To request conscious sedation for egg retrieval (IVF)

[SquashedSquashess]

I have IVF coming up in the next few months.

Our NHS IVF clinic offers only gas and air as standard for the egg retrieval procedure. Our nurse was emphatic that this is clinically effective, and has persuaded my husband (who won’t be having a needle repeatedly jabbed through his uterus wall into his ovaries) that this is fine.

A friend of mine who has been through IVF recommended sedation, and seemed shocked I’d only be offered gas and air.

I’m concerned that, as with so much in women’s health, this “clinically effective” option is offered to keep costs down without any consideration of whether it’s best for me.

In addition, I previously had PTSD from a rape which I’ve overcome. I’ve been through various intrusive procedures on the IVF journey without incident, but don’t fancy the prospect of being re-triggered if gas and air is going to result in the egg retrieval process being both invasive and painful.

Grateful for any insights from others that have been through this.

YABU: gas and air will be fine
YANBU: request the sedation

I haven’t had this procedure but I have had sedation and it was horrible, completely messed with my head and I felt really weird for many hours, it means you have to stay in the hospital for an extended period rather than being able to leave. The procedure I have done is recurring and ever since I’ve opted for no pain relief, it is in my case a few seconds of discomfort if there’s one, a few minutes if a few rather than hours of post sedation fog. Apparently most do want the drugs and most feel ill afterwards. Perhaps I’m just a control freak as I hated feeling out of it. Do your research on the negatives before you fight it

Gas and air is very effective if you really go for it. Ideal for short term pain.

I had sedation for IVF (standard in USA) and it was v effective. Gas and air doesn’t do much for me.

Absolutely refuse gas and air, this should be done with sedation.
You're in Scotland I assume?

I had a GA for mine!

I can’t imagine having it under G&A. I was sedated for mine and wouldn’t have wanted it any other way.

I’ve had just G&A for egg retrieval twice. Once under NHS and once as private patient under care - I could have bought sedation extra but didn’t feel I needed it. Yes it was a bit painful but it didn’t take long and it meant I could leave quickly afterwards. I’ve had sedation for endoscopy before and it took me ages to come round. I don’t think either option is unreasonable, but most do have it under G&A.

Edit to clarify that by ‘private patient under care’ I mean that the clinic was called ‘care’!!

I've had several rounds of IVF and it was always under 'twilight' sedation. All at the same hospital (Guys in London)- the first under NHS and the rest we paid for. I was out to it, didn't hear or feel a thing till they woke me up in the recovery room. Once I could walk/dress etc I could go home. Only about an hour I think, so not like a general anaesthetic which can be hours.

I read about another woman on MN, abroad, who has gas and air. After reading her account and others, I too would want sedation. Its extra cost because they need an anaesthetist there too. Have you enquired what the additional cost is or if that is even an option?

I had sedation, I wouldn't have wanted just G&A.

You should request whatever makes you most comfortable

This is a clinic in south west England

Partner (same sex) had this procedure privately and was sedated. Found it fine. Didn’t have to stay in the room for hours and no lasting impact. In fact said it felt really nice going under. Didn’t feel ill afterwards.

Abso-fucking-lutely not, you need to be sedated. I don't remember any part of either of mine but I had 30+ follicles done each time, no fucking way was I have a needle shot through the wall of my vagina dozens of times without being knocked out for it. I've had gas and air for other procedures and it is great in some ways but it's definitely not enough for egg collection, in my opinion. We used Oxford and they sedated as standard.

It's just a money issue. Nothing about wellbeing at all.
Have you posted on the infertility board about it?

I've had sedation, not for IVF but for a different medical procedure, and this wasn't my experience. I was discharged immediately on coming around, their only stipulation was that I had to have a responsible adult with me and I wasn't allowed to drive. I would have been fine to go back to work the next day, I felt normal, but the no driving was for 24 hours so my insurance wouldn't have been valid if something happened.

Why is it your husband that she's persuading? That would immediately erode my trust in her.

Same. I've had different types of sedation, fentanyl which is looovely! I came round fine, just had to have someone with me, and the driving ban.

Then a different type this week on fact which is more like anaesthetic, that made me sick - same re having someone with you and no driving. But they got me up and out pretty quickly. Neither left me groggy after more than an hour or so.

The latter one I woke up in a lot of pain so I'm not convinced it was enough for the procedure and I probably should have had a GA.

This!!! 1000 x this!

OP, I'm so sorry. Thing is, as you have said, there are two elements to this: your PTSD and then the pain. It sounds incredibly difficult.

FWIW, I've not heard of "most people" experiencing prolonged negative effects from sedation.

Oops, I was citing @GCAcademic

I don’t think you’d be unreasonable to ask for sedation if that is your preference, having had the benefits/risks of the procedure with and without sedation explained to you. My understanding (not my specialty) is that it can be done without sedation, but this approach is generally used when a smaller number of eggs are being retrieved. I think gas & air is safe and I have no doubt used in the correct cases, is absolutely fine. Whether it is suitable for your case, obviously I cannot say. In any case, you aren’t unreasonable to have this preference, regardless of safety/efficacy of the other option.

