Introduction:
Ultrasound guided transvaginal oocyte retrieval for in vitro
fertilization (IVF) is a very common procedure [1]. Although some
patients prefer the procedure to be performed without anesthesia, it is
recommended to be performed under anesthesia as it is a short but
painful procedure [2, 3]. Performing the procedure with anesthesia
not only increases the comfort of the patient, but also facilitates the
procedure, and prevents the patient from being damaged due to trauma
during the procedure [3]. For this purpose, different anesthetic
techniques such as monitored anesthesia care, sedation, local
anesthesia, regional anesthesia, and general anesthesia can be used
during the oocyte retrieval procedure [3, 4, 5]. The combination of
sedative and analgesic drugs with a rapid onset and a short duration of
action is ideal in this day-case procedures.
Propofol (2,6-diisopropylphenol) and fentanyl are commonly used agents
in oocyte retrieval procedures. Propofol is used as continuous
intravenous infusion or intermittent bolus injections [6].
Although propofol is widely used during oocyte retrieval, studies on its
effects on fertilization are controversial. In vitro studies on mouse
oocytes [6] and some human studies have shown that propofol may be
dose- and time-dependent detrimental to fertilization [7]. Propofol
is detected in significant concentrations in the follicular fluid,
depending on the dose and the duration of propofol administration
[8]. Due to its potential adverse effects on fertilization, there
are studies suggesting that propofol should be used with caution during
oocyte retrieval [6] the total dose should be strictly limited
[8]. Therefore, our aim is to use as low amount of propofol as
possible during oocyte retrieval.
BIS monitoring systems provide an objective measure of a patient’s depth
of consciousness [9]. A BIS value between 40 and 60 indicates the
appropriate level of general anesthesia recommended by the manufacturer
and in previous studies [10, 11]. It has been demonstrated that
titration of propofol with BIS monitoring during anesthesia reduces
propofol use [9, 12].
Our hypothesis was that during the transvaginal oocyte retrieval
procedure, the amount of propofol given as an infusion with BIS
monitoring would be less compared to the amount used when bolus doses
are given according to the clinical evaluation.