Anesthesia Techniques for Oocyte Retrieval in Assisted Reproductive Technologies

An oocyte retrieval procedure for in vitro fertilisation or intracytoplasmic sperm injection typically employs one of several anaesthetic approaches tailored to patient comfort, procedural efficiency and potential effects on gamete quality. General anaesthesia with intravenous agents such as propofol or combinations of opioids and sedatives provides deep sedation but raises concerns about drug penetration into follicular fluid and possible impacts on fertilisation and embryo development. Conscious sedation techniques using agents such as midazolam, remifentanil or dexmedetomidine, often supplemented by local paracervical blocks, aim to reduce systemic exposure while maintaining patient comfort and rapid recovery. Regional and locoregional techniques, including spinal anaesthesia or paracervical block with lidocaine, offer alternatives that minimise total intravenous drug load. Advances in pharmacological monitoring, such as bispectral index (BIS) guidance, seek to optimise dosing, although their benefit during transvaginal oocyte retrieval remains under evaluation. The global significance of refining these techniques lies in balancing procedural safety and patient satisfaction against any subtle influences on oocyte viability, fertilisation rates and downstream embryo quality.

Research from Nature Portfolio

Recent clinical data from a retrospective cohort of women undergoing oocyte retrieval under propofol-based general anaesthesia demonstrated a modest reduction in fertilisation rate compared with unstimulated retrievals, although pregnancy and live birth rates remained statistically indistinguishable. The findings underscore the need for further mechanistic studies into how anaesthetic agents interact with oocyte physiology. In a parallel randomised trial, use of BIS-guided propofol infusion was compared with standard bolus administration during transvaginal oocyte retrieval. Despite tighter sedation monitoring, the infusion group received higher total propofol doses without improvement in discharge times or patient and clinician satisfaction, suggesting that routine BIS monitoring may not confer additional benefit in this short procedural setting.

Anesthesia Techniques for Oocyte Retrieval in Assisted Reproductive Technologies publication trend

The graph below shows the total number of articles in anesthesia techniques for oocyte retrieval in assisted reproductive technologies across all publications each year (not limited to Nature Index journals).

Technical terms

Conscious sedation: A moderate level of sedation in which the patient remains responsive and maintains airway reflexes, often achieved with combinations of benzodiazepines and opioids.

General anaesthesia: A drug-induced, reversible loss of consciousness and sensation, commonly achieved with intravenous agents such as propofol and adjunctive opioids or inhalational agents.

Monitored anaesthesia care (MAC): A spectrum of care encompassing local or regional anaesthesia with sedatives and analgesics, where an anaesthetist monitors vital signs without necessarily inducing full unconsciousness.

Paracervical block: A regional anaesthetic technique involving local infiltration of anaesthetic around the cervix to block pelvic pain fibres, often used as adjunct to intravenous sedation.

Bispectral index (BIS): A processed electroencephalographic parameter providing a numerical indicator of sedation depth, used to titrate hypnotic agents such as propofol.

References

1. General anesthesia with propofol during oocyte retrieval and in vitro fertilization outcomes: retrospective cohort study. Scientific Reports (2023).
2. Trends in research on pain relief during oocyte retrieval for IVF/ICSI: a systematic, methodological review. Human Reproduction Open (2022).
3. Infusion of propofol with bispectral index monitoring does not reduce the amount of propofol used during transvaginal oocyte retrieval procedure. Scientific Reports (2023).
4. Comparison of a Reduced Needle With a Thin Tip and a Standard Thin Needle (Same Width Overall) for Oocyte Retrieval. Cureus (2024).
5. Effect of intravenous anesthetic drugs on fertilization rate in oocyte retrieval. BMC Anesthesiology (2024).