An egg retrieval for IVF is performed by passing a needle through the vagina and directly into the
ovaries. If that sounds like it might be painful, you’re right, it is painful. An egg retrieval is
therefore performed under anesthesia. You probably already knew that. But, did you know that there
are different types of anesthesia given for an egg retrieval? Some types of anesthesia might
not work very well for you. It is extremely important, therefore, for you to find out
what type of anesthesia is given at your chosen IVF center before you start the IVF process.
First, let's talk about sedation. Sedation is also known as "monitored anesthesia care" or
“MAC” for short. Medications are given, usually through an IV, to make you feel
drowsy and relaxed. Different levels of sedation are possible, depending on the type of procedure
Minimal sedation is what people have sometimes referred to in the
past as "twilight". With this type of anesthesia,
you will feel drowsy and relaxed, but you will still be aware of what’s going on around you.
Moderate sedation is also known as conscious sedation or procedural sedation. At this level
you are semi-conscious. You can still breathe on your own and respond to painful stimulation.
In our opinion, minimal and moderate sedation are not adequate for an egg retrieval for two
reasons. First, is that you will still feel too much pain during the procedure. Second,
because of that pain, you might move around too much - which could increase the risk that
the doctor might damage something in your abdomen with the needle.
During deep sedation, you are very nearly unconscious and will typically not respond
to painful stimuli even if it is repeated and very painful stimulation. Remember,
sometimes sedation is called MAC or monitored anesthesia care. Some
people may refer to deep sedation as a Big MAC. Like the popular hamburger.
Deep sedation is nearly the same as general anesthesia. At times, with deep sedation,
the patient may need assistance with breathing. During general anesthesia, you are completely
unconscious and will always need assistance from the anesthesia provider with breathing.
General anesthesia is what people most often think of when they hear the word
"anesthesia". Many different medications may be used during general anesthesia. Some
are anesthetic gases or vapors that are given through a breathing tube or a mask.
Some medications are given through the IV to induce sleep, relax muscles, and treat pain.
The use of deep sedation is preferred for performing egg retrievals. General
anesthesia is usually reserved for extraordinary circumstances such as
for people with certain medical problems or who can’t tolerate deep sedation.
What medications are used for sedation?
I don’t want to go into a deep dive on the pharmacology here. Suffice it to say,
that for the deep sedation needed for an egg retrieval, there are usually two or three
medications that are given. It is perfectly appropriate for you to ask your doctor which
of these medications will be used during the egg retrieval. Be sure you ask BEFORE you start
the process. If it is the day before your egg retrieval is scheduled, it might be too late.
The three medications which are most often used for deep sedation in an
egg retrieval are Fentanyl, Propofol and sometimes Versed. What do each of
these medications do? Versed is mostly used as a relaxing medication though
it also can produce some sedation. Versed, by itself, does not block pain sensations.
Fentanyl is a morphine derivative. It is the medication used to block the pain signals
between your brain and the rest of your body. In other words, fentanyl is the painkiller. It
is given through your IV, works very quickly but is also out of your body very quickly.
Finally, there is Propofol. The first thing you should know about Propofol
is that unlike Fentanyl and Versed which is clear,
Propofol is white. It actually looks like milk. Propofol produces deep sedation by
acting on your brain. Propofol is what makes deep sedation possible. Like fentanyl, however,
Propofol is short acting so once they stop giving it to you, you will wake up relatively quickly.
Who should be administering your anesthesia? In the USA, nurses are authorized by many
state boards of nursing to administer mild or moderate sedation. Propofol is meant to cause
deep sedation and is not therefore, typically given by nurses. The exception to this general
rule is if there is an anesthesiologist in the area to supervise. Therefore, in order to be
sure you will get deep sedation, make sure that your IVF center uses either an anesthesiologist,
who is a physician, or a certified registered nurse anesthetist or CRNA.
Where is a safe place to have anesthesia? A hospital or a licensed ambulatory surgery
center (like the Naperville Fertility Center) where I do my egg retrievals, is going to be
the safest choice. What about in a back room in a doctor’s office? In my opinion, this is a
hit or miss. There may be some locations that are perfectly fine. I have seen centers who employ an
anesthesia service who bring all of the equipment needed along with well trained anesthesia
providers. I have also seen some doctor office procedure areas that are frankly very scary.
Every patient can be different. I have seen patients that had to be converted
from deep anesthesia to general anesthesia because the anesthesia provider couldn’t
safely get the amount of deep sedation necessary to make the patient pain free
or because they were having some other medical problem related to the sedation.
In general, egg retrieval is a very safe procedure but it is not completely risk
free. Having providers, facilities and equipment to handle emergencies is always a good idea.
Our InfertilityTV bottom line is this. In 2023,
there is no reason why you can’t be made comfortable during an egg
retrieval. Be proactive in choosing an IVF center that will do that for you.