FERTILIZATION
EDITORIAL REVIEW
By
Marc Van de Velde
Published in
Current opinion in Anaesthesiology
Vol.18 No.4 August 2005
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
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
IVF
RISK:
Multiple Pregnancy
Preterm Delivery
LBW & SGA
OHSS (ovarian hyper stimulation syndrome)
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