A cohort study on safety for oocyte retrieval in IVF using the same 20G needle for local analgesia and retrieval. Vaginal cleaning did not add to the safety of the procedure

G. Almind, E. Færch, F. Lægaard, S. Smidt‐Jensen, S. Lindenberg
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引用次数: 1

Abstract

Aim of study: What is the effectiveness and safety of using a 20G single lumen needle (SLN) for both applying local analgesia (LA) in the vaginal vault and ovarian capsule and oocyte retrieval (OR) using a simple syringe? And will thoroughly cleaning (TC) of the vagina before reducing the risk of the puncture procedure? Using a thin SLN has been postulated to jeopardize cumulus oocyte complexes (COC). Further applying LA in the same needle without retracting the needle before OR has been claimed to harm oocyte development. Also, many clinics extensively clean the vagina before OR. Methods: We performed a retrospective cohort study including 4983 women. 877 underwent no cleaning (nonTC) of the vagina and 4106 underwent TC using NaCl. All had OR with a 20G SLN attached to a syringe for local anaesthesia and egg collection. The treatments were done in one centre during the period from January 2016 to June 2019. We studied women undergoing IVF treatment aged 18–45 years. Women had either thoroughly vaginal cleaning before OR or no cleaning depending on the physicians preferences. All women had LA using Citanest Dental Octapressin 2ml. placed in the vaginal vault in the direction of the intended puncture including in the ovarian capsule. Therefore, only one puncture was needed in both sides, left and right. All punctures were hereafter followed by OR using the same 20G SLN. Aspiration was done by a 20ml syringe handled manually by the physician. All women underwent a conventional antagonist protocol with FSH stimulation and Ovitrelle 250IU for induction or Mild Stimulation using Tamoxifen, FSH and Ovitrelle. Outcome measurement were bleeding measured by the necessity of applying compression after the puncture or infection observed up to 1 month. Results: Baseline characteristics including age, BMI and type of stimulation were comparable between the groups. In the nonTC group no infections, bleedings or abscesses were found. In the TC group there were 1 abscess observed. Intact COC was similar in the two groups as well as pregnancy rates. Conclusion: During OR in ART the use of a 20G SLN using the same needle for LA and hereafter, without changing needle in the puncture channel, continue with the egg collection (EC) is simple and safe. In this situation TC is not necessary before puncture, making the procedure more patients friendly. In women undergoing oocyte retrieval for IVF, we found the use of a 20G SLN for both applying LA and retrieving COC safe, effective and simple. Additional TC of the vagina before puncture did not add more to the safety of the procedure.
IVF中使用同一根20G针局部镇痛取卵安全性的队列研究。阴道清洗并没有增加手术的安全性
研究目的:20G单腔针(SLN)用于阴道穹窿和卵巢包膜局部镇痛(LA)和简单注射器取卵(OR)的有效性和安全性如何?彻底清洗阴道是否会减少穿刺手术的风险?使用薄的SLN被认为会危害卵母细胞积云复合物(COC)。在手术前不收针的情况下,在同一根针头上进一步应用LA,据称会损害卵母细胞的发育。此外,许多诊所在手术前会对阴道进行全面清洁。方法:我们进行了一项包括4983名女性的回顾性队列研究。877例患者未进行阴道清洁(non - TC), 4106例患者使用NaCl进行阴道清洁。所有患者都有OR, 20G SLN连接注射器用于局部麻醉和收集卵子。这些治疗于2016年1月至2019年6月在一个中心进行。我们研究了18-45岁接受体外受精治疗的女性。根据医生的喜好,女性要么在手术前彻底清洁阴道,要么不清洁。所有女性均使用西坦尼斯牙科八羟色胺2ml进行LA治疗。沿着预定穿刺的方向放置在阴道穹窿中,包括卵巢囊。因此,只需要在左右两侧穿刺一次。所有穿刺后均使用相同的20G SLN进行OR。用20ml注射器抽吸,由医生手动操作。所有的女性都接受了常规的FSH刺激和卵细胞250IU诱导的拮抗剂方案,或者使用他莫西芬、FSH和卵细胞进行轻度刺激。结果测量是通过穿刺后按压的必要性来测量出血或观察感染长达1个月。结果:两组之间的基线特征包括年龄、BMI和刺激类型具有可比性。非tc组无感染、出血、脓肿。TC组脓肿1例。两组的完整COC和妊娠率相似。结论:在ART手术中使用20G SLN,使用同一针进行LA,此后无需在穿刺通道中更换针,继续取卵(EC)简单安全。在这种情况下,穿刺前不需要TC,使手术对患者更友好。在接受体外受精卵母细胞提取的女性中,我们发现使用20G SLN用于应用LA和提取COC安全、有效和简单。穿刺前阴道的额外TC没有增加手术的安全性。
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