Cover
Vol. 10 No. 1 (2020)

Published: December 31, 2020

Pages: 83-100

Research Article

Effect of drugs used in general anesthesia on oocyte and embryo quality in Iraqi infertile females undergoing intracytoplasmic sperm injection

Hameedah Abdul Hussein Mohsin 1 Mufeda Ali Jwad Raed Ghazi Reshan
1High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al Nahrain University, Baghdad, Iraq.
History
  • Received: August 17, 2020
  • Accepted: September 3, 2020
  • Available Online: December 16, 2020
DOI

https://doi.org/10.28969/IJEIR.v9.i1.r6

Abstract

Various types of anesthetic techniques were described for oocyte recovery. Different anesthetic agents have been used with different effects on oocyte quality and embryonic development and studies on the potential toxicity of general anesthesia ended up with conflicting results. Many experiments as well as human studies documented the existence of anesthetic agents in the follicular fluid (FF) with possible adverse effects on the oocyte quality and subsequent embryo development. Ketamine and remifentanil were used for the studied groups to compare oocytes and embryos characteristic of infertile women during oocytes retrieval under general anesthesia: one group receiving ketamine, midazolam, and propofol and the other group receiving remifentanil, midazolam and propofol. 60 infertile females were undergoing intracytoplasmic sperm injection categorized in two groups, group I received midazolam, remifentanil and propofol; whereas, group II received midazolam, ketamine and propofol. There was highly significant difference in mean abnormal oocyte between ketamine and remifentanil groups. Grade III embryos were significantly limited to ketamine group. FF ketamine and remifentanil were not significantly correlated to any of oocyte characteristics or embryo characteristics. Anesthetic agents, ketamine and remifentanil, were detected in the FF of infertile women and within recommended doses. Ketamine resulted in adverse effects on oocyte and embryo quality in comparison with remifentanil represented by greater percentage of abnormal oocytes and that bad quality embryos were limited to ketamine group.