However, I suppose the issue is whether “do not offer as standard” means they can offer it on request, or whether they do not provide it at all. Or perhaps whether they only offer it when certain clinical are met.

That you feel they should offer sedation doesn’t mean they can. I am a doctor, sometimes we cannot offer something a patient wants because they don’t meet clinical criteria. Our hands can be completely tied by local policy, national guidance, licence restrictions etc. You can appeal if you don’t meet criteria but this will take time so if you are going to do so I’d start that ball rolling now to try to avoid delaying your IVF.

It might be they don’t have the appropriate facilities/clinical staff to offer (heavy) sedation in that clinic. If you are in the UK, heavy sedation (e.g. fentanyl + propofol) requires an anaesthetist. Gas and air would not require this. I am guessing if they do not offer sedation at all, they might not have the staff to do it under any circumstances. They may not have the required equipment either.

Gas and air?? Omg no way, I had a sedation with NHS and in Scotland. It is way too painful for just gas and air.

I’ve had IVF 3 times (privately) and was sedated each time for egg retrieval. I only opted for light sedation as I don’t like the feeling of it, but I do think it’s necessary because even with that it was still uncomfortable.

I don’t think I would have been okay with just gas and air.

oh god, please ask for conscious sedation. I had an egg retrieval last year and definitely needed it. At one point (I was pretty out of it) but I shouted out “it hurts!” And it did! They gave me a bit more and then it was all over. It’s a quick procedure but not pain free at all.

Sedation. Definitely need sedation. I’ve done IVF and had twilight anaesthetic for egg retrieval. From what I can work out that’s the same as conscious sedation. You can breathe for yourself but you have no memory of anything.

I was awake fairly quickly afterwards, ate food, did a wee and was then discharged with a responsible adult (DH). It took me a few days to sleep it off but that’s how I react to general or twilight anaesthetic.

Tell your husband that he can get jabbed through the penis instead if he’s that convinced that gas and air is enough.

@jacks11 has said it might be because the service doesn’t offer IV sedation. Gas and air is nitrous oxide and can be effective as a mild sedation alongside the analgesia (although to be effective it needs to used alongside what is described a semi hypnotic sedation) If the clinic is offering it only for the analgesic effect you could try practising relaxation techniques you could do by yourself at the time.

IV sedation is usually with midazolam but there are other drugs as well and usually needs an anaesthetist to give or someone trained. I think nurse practitioners can give it. I know it from being an operator/sedationist as a dentist (and we use a lot of gas and air as inhalation sedation) I have no idea how painful or difficult egg harvesting is or if it can be delayed by say 24 hours if you tried gas and air and didn’t mange try a different method the next day?

For either to work it’s all about a good assessment of the patient first and trying to select the patients who it will work for. If you are talking about anaesthetist led sedation they tend to give multiple drugs and unless they have an interest in conscious sedation usually prefer just to give a GA.

Some patients can also have a paradoxical reaction to midazolam where they become really unmanageable and it’s almost like having a few drinks. Patients can become really upset/agitated/cry and don’t have the ability to stop. Gas and air means you retain the reasonable side of the brain and not lose control. You also remember it which can be helpful if you are going to have more procedures because you have the memory of how things went and how well the gas and air worked for you so you become less anxious about the next procedure.

If there is some flexibility trying to manage it with gas and air but with a back up of another sedation/GA in a timely way that could work. Even just the fact you could take the pressure of having to manage because there is another option if you can’t.

It’s not just a case of giving you a different medication there is so much governance around IV sedation that if it’s not part of the current service they can’t give it to you. In my experience it’s almost always anaesthetist led sedation in theatre and if you are doing that you may as well just have a GA.

If you step out of a pathway for any treatment /disease trying to to arrange ad hoc theatre sessions, for example, there will be a delay, you lose any flexibility around appointments (you’ll get the appointment and there won’t be an alternative date or if you were unwell and need to cancel it rearranging will delay things)

If you did try with gas and air and the clinicians can see you can’t manage it they usually end up being a really vocal advocate for alternative help for the patient!

I think this is the longest post I’ve ever written so excuse typos! I hope it makes at least a bit of sense to people.

I hope you manage things with as little stress and pain as possible and everything works out for you soon.

@Oinkypig Egg retrieval has no leeway for time. It has to be done on time, pretty much to the exact hour or else the body releases the eggs. The trigger shot is given at an exact time and then it’s a precise number of hours later that the egg retrieval is done. Are you thinking that the gas and air sedation might be like dental gas sedation? My DD has had that for a filling and she was in a happy la-la land. It definitely took away any anxiety. Pain of course required the usual anaesthetic injections into the gum. She still reacted to pain until the injections gave adequate numbing.