Pain relief for women undergoing oocyte retrieval for assisted reproduction

Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre), Social Science ResearchUnit (SSRU), Instituteof Education,University of London, London, UK.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 01/2013; 1(1):CD004829. DOI: 10.1002/14651858.CD004829.pub3
Source: PubMed


Conscious sedation and analgesia are methods used to relieve pain during surgery to retrieve eggs from the ovaries as part of in vitro fertilisation procedures. There have been concerns that the drugs used for sedation and pain relief may have an adverse effect on pregnancy rates. This review identified 21 randomised controlled trials, involving 2974 women, comparing the effects of five different methods of conscious sedation and pain relief including general anaesthesia. We found insufficient evidence to support any one method as being superior to others in terms of pain relief or pregnancy outcomes. The mainstay of pain relief is the use of opioid drugs. Most of the methods seemed to work well and the effect was usually enhanced by addition of another method such as pain relief with paracervical block, which involves a local anaesthetic agent being injected in the cervix prior to egg retrieval. Women reported a high degree of acceptability and satisfaction associated with the various methods that were assessed in this review. Evidence was generally of low quality, mainly due to poor reporting of methods, small sample sizes and inconsistency between the trials. As women vary in their experience of pain and in coping strategies, the optimal method may be individualised.

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Available from: Irene Kwan, Jul 06, 2015
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    • "In contrast, when acupuncture is used to accompany embryo transfer, the primary purpose is to assist conception, electrical stimulation of the needles may or may not be used, and the points are selected to improve blood flow to the uterus to make it more receptive to the embryo (Stener-Victorin et al., 1996). In addition, two systematic reviews (Kwan et al., 2013; Stener-Victorin, 2005) have already evaluated electroacupuncture as an alternative to anaesthesia during oocyte retrieval, and pooled analyses found no statistically significant differences in later pregnancy rates between the electroacupuncture and conventional anaesthesia groups. "
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    ABSTRACT: BACKGROUND Recent systematic reviews of adjuvant acupuncture for IVF have pooled heterogeneous trials, without examining variables that might explain the heterogeneity. The aims of our meta-analysis were to quantify the overall pooled effects of adjuvant acupuncture on IVF clinical pregnancy success rates, and evaluate whether study design-, treatment- and population-related factors influence effect estimates.METHODS We included randomized controlled trials that compared needle acupuncture administered within 1 day of embryo transfer, versus sham acupuncture or no adjuvant treatment. Our primary outcome was clinical pregnancy rates. We obtained from all investigators additional methodological details and outcome data not included in their original publications. We analysed sham-controlled and no adjuvant treatment-controlled trials separately, but since there were no large or significant differences between these two subsets, we pooled all trials for subgroup analyses. We prespecified 11 subgroup variables (5 clinical and 6 methodological) to investigate sources of heterogeneity, using single covariate meta-regressions.RESULTSSixteen trials (4021 participants) were included in the meta-analyses. There was no statistically significant difference between acupuncture and controls when combining all trials [risk ratio (RR) 1.12, 95% confidence interval (CI), 0.96-1.31; I(2) = 68%; 16 trials; 4021 participants], or when restricting to sham-controlled (RR 1.02, 0.83-1.26; I(2) = 66%; 7 trials; 2044 participants) or no adjuvant treatment-controlled trials (RR 1.22, 0.97-1.52; I(2) = 67%; 9 trials; 1977 participants). The type of control used did not significantly explain the statistical heterogeneity (interaction P = 0.27). Baseline pregnancy rate, measured as the observed rate of clinical pregnancy in the control group of each trial, was a statistically significant effect modifier (interaction P < 0.001), and this covariate explained most of the heterogeneity of the effects of adjuvant acupuncture across all trials (adjusted R(2) = 93%; I(2) residual = 9%). Trials with lower control group rates of clinical pregnancy showed larger effects of adjuvant acupuncture (RR 1.53, 1.28-1.84; 7 trials; 1732 participants) than trials with higher control group rates of clinical pregnancy (RR 0.90, 0.80-1.01; 9 trials; 2289 participants). The asymmetric funnel plot showed a tendency for the intervention effects to be more beneficial in smaller trials.CONCLUSIONS We found no pooled benefit of adjuvant acupuncture for IVF. The subgroup finding of a benefit in trials with lower, but not higher, baseline pregnancy rates (the only statistically significant subgroup finding in our earlier review) has been confirmed in this update, and was not explained by any confounding variables evaluated. However, this baseline pregnancy rate subgroup finding among published trials requires further confirmation and exploration in additional studies because of the multiple subgroup tests conducted, the risk of unidentified confounders, the multiple different factors that determine baseline rates, and the possibility of publication bias.
    Human Reproduction Update 06/2013; 19(6). DOI:10.1093/humupd/dmt026 · 10.17 Impact Factor

  • Fertility and Sterility 09/2012; 98(3):S283. DOI:10.1016/j.fertnstert.2012.07.1029 · 4.59 Impact Factor
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    ABSTRACT: Background As many as one in six couples encounter problems with fertility, defined as failure to achieve a clinical pregnancy after regular intercourse for 12 months. Increasingly, couples are turning to assisted reproductive technology (ART) for help with conceiving and ultimately giving birth to a healthy live baby of their own. Fertility treatments are complex and costly, and each assisted reproduction cycle consists of several steps. If one of the steps is incorrectly applied, the stakes are high as conception may not occur. With this in mind, it is important that each step involved in ART is supported by good evidence from well-designed studies. Cochrane reviewers examined the evidence from Cochrane systematic reviews on ART published in The Cochrane Library. Study characteristics We included 58 Cochrane systematic reviews on various stages in the ART cycle. All were high quality. Reviews of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) were included in the overview. Reviews of intrauterine insemination and ovulation induction were not included. This overview provides the most up to date evidence from truly randomised controlled trials for ART cycles. Key results Thirty-two reviews identified interventions that were effective or promising, 14 reviews identified interventions that were ineffective or possibly ineffective, and 12 reviews were unable to draw conclusions due to lack of evidence. Use of the evidence from this overview to guide clinical practice should help to improve live birth rates and reduce rates of multiple pregnancy, cycle cancellation and ovarian hyperstimulation syndrome.
    Cochrane database of systematic reviews (Online) 08/2013; 8(8):CD010537. DOI:10.1002/14651858.CD010537.pub2 · 6.03 Impact Factor
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