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

Anaesthesia for Transvaginal Oocyte Retrieval in IVF: A Prospective Comparative Cohort Study from Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anaesthesia for Transvaginal Oocyte Retrieval in IVF: A Prospective Comparative Cohort Study from Ghana Rex Mawuli Kwadjo Djokoto, Wilfred Kwamina Jnr Sam-Awortwi, Nana Addo Boateng, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9248000/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract 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. Anaesthesia Oocyte Retrieval In Vitro Fertilization Sevoflurane Fertilisation Rate Post-Operative Nausea and Vomiting Introduction Infertility is a major global health issue, and its burden is especially heavy in sub-Saharan Africa [1]. In Ghana, where pro-natalist attitudes create strong societal pressure to conceive, assisted reproductive technology (ART) has become an essential medical intervention [2]. However, access to ART is restricted by high costs and the concentration of clinics in major urban centers, leading patients to make significant financial and emotional investments with each cycle [3]. Therefore, it is a clinical necessity to optimize every procedural step to increase success rates and ensure patient safety. A key part of the in vitro fertilization (IVF) process is transvaginal ultrasound-guided oocyte retrieval, a painful procedure that requires effective anesthesia [4]. The ideal anesthesia protocol should provide quick induction, maintain hemodynamic stability, and enable rapid recovery, all while avoiding negative effects on the delicate reproductive microenvironment. Anesthetic agents can cross the blood-follicle barrier, raising concerns about possible gonadotoxicity that could negatively affect oocyte quality, fertilization, and embryo development [5]. Total intravenous anesthesia (TIVA) with propofol and short-acting opioids is widely preferred for its rapid onset and antiemetic effects [5, 6]. Alternatively, anesthesia can be maintained with volatile agents like sevoflurane or isoflurane. The debate over which method is better continues, as some studies suggest propofol is safe, while others raise concerns about dose-dependent accumulation in follicular fluid and its potential to cause abnormal fertilization [7, 8]. On the other hand, volatile agents such as isoflurane have been linked to inhibited embryo development, whereas newer agents like sevoflurane have been associated with higher fertilization rates and better-quality embryos in certain studies [9]. These agents also differ in their effects on the neuroendocrine stress response, which may impact the intrafollicular hormonal environment [10]. Despite the growth of ART clinics in Ghana, there is a lack of local, evidence-based consensus on the best anesthetic protocol for oocyte retrieval [11]. Global research offers conflicting evidence, causing practitioners to depend on institutional preferences or extrapolated data. This study aims to fill this knowledge gap by prospectively comparing the clinical, physiological, and embryological outcomes of TIVA versus sevoflurane- or isoflurane-based anesthesia during oocyte retrieval at a leading Ghanaian fertility center. Methods Study Design and Setting A prospective comparative cohort study design was employed at Oak Specialist Hospital, a private tertiary healthcare facility and high-volume fertility centre in Kumasi, Ghana [12]. This design enables rigorous evaluation of different clinical interventions in real-world parallel-group settings. The study was approved by the Committee on Human Research, Publication and Ethics at the School of Medical Sciences, Kwame Nkrumah University of Science and Technology (CHRPE/AP/1334/24). Study Population and Sampling The study involved 168 women aged 20–50 years, classified as American Society of Anesthesiologists (ASA) Physical Status I or II, who were undergoing an IVF cycle requiring oocyte retrieval. A consecutive sampling method was used, enrolling every eligible patient who gave written informed consent until the target sample size was achieved. The sample size was determined beforehand using G*Power (version 3.1) for a one-way ANOVA, aiming for 80% power at an alpha of 0.05 with a medium effect size (Cohen's f = 0.25), which indicated a need for at least 159 participants. Exclusion criteria included a history of adverse reactions to the anesthetic agents administered, a significant history of postoperative nausea and vomiting (PONV), or severe systemic comorbidities (ASA Physical Status ≥ III). Interventions Participants were allocated to one of three anaesthetic protocol groups: Group A (n=56): Total Intravenous Anaesthesia (TIVA) with intravenous fentanyl and propofol, with oxygen delivered via nasal prongs. Group B (n=56): Balanced anaesthesia with intravenous fentanyl and propofol for induction, followed by maintenance with sevoflurane delivered via a Laryngeal Mask Airway (LMA). Group C (n=56): Balanced anaesthesia with intravenous fentanyl and propofol for induction, followed by maintenance with isoflurane delivered via an LMA. Data Collection and Outcomes Data were collected in real-time by a dedicated clinical observer using a standardized data extraction form. Primary