Suleyman Demirel University, Faculty of Medicine, Department of Gynecology and Obstetrics, In Vitro Fertilization Unit, Isparta, Turkey.
Taiwan J Obstet Gynecol. 2019 Sep;58(5):673-679. doi: 10.1016/j.tjog.2019.07.016.
General anesthesia is used in most in vitro fertilization (IVF) clinics for oocyte pick-up (OPU), however, there is no consensus on type of anesthetic agent use among clinicians performing OPU. Therefore, we aimed to evaluate the effects of propofol, ketamine, or combination of propofol and ketamine (P + K) for OPU on IVF outcome.
Three hundred and thirty three women (n = 333) undergoing IVF treatment were retrospectively included and were evaluated in three groups depending on whether they received propofol (n = 217), or ketamine (n = 60), or P + K (n = 56) for anesthesia during OPU.
Baseline characteristics and duration of anesthesia of each group were comparable except lower motile sperm percentage in the ketamine group compared to the propofol group (p = 0.002). Fertilization rate (FR) was decreased with ketamine compared to propofol (p = 0.013) and P + K (p = 0.008). After adjustment for sperm motility, this negative effect of ketamine on FR persisted. Implantation, clinical pregnancy, take-home baby rates, and oocyte retrieval parameters (number of total retrieved oocyte, metaphase II oocytes, embryo and methaphase II rate, and embryo quality) did not differ between the groups. Extended anesthesia duration (>30 min) was associated with low implantation (p = 0.04) and clinical pregnancy rates (p = 0.02).
Ketamine use during OPU can affect FR compared to propofol and P + K. Long durations of anesthesia also seem to decrease implantation and clinical pregnancy rates.
大多数体外受精（IVF）诊所都在卵母细胞采集（OPU）时使用全身麻醉，但在进行 OPU 的临床医生中，对于麻醉药物类型的使用尚未达成共识。因此，我们旨在评估丙泊酚、氯胺酮或丙泊酚和氯胺酮（P+K）联合用于 OPU 对 IVF 结局的影响。
回顾性纳入 333 名接受 IVF 治疗的女性（n=333），并根据她们在 OPU 期间接受丙泊酚（n=217）、氯胺酮（n=60）或 P+K（n=56）麻醉的情况，将她们分为三组。
除氯胺酮组的活动精子百分比低于丙泊酚组（p=0.002）外，每组的基线特征和麻醉持续时间均无差异。与丙泊酚相比，氯胺酮组的受精率（FR）降低（p=0.013），与 P+K 组相比（p=0.008）也降低。在调整精子活力后，氯胺酮对 FR 的这种负面影响仍然存在。胚胎着床率、临床妊娠率、活产儿率以及卵母细胞采集参数（总采集卵母细胞数、MⅡ期卵母细胞数、胚胎数和 MⅡ期率、胚胎质量）在各组之间无差异。麻醉时间延长（>30 分钟）与低着床率（p=0.04）和临床妊娠率（p=0.02）相关。
与丙泊酚和 P+K 相比，氯胺酮在 OPU 期间的使用会影响 FR。麻醉时间过长也似乎会降低胚胎着床率和临床妊娠率。
