Which Method Is Best To Reduce Pain During Egg Retrieval?

A combination of opioids injected into the bloodstream and muscles plus painkillers given by mouth seem to give the best results.

Key Points

Highlights: 

• A combination approach seems to be the best to reduce pain to a maximum during egg retrieval for women undergoing IVF or ICSI.

Importance:

• The findings of this study can ensure women experience the least possible pain during egg retrieval

What's done here:

• Researchers conducted a retrospective cohort study comparing the different pain reduction protocols.

Key results:

• Older women experience less pain during egg retrieval compared to younger ones.
• Women with endometriosis experience more pain during egg retrieval compared to those without the disease.
• Women who have never been pregnant before experience more pain during egg retrieval compared to women who had multiple pregnancies.
• Primary subfertility leads to more pain during egg retrieval.
• Pain increases with each follicle retrieved.
• The type of pain reduction protocol used does not affect these findings.
• Intramuscular alfentanil followed by intravenous fentanyl and oral non-sedative analgesics lead to the best results in terms of pain reduction.

Limitations:

• The clinics did not use the same method to objectify pain.
• The retrospective nature of the study.
• Needles of different diameters were used for egg retrieval.
• Only one analgesia protocol was used in each clinic. 

Lay Summary

Women experience the least pain during egg retrieval for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) when alfentanil is injected into the muscles and this is followed by fentanyl injection into the bloodstream and non-sedative analgesics given by mouth.

This is according to a new study published in the Journal of Gynecology Obstetrics and Human Reproduction. The authors of the study also found significant correlations between patient characteristics and pain scores. The findings of this study are important because they can guide decision-making for women undergoing IVF/ICSI.

Women with endometriosis sometimes need to undergo IVF or ICSI. Egg retrieval is essential for these procedures but can be very painful.

This study compared the different pain reduction protocols used for egg retrieval at three different clinics. A total of 2,127 egg retrieval procedures were conducted in the clinics. In the first, women were given 1000 mg of paracetamol and 500 mg of naproxen by mouth as a painkiller. In the second, women received an injection of 50-100 µg fentanyl, an opioid, into the bloodstream. Finally, in the third, they received an injection of another opioid alfentanil at a dose of 0.01 mg/kg into the muscle. 

Researchers analyzed the pain that the women experienced during egg retrieval, which they registered on an 11-point scale. 

The results showed that the pain scores of older women were usually lower, with the pain score decreasing by 0.06 points per year. On the contrary, the pain score increased by 0.05 points for each extra follicle retrieved. 

Women with endometriosis also experienced more pain compared to those without the disease. More precisely, the disease led to a 0.45-point increase in pain scores. Similarly, primary subfertility led to a 0.36-point increase in pain scores. 

Women who have never been pregnant before also had a pain score of 0.41 points higher compared to women who had become pregnant more than once. 

These findings were similar among the three clinics, regardless of the type of pain reduction protocol that was used. 

When the researchers compared the pain scores of women treated in each clinic they found that those treated in the first clinic experience the most pain (average pain score of 5.6) while those in the third clinic experience the least pain (average pain score of 3.9). The average pain score in the second clinic was 5.1.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35487403/