Outcomes: The co-primary outcomes were the percentage of normal fertilization and the occurrence of post-operative vomiting. Secondary Outcomes: Secondary outcomes included intraoperative hemodynamic events (hypotension, hypertension, bradycardia, tachycardia), postoperative recovery times (time to eye-opening, verbal response, and discharge readiness via Aldrete score ≥ 9), other side effects (dizziness, pain, nausea), total number of oocytes retrieved, and patient satisfaction scores. Embryologists, who were blinded to the anesthetic protocol, provided data on oocyte yield and fertilization outcomes. Statistical Analysis Data were analyzed using STATA Version 17.0. Descriptive statistics summarized socio-demographic and clinical characteristics, with continuous variables shown as means ± standard deviations and categorical variables as frequencies and percentages. A one-way analysis of variance (ANOVA) compared the means of continuous variables across the three groups, with Bartlett’s test checking for homogeneity of variances. The Chi-square or Fisher’s exact test was used for categorical variables. A p -value < 0.05 was considered statistically significant. Results Socio-Demographic and Anthropometric Characteristics of Study Participants Table 1 summarises the socio-demographic and anthropometric characteristics of the study participants. The mean age of participants was 29.16 ± 6.84 years , with over half ( 56.55% ) aged 29 years or younger. The mean height was 159.87 ± 5.83 cm , and the majority ( 60.68% ) were shorter than 160 cm. Participants had a mean weight of 71.91 ± 14.27 kg , with 58.97% weighing less than 72 kg. The mean body mass index (BMI) was 27.99 ± 5.42 kg/m² , indicating that most participants were above a healthy weight: 36.75% were overweight, and 32.48% were obese, while 30.77% had a healthy BMI. Regarding educational attainment, 36.31% had a tertiary education, followed by 35.12% with basic education and 28.57% with secondary education. In terms of occupational status, the majority were self-employed (59.87%) , while 24.84% worked in the public sector, 10.83% were unemployed, and only 4.46% were employed in the corporate sector. Table 1: Socio-Demographic and Anthropometric Characteristics of Study Participants Frequency (n) Percentage (%) Age (years) 29.16±6.84 ≤29 95 56.55 >29 73 43.45 Height (cm) 159.87±5.83 <160 71 60.68 ≥160 46 39.32 Weight (kg) 71.91±14.27 <72 69 58.97 ≥72 48 41.03 BMI (kg/m 2 ) 27.99±5.42 Healthy weight 36 30.77 Overweight 43 36.75 Obesity 38 32.48 Educational Level Basic education 59 35.12 Secondary education 48 28.57 Tertiary education 61 36.31 Occupational status Self employed 94 59.87 Co-operate sector 7 4.46 Public sector 39 24.84 Unemployed 17 10.83 Source: OAK, 2025 Medical History of Study Participants Table 2 summarizes the medical history characteristics of the study participants. All respondents were classified as ASA Physical Status I, II, and III, indicating they were normal, healthy patients. Regarding prior surgical history, the majority (61.31%) had no previous surgery, while 4.17% had undergone abdominal surgery and 36.90% reported other types of procedures. Among participants with a history of gynecological procedures, myomectomy was the most common (46.15%), followed by cesarean section (32.31%), salpingectomy (12.31%), and tubal excision (9.23%). Other surgeries, such as laparoscopy and tonsillectomy, were the most frequently reported (each 33.33%), while appendectomy and thyroidectomy were less common (each 16.67%). Most participants reported no known allergies (86.90%), although 10.12% had drug allergies and 2.98% had food allergies. Nearly all respondents had never smoked (99.40%), with only one participant (0.60%) being a former smoker. Regarding alcohol consumption, the majority reported no alcohol use (86.31%), while 13.69% reported occasional drinking of one to two drinks per week. Table 2: Medical History of Study Participants Frequency (n) Percentage (%) ASA Physical status ASA I (Normal healthy Patient) 168 100 Previous surgery* None 103 61.31 Abdominal 7 4.17 Other 62 36.90 Other gynaecological surgery Caesarean section 21 32.31 Myomectomy 30 46.15 Salpingectomy 8 12.31 Tubal excision 6 9.23 Other surgery Appendicectomy 1 16.67 Laparoscopy 2 33.33 Thyroidectomy 1 16.67 Tonsillectomy 2 33.33 Known allergies Drug allergies 17 10.12 Food allergies 5 2.98 None 146 86.90 Smoking history Former smoker (quit >1 year ago) 1 0.60 Never smoked 167 99.40 Alcohol consumption None 145 86.31 Occasional (1-2 drinks/week) 23 13.69 Source: OAK, 2025 Current cycle information Table 3 summarises the current cycle characteristics of the study participants. The majority of patients underwent the LONG GnRH agonist protocol ( 70.24%; n = 118) , while both the GnRH antagonist protocol and the SHORT GnRH agonist protocol were used in 14.88% of cycles (n = 25 each). The mean total follicle-stimulating hormone (FSH) dose administered was 3191 ± 837.48 IU , with 62.05% (n = 103) of participants receiving doses ≤3192 IU and 37.95% (n = 63) receiving higher doses. The mean duration of ovarian stimulation was 12.08 ± 2.00 days , with most participants ( 94.05%, n = 158 ) requiring stimulation for ≤12 days, while only 5.95% (n = 10) exceeded 12 days. Regarding