred anesthetic agent, but should be used by specially trained personnel.


CONCLUSIONS
Conscious sedation is the most popular method of anesthesia used in IVF. Presently, a combination of propofol, fentanyl, and midazolam is used frequently. It is easy to administer in cooperative and motivated patients and is safe in healthy individuals; it has a relatively low risk for adverse effects on oocyte and embryo quality and pregnancy rates.
Vlahos
Nikos F
NF
Division of Reproductive Endocrinology, the Johns Hopkins Medical Institutions, Baltimore, MA, USA. nvlahos@jhmi.edu
Giannakikou
Iosifina
I
Vlachos
Athanasios
A
Vitoratos
Nikolaos
N
D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D016292:Procedural Sedation / Q000379:methods; D005060:Europe; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D054315:Oocyte Retrieval / Q000379:methods*; D014481:United States
D000777:Anesthetics