Keywords

References

  1. Moridi A, Roozbeh N, Yaghoobi H, Soltani S, Dashti S, Shahrahmani N, Banaei M. Etiology and Risk Factors Associated With Infertility. International Journal Of Womens Health And Reproduction Sciences. 2019;7(3):346-53. [Online Article Link]
  2. Sharma A, Borle A, Trikha A. Anesthesia for in vitro fertilization. Journal of Obstetric Anaesthesia and Critical Care. 2015 Jul 1;5(2):62-72. [Online Article Link]
  3. Vlahos NF, Giannakikou I, Vlachos A, Vitoratos N. Analgesia and anesthesia for assisted reproductive technologies. International Journal of Gynecology & Obstetrics. 2009 Jun 1;105(3):201-5. [Online Article Link]
  4. Tola EN. The effect of anesthetic agents for oocyte pick-up on in vitro fertilization outcome: A retrospective study in a tertiary center. Taiwanese Journal of Obstetrics and Gynecology. 2019 Sep 1;58(5):673-9. [Online Article Link]
  5. 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. [Online Article Link]
  6. Oliveira Júnior GL, Serralheiro FC, Fonseca FL, Ribeiro Junior OD, Adami F, Christofolini DM, Bianco B, Barbosa CP. Randomized double-blind clinical trial comparing two anesthetic techniques for ultrasound-guided transvaginal follicular puncture. Einstein (São Paulo). 2016 Sep;14(3):305-10. [Online Article Link]
  7. Rolland L, Perrin J, Villes V, Pellegrin V, Boubli L, Courbiere B. IVF oocyte retrieval: prospective evaluation of the type of anesthesia on live birth rate, pain, and patient satisfaction. Journal of assisted reproduction and genetics. 2017 Nov 1;34(11):1523-8. [Online Article Link]
  8. Urfalioglu A, Yaylali A. Effect of Anesthetics During Oocyte Pick-Up Procedure on Oocyte Quality and Pregnancy. Journal of Clinical and Analytical Medicine. 2016;7(6):840- 843. [Online Article Link]
  9. Bümen S, Günüşen İ, Firat V, Karaman S, Akdoğan A, Göker EN. A comparison of intravenous general anesthesia and paracervical block for in vitro fertilization: effects on oocytes using the transvaginal technique. Turkish Journal of Medical Sciences. 2011 Sep 7;41(5):801-8. [Online Article Link]
  10. Goutziomitrou E, Venetis CA, Kolibianakis EM, Bosdou JK, Parlapani A, Grimbizis G, Tarlatzis BC. Propofol versus thiopental sodium as anaesthetic agents for oocyte retrieval: a randomized controlled trial. Reproductive biomedicine online. 2015 Dec 1;31(6):752-9. [Online Article Link]
  11. Vasudevan B, Borle A, Singh PM, Ramachandran R, Rewari V, Trikha A. The effect of anesthetic technique for transvaginal ultrasound-guided oocyte retrieval on reproductive outcomes: A systematic review and meta-analysis. Journal of Obstetric Anaesthesia and Critical Care. 2015 Jul 1;5(2):54-61. [Online Article Link]
  12. Matsota P, Sidiropoulou T, Batistaki C, et al. Analgesia with remifentanil versus anesthesia with propofol-alfentanil for transvaginal oocyte retrieval: a randomized trial on their impact on in vitro fertilization outcome. Middle East Journal of Anaesthesiology. 2012 Jun;21(5):685- 692. [Online Article Link]
  13. Piroli A, Marci R, Marinangeli F, Paladini A, Di Emidio G, Giovanni Artini P, Caserta D, Tatone C. Comparison of different anaesthetic methodologies for sedation during in vitro fertilization procedures: effects on patient physiology and oocyte competence. Gynecological Endocrinology. 2012 Oct 1;28(10):796-9. [Online Article Link]
  14. Matsota P, Kaminioti E, Kostopanagiotou G. Anesthesia related toxic effects on in vitro fertilization outcome: burden of proof. BioMed research international. 2015;2015: 475362. [Online Article Link]
  15. Wilhelm W, Hammadeh ME, White PF, Georg T, Fleser R, Biedler A. General anesthesia versus monitored anesthesia care with remifentanil for assisted reproductive technologies: effect on pregnancy rate. Journal of clinical anesthesia. 2002 Feb 1;14(1):1-5. [Online Article Link]
  16. Jarahzadeh MH, Davar R, Hajiesmaeili MR, Entezari A, Musavi F. Remifentanil versus fentanyl for assisted reproductive technologies: effect on hemodynamic recovery from anesthesia and Outcome of ART Cycles. International journal of fertility & sterility. 2011 Jul;5(2):86-9. [Online Article Link]
  17. Sarikaya HB, Iyilikci L, Gulekli B, Posaci C, Erbil Dogan O, Ok E, Eglen M, Ellidokuz H, Gunerli A. Comparison of the effects of 2 different doses of remifentanil infusion for sedation during in-vitro fertilization procedure. Saudi Med J. 2011 Jul 1;32(7):689-94. [Online Article Link]
