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ANAESTHESIA FOR IN-VITRO

FERTILIZATION
EDITORIAL REVIEW
By
Marc Van de Velde
Published in
Current opinion in Anaesthesiology
Vol.18 No.4 August 2005

In 1978 Dr.Patrick Steptoe & Robert


Edward (U.K.) reported the Ist successful
live birth following IVF.

Process involves:
Hormonally controlled Ovarian stimulation to
produce Mature Ovum.
Oocyte Retrieval
Fertilization in Lab Conditions.
Embryo Transfer.

Ovarian stimulation
Starts on 3rd day of Menstruation.
Gonadotrophin releasing Hormone agonist
to induce Pituitary Suppression.
10 days injections
FSH & HMGn ( promote follicle growth)
HCG ( induce Oocyte Maturation)
Serially monitored by estradiol level & USG

Oocyte Retrieval
34-36Hr after HCG
3 approaches for Retrieval :
Laproscopically
Trans abdominal
Trans vaginal

Mature follicles are punctured


,aspirated,rinsed & aspirated again to retrieve

Fertilization
Inseminated & incubated for 18 hr in
culture media.
Checked for Fertilization.

Embryo Transfer
Transferred to the uterus in 3-5 days
using Trans Cervical Approach.

Successful ART

Occurrence of Pregnancy & Delivery of Baby.


Maternal Age
No. of Oocytes transferred
Quality of Sperm
Response to Hormonal Stimulation
STRESS

IVF

RISK:
Multiple Pregnancy
Preterm Delivery
LBW & SGA
OHSS (ovarian hyper stimulation syndrome)

OHSS (ovarian hyper stimulation syndrome)


After transfer of fertilized Oocytes
Abd. Discomfort
Ovarian enlargement
Ascitis
Hmge of a ruptured follicle
Pleural Effusion
Haemoconcentration
Oliguria
Thromboembolism

Anaesthetic Management
Any Anaesthetic technique may interfere
with certain aspects of human Oocyte
fertilization
CO2 Pneumoperitoneum
Duration of procedure
Degree of respiratory depression
Dose / combination of drugs
Maternal age

Local Anaesthetic
High concentration of LA
Adversely affects Fertilization & embryonal
development in Mouse
No adverse effects in Human trials.

INHALATIONAL
N2O influence DNA synthesis & reduces
Methionine synthetase activity
Halogenated reduced reproductive
success

OPIOIDS
REMIFENTANIL
MIDAZOLAM & KETAMINE acceptable
PROPOFOL safe alternative

REMIFENTANIL & PROPOFOL based


technique involving deep sedation for IVF