Anaesthesia for Transvaginal Oocyte Retrieval in IVF: A Prospective Comparative Cohort Study from Ghana

Background: The optimal anesthetic regimen for transvaginal oocyte retrieval remains debated, with concerns about potential gonadotoxicity and adverse embryological outcomes. This study aimed to evaluate the efficacy, safety, and embryological impact of three anesthetic protocols for in vitro fertilization (IVF) in a Ghanaian clinical setting. Methods: A prospective comparative cohort study was carried out at Oak Specialist Hospital in Kumasi, Ghana, involving 168 women with ASA Physical Status I and II undergoing IVF. Participants were divided into three groups based on the anesthetic protocol used: Group A (propofol/fentanyl TIVA), Group B (propofol/fentanyl induction with sevoflurane maintenance via LMA), or Group C (propofol/fentanyl induction with isoflurane maintenance via LMA). Intraoperative hemodynamics, post-operative recovery times, side effects, oocyte yield, and fertilization rates were compared. Results: The mean age of participants was 29.16 ± 6.84 years. Intraoperative haemodynamics and post-operative recovery times did not differ significantly across the groups ( p > 0.05). Post-operative vomiting was significantly lower in Group B (0%) than in the other groups ( p = 0.031). While oocyte yield was highest in Group C ( p = 0.001), the normal fertilisation rate was significantly higher in the sevoflurane group (Group B: 47.85%) compared to the isoflurane group (Group C: 30.06%) and the TIVA group (Group A: 43.47%) ( p = 0.009). Conclusion: Sevoflurane-based balanced anesthesia provides better fertilization outcomes and a lower rate of post-operative vomiting compared to propofol-based TIVA and isoflurane-based regimens, without sacrificing hemodynamic stability or recovery speed. These results support using sevoflurane to improve embryological success in IVF cycles.