Differences in Ideal Dose Based on Body Weight and Actual Propofol Dose Administered for Oocyte Retrieval and the Effects on Hemodynamic Parameters and Reproductive Outcomes

Abstract Authors: Aditi Katwala,¹ Madeline Kroeger M.D,^2, Haley Stefan M.D^,3 Karen Summers,⁴ Alexis Ireland,⁴ Ann Smith,⁵ Michael Pomeroy,⁵ Rakesh Sondekoppam Vijayashankar M.D,⁶ Anita Chazhikattu M.D^,7 Amy Sparks Ph.D^,4 Jessica Kresowik M.D,⁴ Abey Eapen MBBS Ph.D⁴
 
1. Carver College of Medicine, University of Iowa, Iowa City, Iowa. USA. 52242
2. Department of Obstetrics and Gynecology, Carle Foundation Hospital, Urbana, Illinois, USA.
3 Department of Obstetrics and Gynecology, University of Iowa Health Care, Iowa City. Iowa. USA. 52242
4 REI Division, Department of Obstetrics and Gynecology, University of Iowa Health Care, Iowa City. Iowa.
USA. 52242
5 Department of Anesthesiology, University of Iowa Health Care, Iowa City. Iowa. USA. 52242
6 Department of Anesthesiology, Stanford University, California
7 Division of Critical Care, Department of Anesthesiology, University of Iowa Health Care, Iowa City. Iowa.
USA. 52242

Abstract Text: Propofol is the drug of choice for IVF oocyte retrievals. While previous IVF studies did not suggest any suboptimal outcomes based on total dose, it is unclear whether there is a dose dependent effect of propofol on reproductive outcomes in women undergoing IVF treatment. This retrospective cohort study included IRB approved, IVF data of 1573 women from a tertiary academic institution between January 2016 through December 2022.
Women undergoing their first oocyte retrieval under monitored anesthesia care (MAC) with planned IVF and subsequent fresh embryo transfer were included. Women in the study were categorized into five cohorts (cohorts A – E) based on increasing dose of total propofol in μg/kg/min. Data was obtained for demographics, treatment variables, anesthesia parameters, and IVF outcomes. Primary outcomes were mean differences in ideal dose of propofol based on body weight vs. actual dose administered and the live birth rate (LBR) following a fresh embryo transfer. Secondary outcomes included changes in hemodynamic parameters following propofol infusion. ANOVA with Tukey post-hoc tests were used to compare means (SD) between the study groups. Paired T-tests assessed the difference between ideal and actual propofol dosing within each group.
A total of 1564 women [mean (SD) age, 32.77 (4.25) and mean (SD) weight, 79.49 (20.70)] were included in the analysis. The live birth rate was 815/1564 (52.1%). There was a statistically significant difference in calculated ideal total dose of propofol (based on body weight) and the actual dose (mg) administered, mean [(95% CI, P value)] is 196.83 [(190.85 – 202.82), < 0.001)].Although not statistically significant, the live birth rate improved with increasing dose of propofol from 50.2% in cohort A to 55.4% in cohort E. The adjusted Risk Ratio (aRR), (95% CI) of LBR with an additional mg of propofol/kg/min was 1.25 (0.75 – 2.09). Similar, non-significant improvements were observed in clinical pregnancy rate also; 60.1% in cohort A to 65.7% in cohort E, aRR (95% CI) = 1.25 (0.80 – 1.96). Compared to hemodynamic parameters at the initiation of the procedure, there was a statistically significant reduction in mean +/- SD in heart rate (bpm), -8.08 ± 13.01 and a statistically significant reduction in mean +/- SD (mm/Hg) for systolic blood pressure [-17.44 ± 16.28], diastolic blood pressure [-12.76 ± 13.62] and mean arterial pressure [-14.04 ± 13.16].
We concluded that despite the statistically significant higher dose of propofol administered during IVF oocyte retrieval and the associated significant changes in hemodynamic parameters; there was a trend of increase in live birth rate and clinical pregnancy rate with higher doses of propofol.