Anaesthesia for assisted reproductive technologies

Question 1

Common causes of male infertility

Answer 1

• Diminished sperm quantity
• Poor motility
• Poor morphology

Question 2

Common causes of female infertility

Answer 2

Hormonal
- PCOS
- Functional hypothalamic amenorrhea
- Menopause

Anatomical
- Premature ovarian insufficiency
- Pelvic inflammatory disease
- Previous abdominal surgery
- Endometriosis
- Previous ectopic pregnancy
- Uterine fibroids

Question 3

Pathophysiology of ovarian hyperstimulation syndrome

Answer 3

• Exogenous hormones (GnRH and hCG) cause multiple follicles to develop
• This leads to VEGF release and increased ovarian vascularity
• This leads to fluid shifts and the possibility of pleural effusions, ascites and pericardial effusions

Question 4

Anaesthetic options for oocyte retrieval

Answer 4

Sedation
- Used most commonly
- Deep sedation only for when transvaginal needle insertion
- Beware contraindications to sedation- OSA, reflux

Neuraxial Blockade
- Good for when the patient wants to be awake
- Good for reflux, OSA
- Reduced exposure to anaesthetic drugs
- Not useful if the patient needs laparoscopy

General Anaesthetic
- Unclear on the safety profile of neuromuscular blocking drugs for fertility
- Avoid metoclopramide and droperidol- increase prolactin levels impairing embryo implantation
- Avoid NSAIDs as inhibition of prostaglandins inhibits embryo implantation