Association between differences in body-weight based dose versus actual propofol dosages administered for oocyte retrieval on hemodynamic parameters and reproductive outcomes

Objective: To evaluate the dose-dependent effect of propofol in hemodynamic parameters and reproductive outcomes following In-Vitro Fertilization (IVF) oocyte retrieval (OR)Design: Retrospective cohort studySubjects: 1575 women who underwent their first OR under monitored anesthesia care (MAC) and subsequent fresh embryo transfer (ET) between January 2016 through December 2022Exposure: Women in the study were categorized into five cohorts (cohorts A – E) based on increasing dose of total propofol in μg/kg/min.Main Outcome Measures: 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 ET. Secondary outcomes included changes in hemodynamic parameters following anesthesia. 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 groupResults: 1564 women [mean (SD) age (years), 32.77 (4.25) and mean (SD) weight (Kg), 79.49 (20.70)] were included in the final analysis. The live birth rate (LBR) was 815/1564 (52.1%). There was a statistically significant difference in the ideal total dose of propofol and the actual dose administered, mean [(95% CI, P value)] 196.83 [(190.85 – 202.82), <0.001)]. Although not statistically significant, the LBR improved with increasing dose of propofol; 50.2% (cohort A) to 55.4% (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; 60.1% (cohort A) to 65.7% (cohort E); aRR (95% CI) = 1.25 (0.80 – 1.96). Compared to the start of procedure, there was a statistically significant reduction in mean +/- SD in heart rate (bpm), -8.08 ± 13.01 and mean +/- SD (mm/Hg) systolic BP [-17.44 ± 16.28], diastolic BP [-12.76 ± 13.62] and mean arterial pressure [-14.04 ± 13.16] at the end of the procedure.Conclusion: 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 increasing LBR and clinical pregnancy rate with higher doses of propofol.