Analgesia and anesthesia for assisted reproductive technologies

Background: Oocyte retrieval for in vitro fertilization (IVF) is one of the most common minor surgical procedures. Objectives: 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. Search strategy: Electronic search of MEDLINE for literature published between 1972 and 2008. Selection criteria: Relevant studies on the types of anesthesia used for oocyte retrieval and the impact on oocyte and embryo quality. Data collection and analysis: Relevant studies were reviewed by the authors and the ones of significant scientific merit, based on methodology, were included. Main 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. Conclusion: 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.