Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Department of Applied Embryology, Institute of Infertility and Assisted Reproductive Techniques, Al-Nahrian University, Al-Nahrain, Iraq

2 Department of Anesthesia, Institute of Infertility and Assisted Reproductive Techniques, Al-Nahrain University, Al-Nahrain, Iraq

3 Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

4 Department of Experimental Embryology Zoology, Faculty of Science, Mansoura University, Mansoura, Egypt


Background & Objective: The presence of anesthetic drugs in the serum with potential negative effects on hormone concentration and pregnancy rate has been shown in a number of human research. To assess the effects on blood hormone concentration and pregnancy rate of two different medications (remifentanil vs. fentanyl) used for general anesthesia during oocyte retrieval.
Materials & Methods: the present prospective comparative study was conducted at Iraq's "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Al-Nahrain University/Baghdad/Iraq" infertility center and was approved by Mansoura University for its validity. Sixty infertile women who were having (ICSI) for a range of infertility-related reasons that entered the study. The women's ages varied from 20 to 45 years. The study's length was extended from September 2022 to September 2023. According to the general anesthetic protocol for oocyte retrieval, those patients were divided into two groups. Midazolam, propofol, and fentanyl were given to the group one, while remifentanil, midazolam, and propofol were given to the group two.
Results: Compare the hormone levels before and after fentanyl anesthesia. The current study's findings indicated that remifentanil led to a greater pregnancy rate (40.0%) than fentanyl (36.7%). According to the results, there were significantly higher LH levels after fentanyl anesthesia (P = 0.014). However, insignificantly higher FSH (P = 0.481) and prolactin (P = 0.076) levels post-fentanyl anesthesia. Also, significantly higher LH levels after remifentanil anesthesia (P = 0.046), insignificantly higher FSH levels (P = 0.383) and prolactin levels (P = 0.16) after remifentanil anesthesia. In the fentanyl group, the recovery time was substantially longer (P<0.001).
Conclusion: Because of its quicker recovery time and much greater pregnancy rate, remifentanil is preferred over fentanyl in normal general anesthetic treatments for egg harvest in ICSI operations.