the trigger agent used , the predominant method was HCG TRIGGER utilised in 80.95% (n = 136) of cycles, followed by AGONIST in 18.45% (n = 31) , whereas dual trigger (hCG plus GnRH agonist) was rarely employed ( 0.60%, n = 1 ). Table 3: Current cycle information of Study Participants Frequency (n) Percentage (%) Stimulation protocol used GnRH antagonist protocol 25 14.88 Short GnRH agonist protocol 25 14.88 Long GnRH agonist protocol 118 70.24 Total FSH dose (IU) 3191±837.48 ≤3192 103 62.05 >3192 63 37.95 Duration of stimulation (days) 12.08±2.00 ≤12 158 94.05 >12 10 5.95 Trigger agent used Dual trigger (hCG + GnRH agonist) 1 0.60 HCG TRIGGER 136 80.95 AGONIST TRIGGER 31 18.45 Source: OAK, 2025 Intraoperative Haemodynamic and Safety Profiles of Three Anaesthetic Regimens Table 4 presents the intraoperative haemodynamic and safety profiles of the three anaesthetic regimens. The adverse haemodynamic events were infrequent across all groups, with no statistically significant differences observed. Hypotension was rare, occurring in only 1 patient (1.59%) in Group B, whereas none were recorded in Groups A or C ( p = 1.00). Hypertension was more common than hypotension, affecting 35.29% of patients in Group A, 38.10% in Group B, and 25.86% in Group C; however, these differences were not statistically significant ( p = 0.340). Bradycardia was uncommon, with one case each in Groups B (1.59%) and C (1.72%) and none in Group A ( p = 1.00). Tachycardia occurred more frequently in Group B (44.44%) than in Group A (23.53%) or Group C (29.31%), although this trend did not reach statistical significance ( p = 0.072). Table 4: Intraoperative Haemodynamic and Safety Profiles of Three Anaesthetic Regimens Group A n(%) Group B n(%) Group C n(%) P-value Hypotension 1.00 Yes 0 (0.00) 1 (1.59) 0 (0.00) No 34 (100.00) 62 (98.41) 58 (100.00) Hypertension 0.340 Yes 12 (35.29) 24 (38.10) 15 (25.86) No 22 (64.71) 39 (61.90) 43 (74.14) Bradycardia 1.00 Yes 0 (0.00) 1 (1.59) 1 (1.72) No 34 (100.00) 62 (98.41) 57 (98.28) Tachycardia 0.072 Yes 8 (23.53) 28 (44.44) 17 (29.31) No 26 (76.47) 35 (55.56) 41 (70.69) Group A (Propofol + Fentanyl only using nasal prongs), Group B (Propofol + Fentanyl + Sevoflurane using Laryngeal Mask Airway), and Group C (Propofol + Fentanyl + Isoflurane using Laryngeal Mask Airway Source: OAK, 2025 Post-Operative Recovery Profiles Across Anaesthetic Groups Table 5 summarises the post-operative recovery profiles across the three anaesthetic groups. Mean time to eye opening was 1.61 ± 0.75 minutes in Group A, 1.55 ± 0.60 minutes in Group B, and 1.76 ± 0.47 minutes in Group C. Time to verbal response ranged from 1.73 ± 0.84 minutes in Group B to 2.02 ± 0.79 minutes in Group C, while time to correctly state their name ranged from 2.36 ± 1.03 minutes in Group A to 2.72 ± 0.98 minutes in Group C. Total recovery room time varied slightly among groups (7.73 ± 5.65, 8.38 ± 6.99, and 8.15 ± 5.72 minutes for Groups A, B, and C, respectively), and time to discharge readiness (Aldrete ≥9) ranged from 5.03 ± 2.36 minutes in Group A to 7.16 ± 6.23 minutes in Group B. None of these differences were statistically significant (all p > 0.05), and while Bartlett’s test indicated unequal variances for eye opening and discharge readiness, the overall recovery profiles were comparable across all three groups. Table 5: Post-Operative Recovery Profiles Across Anaesthetic Groups Outcome (min) Group A Mean (SD) Group B Mean (SD) Group C Mean (SD) F p -value Time to eye-opening 1.61 (0.75) 1.55 (0.60) 1.76 (0.47) 1.73 0.182 Time to verbal response 1.97 (0.98) 1.73 (0.84) 2.02 (0.79) 1.70 0.187 Time to state the name correctly 2.36 (1.03) 2.48 (1.21) 2.72 (0.98) 1.28 0.282 Total recovery room time ( 7.73 (5.65) 8.38 (6.99) 8.15 (5.72) 0.11 0.894 Time to discharge readiness 5.03 (2.36) 7.16 (6.23) 6.30 (5.03) 1.81 0.168 SD = standard deviation. F and p values are from one-way ANOVA; Bartlett’s test indicated unequal variances for time to eye opening, time to verbal response, time to state name correctly, total recovery room time, and time to discharge readiness χ²(2) = 8.62, p = 0.013, χ²(2) = 2.04, p = 0.360, χ²(2) = 2.53, p = 0.282, χ²(2) = 2.85, p = 0.240, and χ²(2) = 28.84, p <0.001 respectively. Source: OAK, 2025 Incidence and Severity of Post-Operative Side Effects Across Anaesthetic Groups Post-operative side effects were generally mild and varied slightly across the three anaesthetic groups (Table 6). The incidence of vomiting differed significantly among groups ( p = 0.031), with Group A reporting 2 patients (6.06%) experiencing a single episode and Group C reporting 1 patient (1.85%) with 2–3 episodes; no vomiting was observed in Group B. Dizziness was the most commonly reported side effect, predominantly of low severity, affecting 66.07–81.48% of participants across groups, though differences were not statistically significant ( p = 0.202). Sore throat was rare and mostly mild, reported by 3.03% of Group A and 1.85% of Group C, with no cases in Group B ( p = 0.520). Pain scores at 5 and 10 minutes post-operatively were mostly low to moderate across all groups, with no significant differences observed (5 minutes: p = 0.658; 10 minutes: p = 0.329). Nausea was uncommon, affecting 1–2 participants per group at moderate