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High level of satisfaction among women who underwent oocyte retrieval without anesthesia
Abstract Number: T3A-2
Abstract Type: Original Research
Introduction: Transvaginal oocyte retrieval (TOR) for in vitro fertilization (IVF) is a common minor surgical procedure. The various anesthetic modalities in use and that have been assessed in previous studies include monitored anesthesia care, conscious sedation, general or regional anesthesia, paracervical block, total intravenous anesthesia, patient-controlled analgesia, local anesthesia and acupuncture. Though some women undergo this procedure without anesthesia at all, their satisfaction from the procedure has not been studied yet.
Objectives: To assess level of satisfaction of women undergoing TOR for IVF without anesthetic or sedative agents. Additionally, to assess the grade of comfort of performing the procedure by the gynecologists.
Methods: This is a single center, prospective cohort study of women undergoing TOR for IVF. Inclusion criteria were women with number of follicles for retrieval ≤ 15. Women with BMI > 35, difficult vaginal approach to the follicles (evaluated by clinical examination), endometrioma > 15 cm or pelvic inflammatory disease were excluded. All admitted women who were willing to have their procedure performed without anesthesia and signed an informed consent were evaluated. TOR was performed under ultrasound guidance using 20 G aspiration needles. Our primary end point was patient's satisfaction [on a 1-10 scale, 1 being the worse and 10 being the best]. A cutoff of 5 was selected. Secondary endpoints were: women willingness to recommend or undergo the procedure again without anesthesia; rate of conversion to sedation; gynecologist rating of level of difficulty of performing the TOR.
Results: From July-December 2017, 382 TOR were performed in our institution. Three hundred and five (79.8%) patients were screened, and 281 (92.1%) were eligible for the study. Seventy (24.9%) procedures were performed without anesthesia, of which in 60 procedures women consented to participate in the study and were thus enrolled.
In the majority of the procedures - 51 (85%), patients graded their satisfaction > 5. Additionally, in 48 (80%) procedures, patients would have recommended other women to perform the procedure without anesthesia. Two (3.3%) procedures converted to anesthesia due to patient's pain and request to convert to anesthesia. Gynecologists graded the difficulty of performing the procedure as very easy or easy in 35 (58%) and 10 (16.6%) procedures, respectively, difficult and very difficult in 7 (11.6%) and 2 (3.3%) procedures, respectively. In the remaining procedures, 3 (5%) patients withdrew their consent, 2 (3.3%) patients converted to anesthesia and in one (0.6%) procedure oocytes were not found in the aspirated follicles, and no grading was given.
Conclusion: Preliminary data demonstrate high level of satisfaction following TOR without anesthesia, among both patients and gynecologists. Data on a larger cohort is currently under way.