Main Subjects

1. Hussam F, Abdulhameed Khudair S, K. Alkhafaje W, S. Alnassar Y, M. Kaoud R, Najm Abed A, et al. A Cross-Sectional Study Regarding Infertility Among Women in Iraq. J Obstet Gynecol Cancer Res. 2022;8(1):47-52. [DOI:10.30699/jogcr.8.1.47]
2. Cox CM, Thoma ME, Tchangalova N, Mburu G, Bornstein MJ, Johnson CL, Kiarie J. Infertility prevalence and the methods of estimation from 1990 to 2021: a systematic review and meta-analysis. Hum Reprod Open. 2022;2022(4):hoac051. [DOI:10.1093/hropen/hoac051] [PMID] [PMCID]
3. Rezaei Z, Taghdisi S. A Comparison of Fertility Rates in Women Undergoing IVF with a Tubal Factor with Surgery, Tubal Factor Infertility Without Surgery, and Unexplained Infertility. J Obstet Gynecol Cancer Res. 2020;5(2):61-7. [DOI:10.30699/jogcr.5.2.61]
4. Nardelli AA, Stafinski T, Motan T, Klein K, Menon D. Assisted reproductive technologies (ARTs): Evaluation of evidence to support public policy development. Reprod Health. 2014;11(1):76. [DOI:10.1186/1742-4755-11-76] [PMID] [PMCID]
5. Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. Hum Reprod Sci. 2015;8(4):191-6. [DOI:10.4103/0974-1208.170370] [PMID] [PMCID]
6. Homer HA. Modern management of recurrent miscarriage. Aust N Z J Obstet Gynaecol. 2019;59(1):36-44. [DOI:10.1111/ajo.12920] [PMID]
7. Garolla A, Pizzol D, Carosso AR, Borini A, Calogero AE, Ferlin A, et al. Practical clinical and diagnostic pathway for the investigation of the infertile couple. Front Endocrinol (Lausanne). 2021;11:591837. [DOI:10.3389/fendo.2020.591837] [PMID] [PMCID]
8. Souilm NA, Abd Elkhalek NK, Hassan MM. Effectiveness of an Educational Program in Enhancing Infertile Women's Psychological Health. Am J Nurs. 2018;6(6):515-23. [DOI:10.12691/ajnr-6-6-20]
9. Jain G, Khatuja R, Juneja A, Mehta S. Laparoscopy:as a first line diagnostic tool for infertility evaluation. J Clin Diagn Res. 2014;8(10):Oc01-2. [DOI:10.7860/JCDR/2014/9822.4929] [PMID] [PMCID]
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. Reprod Biomed Online. 2015;31(6):752-9. [DOI:10.1016/j.rbmo.2015.08.013] [PMID]
11. Buisman E, Grens H, Wang R, Bhattacharya S, Braat DDM, Huppelschoten AG, van der Steeg JW. Trends in research on pain relief during oocyte retrieval for IVF/ICSI: a systematic, methodological review. Hum Reprod Open. 2022;2022(1):hoac006. [DOI:10.1093/hropen/hoac006] [PMID] [PMCID]
12. Bümen S, Günüşen İ, Firat V, Karaman S, Akdoğan A, Göker ENT. A comparison of intravenous general anesthesia and paracervical block for in vitro fertilization: effects on oocytes using the transvaginal technique. Turk J Med Sci. 2011;41(5):801-8. [DOI:10.3906/sag-1009-1101]
13. Khetarpal R, Chatrath V, Kaur P, Trikha A. Anaesthesia for Assisted Reproductive Technology (ART): A Narrative Review. Int J Obstet Anesth Crit Care. 2022;12(1):5-16. [DOI:10.4103/JOACC.JOACC_63_21]
14. UrfalioĞLu A, Yaylali A. Effect of anesthetics During oocyte pick-up procedure on oocyte quality and pregnancy. J Clin Anal Med. 2016;7(6):840-3.
15. 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. JBRA Assist Reprod. 2017;34:1523-8. [DOI:10.1007/s10815-017-1002-7] [PMID] [PMCID]
16. Matsota P, Sidiropoulou T, Vrantza T, Boutsikou M, Midvighi E, Siristatidis C. Comparison of two different sedation protocols during transvaginal oocyte retrieval: Effects on propofol consumption and IVF outcome: A prospective cohort study. J Clin Med. 2021;10(5):963. [DOI:10.3390/jcm10050963] [PMID] [PMCID]
17. Pergolizzi JV, Jr., LeQuang JA, Berger GK, Raffa RB. The Basic Pharmacology of Opioids Informs the Opioid Discourse about Misuse and Abuse: A Review. Pain Ther. 2017;6(1):1-16. [DOI:10.1007/s40122-017-0068-3] [PMID] [PMCID]
18. Adamson GD, de Mouzon J, Chambers GM, Zegers-Hochschild F, Mansour R, Ishihara O, et al. International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011. Fertil Steril. 2018;110(6):1067-80. [DOI:10.1016/j.fertnstert.2018.06.039] [PMID]
19. Matsota P, Sidiropoulou T, Batistaki C, Giannaris D, Pandazi A, Krepi H, 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 J Anaesthesiol. 2012;21(5):685-92.
20. Ben-Shlomo I, Moskovich R, Katz Y, Shalev E. Midazolam/ketamine sedative combination compared with fentanyl/propofol/isoflurane anaesthesia for oocyte retrieval. Hum Reprod. 1999;14(7):1757-9. [DOI:10.1093/humrep/14.7.1757] [PMID]
21. Mohsin HAH, Jwad MA, Reshan RG. Effect of drugs used in general anesthesia on oocyte and embryo quality in Iraqi infertile females undergoing intracytoplasmic sperm injection. Iraqi J Emb Inferti Res. 2020;10(1):83-100. [DOI:10.28969/IJEIR.v10.i1.r6]
22. Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility: lippincott Williams & wilkins; 2005.
23. Sharma A, Borle A, Trikha A. Anesthesia for in vitro fertilization. J Obstet Anesth Crit Care. 2015;5(2):62-72. [DOI:10.4103/2249-4472.165132]
24. 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. J Clin Anesth. 2002;14(1):1-5. [DOI:10.1016/S0952-8180(01)00331-2] [PMID]
25. 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. Int J Fertil Steril. 2011;5(2):86-9.
26. Tola EN. The effect of anesthetic agents for oocyte pick-up on in vitro fertilization outcome: A retrospective study in a tertiary center. Taiwan J Obstet Gynecol. 2019;58(5):673-9. [DOI:10.1016/j.tjog.2019.07.016] [PMID]
27. Nossair WS, Maaty AMA. Comparative Study among Ketamine, Thiopental and Probofol for Sedation during In Vitro Fertilization Procedures. Obstet Gynecol. 2017;3(1):1020.
28. Jarahzadeh MH, Jouya R, Mousavi FS, Dehghan-Tezerjani M, Behdad S, Soltani HR. Propofol or Thiopental sodium in patients undergoing reproductive assisted technologies: Differences in hemodynamic recovery and outcome of oocyte retrieval: A randomized clinical trial. Iran J Reprod Med. 2014;12(1):77-82.
29. 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;15(5):487-95. [DOI:10.1111/papr.12189] [PMID]
30. Oliveira Júnior GLd, Serralheiro FC, Fonseca FLA, Ribeiro Junior OD, Adami F, Christofolini DM, et al. Randomized double-blind clinical trial comparing two anesthetic techniques for ultrasound-guided transvaginal follicular puncture. Einstein (São Paulo). 2016;14(3):305-10. [DOI:10.1590/S1679-45082016AO3714] [PMID] [PMCID]