or severe levels, with no significant differences ( p = 0.694). Table 6: Incidence and Severity of Post-Operative Side Effects Across Anaesthetic Groups Group A n(%) Group B n(%) Group C n(%) P-value Vomiting (episode) 0.031* None 31 (93.94) 56 (100.00) 53 (98.15) 1 2 (6.06) 0 (0.00) 0 (0.00) 2-3 0 (0.00) 0 (0.00) 1 (1.85) Dizziness 0.202 Low 22 (66.67) 37 (66.07) 44 (81.48) Moderate 9 (27.27) 17 (30.36) 7 (12.96) Sever 2 (6.06) 2 (3.57) 3 (5.56) Sore throat 0.520 Low 32 (96.97) 56 (100.00) 53 (98.15) Moderate 1 (3.03) 0 (0.00) 1 (1.85) Pain score at 5 minutes 0.658 Low 27 (81.82) 43 (76.79) 44 (81.48) Moderate 4 (12.12) 5 (8.93) 3 (5.56) Sever 2 (6.06) 8 (14.29) 7 (12.96) Pain score at 10 minutes 0.329 Low 31 (93.94) 52 (92.86) 46 (85.19) Moderate 2 (6.06) 2 (3.57) 7 (12.96) Sever 0 (0.00) 2 (3.57) 1 (1.85) Nausea 0.694 Low 31 (93.94) 53 (94.64) 52 (96.30) Moderate 0 (0.00) 2 (3.57) 1 (1.85) Sever 2 (6.06) 1 (1.79) 1 (1.85) Group A (Propofol + Fentanyl only using nasal prongs), Group B (Propofol + Fentanyl + Sevoflurane using Laryngeal Mask Airway) and Group C (Propofol + Fentanyl + Isoflurane using Laryngeal Mask Airway) Source: OAK, 2025 Effects of Three Anaesthetic Protocols on Oocyte Retrieval Efficiency, Embryological Outcomes, and Patient Satisfaction with Anaesthetic Experience Table 7 compares oocyte retrieval efficiency, embryological outcomes, and patient satisfaction across the three anaesthetic protocols. The mean number of oocytes used differed significantly among the groups (F = 9.16, p = 0.001), with Group C recording the highest mean, followed by Group B and Group A. Similarly, the normal fertilisation rate varied significantly across the groups (F = 4.97, p = 0.009), with Group B having the highest rate and Group C the lowest. However, there were no statistically significant differences in the number of normal fertilisations (p = 0.171), blastocyst rate (p = 0.223), total number of blastocysts (p = 0.076), or number of failed fertilisations (p = 0.148), although Group C tended to show higher mean values for blastocyst-related outcomes. Regarding patient-reported anaesthetic and procedural experiences, no statistically significant differences were observed among the three groups. Overall satisfaction with the anaesthetic experience (p = 0.474), comfort during the procedure (p = 0.969), adequacy of pain management (p = 0.965), and recovery experience (p = 0.667) were comparable across all groups, with mean scores consistently high, indicating generally positive experiences irrespective of group assignment. Table 7: Effects of Three Anaesthetic Protocols on Oocyte Retrieval Efficiency, Embryological Outcomes, and Patient Satisfaction with Anaesthetic Experience Variable Group A Mean (SD) Group B Mean (SD) Group C Mean (SD) F p-value Number of oocytes used 9.76(5.74) 15.43 (8.93) 17.79 (8.13) 9.16 0.001* Number of normal fertilisations 4.38(4.03) 6.92 (6.85) 5.77 (4.78) 1.79 0.171 Normal fertilisation rate 43.47(31.82) 47.85 (26.28) 30.06 (21.83) 4.97 0.009* Blastocyst rate 61.52(39.56) 65.74 (38.63) 77.00 (40.44) 1.52 0.223 Total number of blastocysts 2.83 (2.52) 4.19 (4.06) 4.81 (3.83) 2.64 0.076 Number of failed fertilisations 2.59 (3.43) 3.51 (4.91) 4.67 (4.70) 1.95 0.148 Overall satisfaction with anaesthetic experience 4.24 (0.71) 4.27 (0.82) 4.09 (0.81) 0.75 0.474 Comfort during the procedure 3.97 (0.81) 3.96 (1.04) 3.93 (0.89) 0.03 0.969 Pain management adequacy 4.24 (0.75) 4.20 (0.88) 4.22 (0.77) 0.04 0.965 Recovery experience 4.30 (0.77) 4.45 (0.76) 4.39 (0.66) 0.41 0.667 Group A (Propofol + Fentanyl only using nasal prongs), Group B (Propofol + Fentanyl + Sevoflurane using Laryngeal Mask Airway) and Group C (Propofol + Fentanyl + Isoflurane using Laryngeal Mask Airway Source: OAK, 2025 Discussion This prospective comparative cohort study found that while TIVA, sevoflurane-based, and isoflurane-based anesthesia are all safe and effective for oocyte retrieval in terms of hemodynamic stability and recovery [13], they have significantly different impacts on embryological outcomes and post-operative side effects. The finding that all three regimens provided stable hemodynamics and rapid recovery aligns with previous studies showing the safety of modern anesthetic agents in an outpatient setting [14, 15]. The quick emergence from anesthesia across all groups highlights their suitability for high-turnover day-case procedures. A key finding was the notably lower rate of post-operative vomiting in the sevoflurane group (0%). This contrasts with the traditional belief that volatile agents are more likely to cause nausea than propofol, which has known antiemetic effects[6, 16]. The brief procedure duration and the avoidance of nitrous oxide probably contributed to this positive result, indicating that in this setting, sevoflurane maintenance may be better than propofol TIVA for preventing PONV. The most clinically important findings were in the embryological outcomes. The higher oocyte yield in the volatile anesthetic groups (B and C) may be due to better surgical conditions, such as deeper immobility, provided by maintenance anesthesia through an LMA compared to lighter sedation with TIVA. However, a high oocyte count is meaningless without oocyte quality. The sevoflurane group (B) showed