Hormonal and Clinical Predictors for Post–egg Retrieval Pain in Women Undergoing Assisted Reproductive Technology Procedures

Abstract

ObjectivesThe intensity of post-egg retrieval pain is underestimated, with few studies examining postprocedural pain and predictors to identify women at risk for severe pain. We evaluated the influence of pre-procedural hormonal levels, ovarian factors, as well as mechanical temporal summation (mTS) as predictors for post-egg retrieval pain in women undergoing in vitro fertilization (IVF). MethodsEighteen women scheduled for ultrasound-guided egg retrieval under standardized anesthesia and post-procedural analgesia were enrolled. Pre-procedural mTS, questionnaires, clinical data related to anesthesia and the procedure itself, post-procedural pain scores and pain medication for breakthrough pain were recorded. Statistical analysis included Pearson product moment correlations, Mann-Whitney U tests and multiple linear regressions. ResultsAverage peak post-egg retrieval pain during the first 24 hours was 5.0 ± 1.6 on an NRS scale (0=no pain, 10=worst pain imaginable). Peak post-egg retrieval pain was correlated with basal antimullerian hormone (AMH) (r=0.549, p=0.018), pre-procedural peak estradiol (r=0.582, p=0.011), total number of follicles (r=0.517, p=0.028) and number of retrieved eggs (r=0.510, p=0.031). Ovarian hyperstimulation syndrome (OHSS) (n=4) was associated with higher basal AMH (p=0.004), higher peak pain scores (p=0.049), but not with peak estradiol (p=0.13). The mTS did not correlate with peak post-procedural pain (r=0.266, p=0.286), or peak estradiol level (r=0.090, p=0.899).Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited. DiscussionPeak post-egg retrieval pain intensity was higher than anticipated. Our results suggest that post-egg retrieval pain can be predicted by baseline AMH, high peak estradiol, and OHSS.Further studies to evaluate intra-and post-procedural pain in this population are needed, as well as clinical trials to assess post-procedural analgesia in women presenting with high hormonal levels.