Effect of TIVA with Propofol Versus Inhalational Anasthesia Plus Ketamine on Fertilization and Clinical Pregnancy Rate in ICSI
DOI:
https://doi.org/10.61841/m61gab71Keywords:
Vitro Fertilization (IVF), Versus Inhalational, PropofolAbstract
Anesthesia is an important part of in vitro fertilization and can be detrimental to the reproductive result due to potential toxicity encountered by the anesthetic drugs used.
Place and duration of the study: The study is held at the High Institute of Infertility and ARTs at al-Nahrin University in Baghdad, Iraq, from the 1st of April 2018 to the 1st of February 2019.
Material and methods: 80 patients during their ICSI course were randomized blindly at the time of oocyte retrieval anesthesia into two groups: 40 patients subjected to TIVA (total intravenous anesthesia) with midazolam and propofol (group 1) and 40 patients subjected to inhalational anesthesia (isoflurane ) with ketamine and midazolam. Evaluation of fertilization, cleavage, grade 1 embryo, and pregnancy rate was done to determine the more beneficial and less toxic anesthesia for in vitro fertilization patients.
Conclusion: TIVA with midazolam and propofol had better reproductive outcomes on fertilization rate, cleavage, and grade 1 embryo rate with a significantly higher pregnancy rate than inhalational anesthesia with midazolam and ketamine.
Downloads
References
[1] Ankur Sharma, Anuradha Borle, Anjan Trikha, Anesthesia for in vitro fertilization. Journal of Obstetric
Anesthesia and Critical Care 2015: Vol 5: Issue 2; pp. (72-62).
[2] Kwan I, Bhattacharya S, Knox F, McNeil A. Pain relief for women undergoing oocyte retrieval for assisted
reproduction. Cochrane Database Syst Rev 2013; 1: CD004829.
[3] Annie S.O. Leunga, Michael H. Dahana, B and Seang Lin Tana. B Techniques and technology for human
oocyte collection. Expert Review of Medical Devices, 2016: Vol. 13, No. 8, pp. 701-703
[4] Hayes MF, Sacco AG, Savoy-Moore RT, Magyar DM, Endler GC, Moghissi KS. Effect of general
anesthesia on fertilization and cleavage of human oocytes in vitro. Fertil Steril 1987; 48: 975-81.
[5] Vlahos NF, Giannakikou I, Vlachos A, Vitoratos N. Analgesia and anesthesia for assisted reproductive
technologies. Int J Gynaecol Obstet. 2009; 105: 201-205
[6] Paraskevi Matsota, Eva Kaminioti, and Georgia Kostopanagiotou. Anesthesia-Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof. BioMed Research International, Volume 2015, Article ID 475362.
[7] David H. Chestnut, MD, Cunthia A. Wong, MD, and Lawrence C. Tsen, MD. Chestnut's obstetric anesthesia: principle and practice. Chapter 15: In Vitro Fertilization and Other Assisted Reproductive Technology. 2014 by Saunders, an imprint of Elsevier Inc.: pp. 326-340.
[8] Madhuri S. Kurdi, Kaushic A. Theerth, and Radhika S. Deva. Ketamine: Current applications in anesthesia, pain, and critical care. Anasth Essays Res. 2014 Sep-Dec; 8(3): 283–290.
[9] Advisory Council on the Misuse of Drugs. Ketamine: A review of use and harm, 2013. Report. [Last accessed on 2014 Jul 08]. Available from: http://www.gov.uk/government/./ACMD_ketamine_report_dec13.pdf.
[10] ASA House of Delegates/Executive Committee ASA Physical Status classification System October 15, 2014
[11] Ann M. Mangalraj, K. Muthukumar, T.K. Aleyamma, Mohan S. Kamath, and Korula George. Blastocyst stage transfer vs. cleavage stage embryo transfer J Hum Reprod Sci. 2009; 2(1): pp. 23–26.
[12] Lynne S. Wilcox, Herbert B. Peterson, Florence P. Haseltine, Mary c. Martin,
[13] Defining and interpreting pregnancy success rates for in vitro fertilization fertility and sterility. 1993: Vol. 60: No. 1
[14] SAS. 2012. Statistical Analysis System, User's Guide. Statistical. Version 9.1 ed. SAS. Inst. Inc. Cary.
N.C., USA.
[15] David K. Gardner DPhil, Ariel Weissman, MD Colin M. Howles, Zeev Shoham . Textbook of Assisted
Reproductive Techniques Fifth Edition, Volume 2: Clinical Perspectives 2018 by Taylor & Francis Group,
LLC. Chapter 57: Anesthesia for vitro fertilization, Alexander Izaksan Tiberiu Ezri: pp. 739-746)
[16] Edwards JA, Kinsella J, Shaw A, Evans S, Anderson KJ. Sedation for oocyte retrieval using target
controlled infusion of propofol and incremental alfentanil delivered by non-anesthetists. Anaesthesia 2010;
65: pp. pp.453–61.
[17] Izhar Ben-Shlomo Roland Moskovich Joanne Golan Vered Eyali Arek Tabak Eliezer Shalev. The effect of
propofol anesthesia on oocyte fertilization and early embryo quality. Human Reproduction, Volume 15,
Issue 10, 1 October 2000, pp. pp.2197–2199.
[18] Christiaens, F., Janssenswillen, C., Verborgh, C. et al. Propofol concentrations in follicular fluid during general anesthesia for transvaginal oocyte retrieval. Hum. Reprod. 1999; 14: pp.345–348.
[19] Ben-Shlomo I, Moskovich R, Katz Y, Shalev E. Midazolam/ketamine sedative combination compared with fentanyl/propofol/isoflurane anesthesia for oocyte retrieval. Hum Reprod 1999; 14: pp1757–1759.
[20] E.J.E. Lee, A. Bongso, and A. Kumar, “Evaluation of inhalational anaesthetics on murine in vitro fertilization,” Annals of the Academy of Medicine Singapore 1994; 23: 4: pp. 479–485.
[21] I. Soussis, O. Boyd, T. Paraschos et al., “Follicular fluid levels of ofmidazolam, fentanyl, and alfentanil during transvaginal oocyteretrieval, Fertility and Sterility, 1995; 64: 5: pp. 1003–1007.
[22] Wael S. Nossair1* and Ahmed M. A. Maaty2. Comparative Study among Ketamine, Thiopental, and Propofol for Sedation during In Vitro Fertilization Procedures. SM J Gynecol Obstet. 2017; 3(1): 1020.
Downloads
Published
Issue
Section
License
Copyright (c) 2020 AUTHOR

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.