  18. Beleña JM, Núñez M, Vidal A, Anta D. Randomized double-blind comparison of remifentanil and alfentanil in patients undergoing laparoscopic cholecystectomy using total intravenous anesthesia. Journal of anaesthesiology, clinical pharmacology. 2016 Oct;32(4):487-91 [Online Article Link]
  19. Gales A, Maxwell S. Ketamine: Recent evidence and current uses. WFSA, Tutorial 381. 2018. [Online Article Link]
  20. Kolp E, Krupitsky E, Sylvester M, Friedman HL, Jansen K, Young MS, Kolp A. Ketamine Psychedelic Psychotherapy: Focus on its Pharmacology, Phenomenology, and Clinical Applications. International Journal of Transpersonal Studies. 2014 Jul 1;33(2):94-140. [Online Article Link]
  21. Lier MC, Douwenga WM, Yilmaz F, Schats R, Hompes PG, Boer C, Mijatovic V. Patient‐Controlled Remifentanil Analgesia as Alternative for Pethidine with Midazolam During Oocyte Retrieval in IVF/ICSI Procedures: A Randomized Controlled Trial. Pain Practice. 2015 Jun;15(5):487-95. [Online Article Link]
  22. Alpha scientists in reproductive medicine and ESHRE special interest of embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011 Jun;26(6):1270‐ 1283. [Online Article Link]
  23. Ewadh MJ, Jawad AM. Correlation of Reduced Glutathione with Brest Cancer Using High Performance Liquid Chromatography. Biomedical Journal of Scientific & Technical Research. 2017;1(5):1287-90. [Online Article Link]
  24. Milanini MN, D′Onofrio P, Melani Novelli AM, Dabizzi S, Cozzi C, Evangelisti P, et al. Local anesthesia versus intravenous infusion of remifentanil for assisted reproductive technologies: A retrospective study. Minerva Ginecologica.. 2008 Jun;60:203-7. [Online Article Link]
  25. Hammadeh ME, Wilhelm W, Huppert A, Rosenbaum P, Schmidt W. Effects of general anaesthesia vs. sedation on fertilization, cleavage and pregnancy rates in an IVF program. Archives of gynecology and obstetrics. 1999 Dec 1;263(1-2):56-9. [Online Article Link]
  26. Nossair WS, Maaty AMA. Comparative Study among Ketamine, Thiopental and Probofol for Sedation during In Vitro Fertilization Procedures. SM J Gynecol Obstet. 2017;3(1):1020. [Online Article Link]
  27. Ben-Shlomo I, Moskovich R, Katz Y, Shalev E. Midazolam/ketamine sedative combination compared with fentanyl/propofol/isoflurane anaesthesia for oocyte retrieval. Human Reproduction. 1999 Jul 1;14(7):1757-9. [Online Article Link]
  28. Barut C, Akdogan A, Sahin G, Karaman S, Goker ET, Tavmergen E. Does general anesthesia effect IVF outcomes?. Fertility and Sterility. 2008 Sep 1;90:S404-5 .[Online Article Link]
  29. Ziesenitz VC, Vaughns JD, Koch G, Mikus G, van den Anker JN. Pharmacokinetics of fentanyl and its derivatives in children: a comprehensive review. Clinical pharmacokinetics. 2018 Feb 1;57(2):125-49. [Online Article Link]
  30. Mion G, Villevieille T. Ketamine pharmacology: an update (pharmacodynamics and molecular aspects, recent findings). CNS neuroscience & therapeutics. 2013 Jun;19(6):370-80. [Online Article Link]
  31. Endler GC, Stout M, Magyar DM, Hayes MF, Moghissi KS, Sacco AG. Follicular fluid concentrations of thiopental and thiamylal during laparoscopy for oocyte retrieval. Fertility and sterility. 1987 Nov 1;48(5):828-33. [Online Article Link]
  32. Imoedemhe DA, Sigue AB, Ghani IA, Abozeid MA, Halim MA. An evaluation of the effect of the anesthetic agent profofol (Diprivan) on the outcome of human in vitro fertilization. Journal of assisted reproduction and genetics. 1992 Oct 1;9(5):488-91. [Online Article Link]
  33. Wikland M, Evers H, Jakobsson AH, Sandqvist U, Sjöblom P. The concentration of lidocaine in follicular fluid when used for paracervical block in a human IVF-ET programme. Human Reproduction. 1990 Nov 1;5(8):920-3. [Online Article Link]
  34. Soussis I, Boyd O, Paraschos T, Duffy S, Bower S, Troughton P, Lowe J, Grounds R. Follicular fluid levels of midazolam, fentanyl, and alfentanil during transvaginal oocyte retrieval. Fertility and sterility, 1995;64(5):1003-1007. [Online Article Link]
  35. Ben-Shlomo I, Moskovich R, Golan J, Eyali V, Tabak A, Shalev E. The effect of propofol anaesthesia on oocyte fertilization and early embryo quality. Human reproduction. 2000 Oct 1;15(10):2197-9. [Online Article Link]