a significantly higher normal fertilization rate than the isoflurane group (C). This strongly suggests that isoflurane may have a direct gonadotoxic effect, supported by animal studies showing it can inhibit DNA synthesis and impair cellular cleavage [5]. Its accumulation in the follicular fluid seems to reduce the developmental potential of human oocytes. Conversely, sevoflurane appears to create a more favorable microenvironment for oocytes, combining the benefits of a stable anesthetic plane for maximum oocyte retrieval with the absence of the cytotoxic effects associated with isoflurane [9]. The superior performance of sevoflurane over propofol-only TIVA in fertilization rates may be due to its effects on the neuroendocrine stress response. Propofol is known to suppress stress hormones like cortisol, while sevoflurane might better maintain the delicate intrafollicular hormonal balance necessary for final oocyte maturation [10]. This combination of higher yield than TIVA and higher fertilization rates than isoflurane makes the sevoflurane-based protocol the preferred choice. Conclusion An anaesthetic regimen of propofol induction followed by sevoflurane maintenance is clinically and biologically superior for oocyte retrieval. This protocol significantly increases the normal fertilisation rate compared to an isoflurane-based regimen and eliminates post-operative vomiting compared to propofol-only TIVA, without compromising patient safety, haemodynamic stability, or recovery time. To maximise the success of IVF cycles, the adoption of sevoflurane-based anaesthesia should be strongly considered over traditional propofol-only and isoflurane-based techniques. Limitations This study was conducted at a single centre, which may limit the generalizability of the findings. The use of consecutive sampling, while practical, is not as robust as true randomization in eliminating all potential confounders. Finally, this study did not track long-term outcomes such as cumulative live birth rates. Declarations A cknowledgments The authors thank the staff of Oak Specialist Hospital and the study participants for their invaluable contributions. 1. Funding Source Authors receive no source of funding for the study. 2. Conflict of Interest Authors declare no conflict of interest. 3. Ethical approval and consent to participant This study received ethical approval from the Committee on Human Research, Publications, and Ethicsof the Kwame Nkrumah University of Science and Technology, with reference number (CHRPE/AP/1334/24) . 4. Consent to Participate Written informed consent was obtained from all participants after providing detailed information about the purpose, procedures, potential risks, and benefits of the study. Participation was entirely voluntary, and participants were informed of their right to withdraw at any point without any consequences. Confidentiality and anonymity of respondents were strictly maintained throughout the study. 5. Consent for Publication Written informed consent for publication was obtained from all participants. Participants were assured that no personally identifiable information would be included in any publication or dissemination of the study findings. All data presented in this manuscript are anonymized to protect participants’ privacy. 6. Availability of Data and Materials The datasets generated and/or analyzed during the current study are not publicly available due to ethical and confidentiality considerations, but are available from the corresponding author on reasonable request. Data sharing will be subject to approval by the relevant ethics committee and in accordance with institutional guidelines to ensure participant confidentiality. 7. Code Availability The analysis for this study was conducted using Stata version 17. Standard statistical procedures and commands available within the software were utilized. Any additional details regarding the analytical procedures can be obtained from the corresponding author upon reasonable request. 8. Authors’ Contribution RMKD: data curation, methodology, review and editing, WKJSA: write-up and editing. NAB: write-up and editing. IB: write-up and editing. AT: write-up and editing. 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Taiwanese Journal of Obstetrics and Gynecology 2019; 58: 536–540. Juckenhöfel S, Feisel C, Schmitt HJ, et al. [TIVA with propofol-remifentanil or balanced anesthesia with sevoflurane-fentanyl in laparoscopic operations. Hemodynamics, awakening and adverse effects]. Anaesthesist 2019; 48: 807–812. Dhungana A, Baral P, Singh SN, et al. Comparison between total intravenous anesthesia (TIVA) with propofol–fentanyl and balanced anesthesia with sevoflurane–fentanyl in terms of hemodynamic changes and recovery profiles during laparoscopic cholecystectomy. Journal of Chitwan Medical College 2022; 12: 63–67. Saravanaperumal G, Udhayakumar P. Opioid-free TIVA Improves Post- operative Quality of Recovery (QOR) in Patients Undergoing Oocyte Retrieval. J Obstet Gynaecol India 2022; 72: 59–65. