Effect Of Intravenous Combined Anesthesia On Pregnancy Outcome Of IVF-ET

Background and ObjectivePatients who need in vitro fertilization-embryo transfer (IVF-ET) technology also will be increased with the increase of infertility patients in recent years. Oocyte retrieval is one of IVF,safe and effective oocyte retrieval under anesthesia is the goal of reproductive medicine and anesthesiology,this research mainly discusses the influence of intravenous anesthesia drugs on outcome of pregnancy of IVF-ET.MethodsWe collects97cases patients who need transvaginal oocyte retrieval in Department of Assisted Reproduction,General Hospital,Tianjin Medical University for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)from March2011to December2011,induction of anesthesia in patients of the group of intravenous combined anesthesia (n=81) undergoing the slow intravenous infusion of fentanyl0.05mg and propofol in2mg/kg and intravenous maintenance of propofol in8～12mg/kg/h,preoperative patients of the control group(n=16) are intravenously injected with pethidine50mg.After the end of transvaginal oocyte retrieval opertion,we take all patients with follicular fluid and venous blood,then we detect concentration of propofol in follicular fluid and venous plasma by high performance liquid chromatography (HPLC). Oocyte retrieval rate, fertilization rate,cleavage rate,good embryo rate, embryo implantation rate, clinical pregnancy rate, early abortion rate are compared between the two groups, and we observe the influence of intravenous combined anesthesia, duration of anesthesia, the total dosage of propofol, concentration of propofol in plasma, concentration of propofol in follicular fluid on outcome of pregnancy of IVF-ET.Results1. pregnancy outcome of the anesthesia group and the control groupThere is no significant difference between the two groups in oocyte retrieval rate, fertilization rate,cleavage rate.good embryo rate,embryo implantation rate,clinical pregnancy rate,early abortion rate (P>0.05).2.The relationship of the follicular fluid concentration of propofol,the plasma concentration of propofol,the total dosage of propofol, the duration of anesthesiaAccording to the duration of anesthesia (T), the anesthesia group is divided into five groups:T1≤10min,10min<T2≤15min,15min<T3≤20min,20min<T4≤25min),T5>25min.2.1The follicular fluid concentration of propofol has correlation with the duration of anesthesia(P<0.05),with the increasing of the duration of anesthesia,the follicular fluid concentration of propofol is increased.2.2The follicular fluid concentration of propofol has correlation with the total dosage of propofol(P<0.05),with the increasing of the total dosage of propofol,the follicular fluid concentration of propofol is increased.2.3The follicular fluid concentration of propofol has no correlation with the plasma concentration of propofol (P>0.05).2.4The plasma concentration of propofol has no correlation with the duration of anesthesia(P>0.05), the plasma concentration of propofol is not increased with the increasing of the duration of anesthesia.2.5The plasma concentration of propofol has no correlation with the total dosage of propofol(P>0.05).3.1T1～T5groups in oocyte retrieval rate,fertilization rate,cleavage rate,good embryo rate.embryo implantation rate,clinical pregnancy rate(P>0.05),early abortion cases:T1group has1cases,T2group has2cases,T3group has2cases,T4group has0cases,T5group has1cases.3.2According to the total dosage of propofol(Z), the anesthesia group is divided into five groups:Z1≤100mg,100mg<Z2≤150mg,150mg<Z3≤200mg,200mg<Z4≤250mg,Z5>250mg.There is no significant difference among Z1～Z5groups in oocyte retrieval rate,fertilization rate,cleavage rate,good embryo rate,embryo implantation rate,clinical pregnancy rate(P>0.05),early abortion cases:Z1group has0cases,Z2group has2cases,Z3group has2cases,Z4group has1cases, Z5group has1cases.3.3According to concentration of propofol in venous plasma(X),the anesthesia group is divided into five groups:X1≤2μg/ml,2μg/ml<X2≤3μg/ml,3μg/ml4μg/ml,4ug/ml<X4≤5μg/ml,X5>5μg/ml.There is no significant difference among X1～X5groups in oocyte retrieval rate,fertilization rate,cleavage rate,good embryo rate,embryo implantation rate,clinical pregnancy rate(P>0.05),early abortion cases:X1group has0cases, X2group has3cases,X3group has2cases,X4group has0cases, X5group has1cases.3.4According to concentration of propofol in follicular fluid, the anesthesia group is divided into five groups:L1≤0.01μg/ml,0.01μg/ml<L2≤0.1μg/ml,0.1μg/ml<L3≤0.2μg/ml,L4>0.2μg/ml.There is no significant difference among L1～L4groups in oocyte retrieval rate, fertilization rate,cleavage rate,good embryo rate, embryo implantation rate,clinical pregnancy rate(P>0.05),early abortion cases:L1group has1cases,L2group has2cases,L3group has2cases,L4group has1cases.Conclusion1. Propofol and Fentanyl intravenous combined anesthesia has no effecton outcome of pregnancy of IVF-ET.2.The follicular fluid concentration of propofol has correlation with the duration of anesthesia(P<0.05),with the increasing of the duration of anesthesia, the follicular fluid concentration of propofol is increased.3.The follicular fluid concentration of propofol has correlation with the total dosage of propofol(P<0.05),with the increasing of the total dosage of propofol,the follicular fluid concentration of propofol is increased.4.The follicular fluid concentration of propofol has no correlation with the plasma concentration of propofol (P>0.05).5. With the range(6～35,19.04±9.87)min,the duration of anesthesia does not affect the pregnancy outcome of IVF-ET.6. With the range(80～400,180.34±98.53)mg, the number of the total dosage of propofol has no effect on outcome of pregnancy of IVF-ET.7.With the range(1.03～7.82,3.23±2.60)μg/ml,the level of concentration of propofol in plasma does not affect the pregnancy outcome of IVF-ET.8.With the range(0.002～0.46,0.125±0.062)μg/ml,the level of concentration of )ropofol in follicular fluid has no effect on outcome ot pregnancy ot IVF-—EI.