Embargoed until 16-Oct-2000
REGIONAL ANESTHESIA FOR EGG RETRIEVAL INCREASES IN VITRO FERTILIZATION PREGNANCIES
SAN FRANCISCO -- In terms of higher pregnancy rates and patient satisfaction but at less cost, spinal anesthesia (SA) emerges as the superior anesthetic choice over general anesthesia (GA) for oocyte, or egg, retrieval procedures for in vitro fertilization (IVF), according to research conducted at Boston's Massachusetts General Hospital.
According to a study of 25 women, those who chose SA for egg retrieval had a significantly higher overall pregnancy rate than those who opted for GA (50 percent versus 33 percent, respectively), anesthesiologist Bobbie Jean Sweitzer, M.D., said.
The differences in pregnancy rates could have something to do with the different ways SA and GA affect the body, Dr. Sweitzer said at the American Society of Anesthesiologists annual meeting.
Some laboratory studies suggest the anesthetic agents used for GA can affect an egg's ability to be fertilized in vitro, she said. In addition, GA enters the blood stream quickly, reaching the brain -- and the ovaries -- within about 10 minutes.
By contrast, SA enters the blood stream very slowly, the anesthesiologist uses a much smaller amount of drug, and the medication stays in the spinal region for a relatively long time. "By the time the drug enters the blood stream, the oocytes have been retrieved," Dr. Sweitzer said.
SA also causes fewer side effects, while GA can cause prolonged drowsiness or nausea and vomiting during recovery. Dr. Switzer said since patients recuperate faster and remain alert, nurses who provide extensive follow-up education after surgery can communicate more effectively with patients and accomplish their teaching goals in less time the same day, without the need for a return visit from the patient.
Both SA and GA have been used for egg retrievals, but few studies have explored the effect of anesthetic choice on recovery times, complication rates, pregnancy rates, costs and patient satisfaction, Dr. Sweitzer said.
"Although the study was small, the results were significant, and all pointed to spinal anesthesia as the more effective choice," Dr. Sweitzer said.
Both the SA and GA patients reported high levels of satisfaction with their choice of anesthesia; however, the SA ratings deserve attention because patients who have SA for other procedures often say they would have preferred to be "asleep." The fact that every SA patient in this study indicated she would choose SA again attests to the technique's effectiveness for this patient population and procedure, Dr. Sweitzer said.
SA helps surgeons, she said, because oocyte retrieval is an extremely delicate procedure that places an ultra-fine needle into a follicle to retrieve a microscopic egg. "Some patients may move slightly under GA, and even tiny movements can make it harder to retrieve the eggs," she said.
By contrast, SA temporarily immobilizes patients from the waist down. Patients having SA also required less postoperative pain medications.
Currently for mothers and babies alike, SA and epidural analgesia are widely considered the safest, most effective anesthetic choices for childbirth as well. Though different in some respects, both techniques involve blocking pain via the delivery of medication to areas near the spinal cord.
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