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 20 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviews received at journal 06 Apr, 2026 Reviews received at journal 06 Apr, 2026 Reviewers agreed at journal 04 Apr, 2026 Reviewers agreed at journal 04 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers invited by journal 01 Apr, 2026 Editor assigned by journal 31 Mar, 2026 Submission checks completed at journal 31 Mar, 2026 First submitted to journal 27 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9248000","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617601956,"identity":"4e44dd04-aec3-4bcc-af03-bf041da6bb96","order_by":0,"name":"Rex Mawuli Kwadjo Djokoto","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIie3PwWrCMBjA8a8E4uUDry0TfIWUQkUs9FVaCvU2GLtMcFIQ4iWys+BLeNuxJdBd+gDKLuvdHXYZO5rIGIMR9Sgsf0gCH/xIAmCzXWuIwNThtMX3wFUrOU8oEF8TvIzAkVDvIjJYCAb7XhR0+/N6snqWcQykekV4vDWRXlMnzhrz0OM0320amQqg2Qjh5d5EXDcrCaKMWI3hruUyQcDwBqFOCxPpt8UPuVMkRuh+niYuOd4SauJsuHQEIFVkaiaYJ5X6S+DxPPNWfJwKSYPhmpVm0mn8t3cR+U9EVh9LPoo7i3m73T/MjERXqsf8iuiNyRNA9/V3NDtDbDab7R91ALAJT8etHaLYAAAAAElFTkSuQmCC","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Rex","middleName":"Mawuli Kwadjo","lastName":"Djokoto","suffix":""},{"id":617601957,"identity":"20c16486-3027-45a2-887e-db41fc402efc","order_by":1,"name":"Wilfred Kwamina Jnr Sam-Awortwi","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Wilfred","middleName":"Kwamina Jnr","lastName":"Sam-Awortwi","suffix":""},{"id":617601958,"identity":"a5867d9e-342e-4f0c-82ec-de4cebc2cc0c","order_by":2,"name":"Nana Addo Boateng","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Nana","middleName":"Addo","lastName":"Boateng","suffix":""},{"id":617601959,"identity":"c12f636a-a833-4f18-9ae5-9dd695501613","order_by":3,"name":"Irene Bandoh","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Irene","middleName":"","lastName":"Bandoh","suffix":""},{"id":617601960,"identity":"1b7579eb-a8f0-42ea-a1be-8e947b51a454","order_by":4,"name":"Augustine Tawiah","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Augustine","middleName":"","lastName":"Tawiah","suffix":""},{"id":617601961,"identity":"1bb667ce-8bd7-496f-8bba-bc2efeb4539d","order_by":5,"name":"Edward Anabila Agana","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Edward","middleName":"Anabila","lastName":"Agana","suffix":""},{"id":617601962,"identity":"343f542b-18a0-41c5-b6ae-443fde78f4d8","order_by":6,"name":"Kingsley Afreh Nduroh","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Kingsley","middleName":"Afreh","lastName":"Nduroh","suffix":""},{"id":617601963,"identity":"94bb2195-cc31-46e1-9528-ded61adb3a89","order_by":7,"name":"Johnny Arthur-Komeh","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Johnny","middleName":"","lastName":"Arthur-Komeh","suffix":""},{"id":617601964,"identity":"a8006e09-263b-428f-9234-89342df3ac94","order_by":8,"name":"Opei Adarkwa","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Opei","middleName":"","lastName":"Adarkwa","suffix":""},{"id":617601966,"identity":"b6591f81-19b3-4cc6-b572-9df9f511a07f","order_by":9,"name":"Andrew Panyin Vormawor","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"Panyin","lastName":"Vormawor","suffix":""},{"id":617601968,"identity":"ecd59322-c62f-42ef-b8e5-5a0e2eec9d17","order_by":10,"name":"Amponsah Peprah","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Amponsah","middleName":"","lastName":"Peprah","suffix":""},{"id":617601969,"identity":"284c7a7a-b5d6-43fc-bc9a-8886aa097bac","order_by":11,"name":"Anthony Amanfo Ofori","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"Amanfo","lastName":"Ofori","suffix":""},{"id":617601970,"identity":"9a551cc0-3081-4c44-98f4-07263d3c1306","order_by":12,"name":"Victor Boachie Owusu","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Victor","middleName":"Boachie","lastName":"Owusu","suffix":""},{"id":617601972,"identity":"b7697c0f-4535-4aae-8a91-634009ad0794","order_by":13,"name":"Isaac Kofi Adu","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"Kofi","lastName":"Adu","suffix":""}],"badges":[],"createdAt":"2026-03-27 19:54:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9248000/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9248000/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106215671,"identity":"d8eb941b-bdaa-4cb3-9bcf-0764af72fcdf","added_by":"auto","created_at":"2026-04-06 08:26:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2197286,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9248000/v1/f3f12067-d7c6-48ba-912f-a8dcd82ea868.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anaesthesia for Transvaginal Oocyte Retrieval in IVF: A Prospective Comparative Cohort Study from Ghana","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfertility is a major global health issue, and its burden is especially heavy in sub-Saharan Africa [1]. In Ghana, where pro-natalist attitudes create strong societal pressure to conceive, assisted reproductive technology (ART) has become an essential medical intervention [2]. However, access to ART is restricted by high costs and the concentration of clinics in major urban centers, leading patients to make significant financial and emotional investments with each cycle [3]. Therefore, it is a clinical necessity to optimize every procedural step to increase success rates and ensure patient safety.