ANESTHESIA FOR YOUR IVF PROCEDURE

The oocyte retrieval is a surgical procedure performed in the operating room. A nurse anesthetist or anesthesiologist will be present to give you medication to make the procedure painless. There are two options for the IVF process: 1) conscious sedation (intravenous sedation), and 2) spinal anesthesia. The majority of patients choose the conscious sedation (intravenous sedation) technique. On the day of your oocyte retrieval you will meet with the anesthesiologist in the preop holding area and review the risks and benefits of each technique. The anesthesiologist and IVF team will advise you on which method they feel is best for you.

1. CONSCIOUS SEDATION (intravenous sedation)
   Conscious sedation is a unique method of pain control. It reduces pain and produces a trance-like state. Conscious sedation is useful for short procedures that are painful, such as an oocyte retrieval. This method is safe and lasts only a short time making recovery time quick. Medicine to stop pain and cause you to "forget" the procedure will be given during the "conscious sedation" procedure.

   How is this procedure performed?
   The medications used for conscious sedation are given through a shot into an intravenous line, or IV. An IV is a thin tube that is usually placed into one of the veins of the forearm or hand. The medication quickly takes effect. The primary medication used is called propofol (Diprivan). Propofol (Diprivan) produces a trance-like state in about 1 to 5 minutes. Often other medications are added to the IV such as Versed (mitazolam) during the sedation process. Versed is a Valium-like medication. Additional doses of medication can be given if the procedure is painful or takes longer than expected. The individual's eyes stay open during the procedure, but she is in a daze and feels no pain.

   What happens right after the procedure?
   A person who has had conscious sedation usually does not remember the procedure. Most people feel back to normal within 1 hour. However, someone else must drive the person home because the medications can impair coordination and reflexes for several hours after the procedure.

   What happens later at home?
   Once at home a person may have effects as a result of the procedure, but usually not as a result of the medication used for conscious sedation.

   What are the potential complications after the procedure?
   Problems are rare, although allergic reactions to the anesthesia are possible. The American Society of Anesthesiologists recently issued a warning about the potential side effects and interactions of herbal remedies with medications used before, during, and after surgery. The group recommends discontinuing all herbal remedies and supplements at least 2 weeks before planned surgery.

2. SPINAL ANESTHESIA
   Spinal anesthesia is a way to eliminate pain during certain procedures or surgeries. It is occasionally used for IVF procedures. The procedure is commonly called "a spinal". It is used for procedures below the rib cage. Patients who have many follicles to retrieve or low pain tolerance may need a spinal for their IVF procedure. Patients who are very overweight or have spinal deformities are not candidates for spinal anesthesia.

   How is the procedure performed?
   This procedure involves injecting medications around the spinal cord. A needle or special tube is inserted through the skin of the back until it enters the spinal column, or spine. Medication is then injected inside a special sac that surrounds the spinal cord. The medication acts on nerves that come from the spinal cord.

   Spinal anesthesia is different from but similar to epidural anesthesia, also known as an epidural. With an epidural, medication is also put inside the spinal column. However, with an epidural the medication is injected just outside the sac that surrounds the spinal cord. A spinal requires less medicine and works faster than an epidural. However, a spinal is more likely to cause a headache or low blood pressure. Medication for a spinal is usually given as a one-time injection with a special needle.

   The medicine stops the sensation of pain and paralyzes the muscles, usually only below the rib cage. The amount of medication given and the location of the injection in the back are important. These factors can control where the numbness and paralysis are in the body. People are generally awake during the procedure. Sedatives can be given if people are anxious. During a spinal people usually breathe on their own without needing an artificial breathing machine, or ventilator.

   Careful monitoring is done during the procedure. Oxygen levels in the blood, blood pressure, pulse, and other functions are monitored. Fluids are usually given through an intravenous or IV. An IV is a thin tube that is inserted into a vein in the hand or arm. The fluid is given to prevent dehydration and low blood pressure.

   What happens right after the procedure?
   A person is taken to an area called the recovery room after the procedure. If sedatives were used, people may feel groggy for a few hours. Pain medication can be given if needed. The pain medication can be given through an IV.

   The numbness and paralysis usually go away within a few hours. People are usually asked to lie flat on their back for an hour or more after the procedure. This may help prevent problems with the injection site and decrease the chance of headache. After a spinal, a person must be able to urinate before they are allowed to go home. This lets the healthcare provider know that the medication has worn off.

   What happens later at home?
   A bandage is usually placed over the area on the back where the needle was inserted. This should be left on for at least 24 hours. The area should not be disturbed. Little else needs to be done at home related to the spinal.

   What are the potential complications after the procedure?
   The most feared complication of anesthesia is death. This is thought to occur in roughly 1 out of every 10,000 people who have spinal anesthesia. It is not usually possible to predict who will have this type of severe reaction.

   The most common problem after a spinal is a headache. This usually goes away within 24 hours. The headache often responds to pain medicine. Some people may need a repeat injection in the back to help the pain. Nausea is also fairly common for a few hours after the procedure.

   Blood pressure can get very low during the procedure, but this usually doesn't cause problems. Allergic reactions and irregular heartbeats are rare complications of spinal anesthesia. Though often feared, nerve or spinal cord damage almost never occurs. Bleeding and infection can occur at the site of the needle injection. Other side effects may occur depending on the specific medicines used. Our package price is for the use of conscious sedation, if you choose spinal anesthesia additional anesthesia fees may apply.