\u003c/p\u003e\n\u003cp\u003eA key part of the in vitro fertilization (IVF) process is transvaginal ultrasound-guided oocyte retrieval, a painful procedure that requires effective anesthesia [4]. The ideal anesthesia protocol should provide quick induction, maintain hemodynamic stability, and enable rapid recovery, all while avoiding negative effects on the delicate reproductive microenvironment. Anesthetic agents can cross the blood-follicle barrier, raising concerns about possible gonadotoxicity that could negatively affect oocyte quality, fertilization, and embryo development [5].\u003c/p\u003e\n\u003cp\u003eTotal intravenous anesthesia (TIVA) with propofol and short-acting opioids is widely preferred for its rapid onset and antiemetic effects [5, 6]. Alternatively, anesthesia can be maintained with volatile agents like sevoflurane or isoflurane. The debate over which method is better continues, as some studies suggest propofol is safe, while others raise concerns about dose-dependent accumulation in follicular fluid and its potential to cause abnormal fertilization [7, 8]. On the other hand, volatile agents such as isoflurane have been linked to inhibited embryo development, whereas newer agents like sevoflurane have been associated with higher fertilization rates and better-quality embryos in certain studies [9]. These agents also differ in their effects on the neuroendocrine stress response, which may impact the intrafollicular hormonal environment [10].\u003c/p\u003e\n\u003cp\u003eDespite the growth of ART clinics in Ghana, there is a lack of local, evidence-based consensus on the best anesthetic protocol for oocyte retrieval [11]. Global research offers conflicting evidence, causing practitioners to depend on institutional preferences or extrapolated data. This study aims to fill this knowledge gap by prospectively comparing the clinical, physiological, and embryological outcomes of TIVA versus sevoflurane- or isoflurane-based anesthesia during oocyte retrieval at a leading Ghanaian fertility center.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective comparative cohort study design was employed at Oak Specialist Hospital, a private tertiary healthcare facility and high-volume fertility centre in Kumasi, Ghana [12]. This design enables rigorous evaluation of different clinical interventions in real-world parallel-group settings. The study was approved by the Committee on Human Research, Publication and Ethics at the School of Medical Sciences, Kwame Nkrumah University of Science and Technology (CHRPE/AP/1334/24).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study involved 168 women aged 20–50 years, classified as American Society of Anesthesiologists (ASA) Physical Status I or II, who were undergoing an IVF cycle requiring oocyte retrieval. A consecutive sampling method was used, enrolling every eligible patient who gave written informed consent until the target sample size was achieved. The sample size was determined beforehand using G*Power (version 3.1) for a one-way ANOVA, aiming for 80% power at an alpha of 0.05 with a medium effect size (Cohen's f = 0.25), which indicated a need for at least 159 participants. Exclusion criteria included a history of adverse reactions to the anesthetic agents administered, a significant history of postoperative nausea and vomiting (PONV), or severe systemic comorbidities (ASA Physical Status ≥ III).\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eInterventions\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eParticipants were allocated to one of three anaesthetic protocol groups:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eGroup A (n=56):\u003c/strong\u003e Total Intravenous Anaesthesia (TIVA) with intravenous fentanyl and propofol, with oxygen delivered via nasal prongs.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eGroup B (n=56):\u003c/strong\u003e Balanced anaesthesia with intravenous fentanyl and propofol for induction, followed by maintenance with sevoflurane delivered via a Laryngeal Mask Airway (LMA).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eGroup C (n=56):\u003c/strong\u003e Balanced anaesthesia with intravenous fentanyl and propofol for induction, followed by maintenance with isoflurane delivered via an LMA.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection and Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected in real-time by a dedicated clinical observer using a standardized data extraction form.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003ePrimary Outcomes:\u003c/strong\u003e The co-primary outcomes were the percentage of normal fertilization and the occurrence of post-operative vomiting.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSecondary Outcomes:\u003c/strong\u003e Secondary outcomes included intraoperative hemodynamic events (hypotension, hypertension, bradycardia, tachycardia), postoperative recovery times (time to eye-opening, verbal response, and discharge readiness via Aldrete score ≥ 9), other side effects (dizziness, pain, nausea), total number of oocytes retrieved, and patient satisfaction scores. Embryologists, who were blinded to the anesthetic protocol, provided data on oocyte yield and fertilization outcomes.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using STATA Version 17.0. Descriptive statistics summarized socio-demographic and clinical characteristics, with continuous variables shown as means ± standard deviations and categorical variables as frequencies and percentages. A one-way analysis of variance (ANOVA) compared the means of continuous variables across the three groups, with Bartlett’s test checking for homogeneity of variances. The Chi-square or Fisher’s exact test was used for categorical variables. A \u003cem\u003ep\u003c/em\u003e-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-Demographic and Anthropometric Characteristics of Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 summarises the socio-demographic and anthropometric characteristics of the study participants. The mean age of participants was \u003cstrong\u003e29.16 \u0026plusmn; 6.84 years\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e with over half (\u003cstrong\u003e56.55%\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e aged 29 years or younger. The mean height was \u003cstrong\u003e159.87 \u0026plusmn; 5.83 cm\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e and the majority \u003cstrong\u003e(\u003cstrong\u003e60.68%\u003c/strong\u003e)\u0026nbsp;\u003c/strong\u003ewere shorter than 160 cm. Participants had a mean weight of \u003cstrong\u003e71.91 \u0026plusmn; 14.27 kg\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e with \u003cstrong\u003e58.97%\u003c/strong\u003e weighing less than 72 kg. The mean body mass index (BMI) was \u003cstrong\u003e27.99 \u0026plusmn; 5.42 kg/m\u0026sup2;\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e indicating that most participants were above a healthy weight: \u003cstrong\u003e36.75%\u003c/strong\u003e were overweight, and \u003cstrong\u003e32.48%\u003c/strong\u003e were obese, while \u003cstrong\u003e30.77%\u003c/strong\u003e had a healthy BMI. Regarding educational attainment, \u003cstrong\u003e36.31%\u003c/strong\u003e had a tertiary education, followed by \u003cstrong\u003e35.12%\u003c/strong\u003e with basic education and \u003cstrong\u003e28.57%\u003c/strong\u003e with secondary education. In terms of occupational status, the majority were \u003cstrong\u003eself-employed (59.87%)\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e while \u003cstrong\u003e24.84%\u003c/strong\u003e worked in the public sector, \u003cstrong\u003e10.83%\u003c/strong\u003e were unemployed, and only \u003cstrong\u003e4.46%\u003c/strong\u003e were employed in the corporate sector.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: \u003cstrong\u003eSocio-Demographic and Anthropometric Characteristics of Study Participants\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e29.16\u0026plusmn;6.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026le;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e56.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026gt;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e43.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e159.87\u0026plusmn;5.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026lt;160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e60.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026ge;160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e39.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e71.91\u0026plusmn;14.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026lt;72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e58.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026ge;72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e41.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e27.99\u0026plusmn;5.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eHealthy weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e30.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e36.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e32.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eEducational Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eBasic education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e35.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e28.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eTertiary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e36.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eOccupational status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eSelf employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e59.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eCo-operate sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003ePublic sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e24.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: OAK, 2025\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedical History of Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 summarizes the medical history characteristics of the study participants. All respondents were classified as ASA Physical Status I, II, and III, indicating they were normal, healthy patients. Regarding prior surgical history, the majority (61.31%) had no previous surgery, while 4.17% had undergone abdominal surgery and 36.90% reported other types of procedures. Among participants with a history of gynecological procedures, myomectomy was the most common (46.15%), followed by cesarean section (32.31%), salpingectomy (12.31%), and tubal excision (9.23%). Other surgeries, such as laparoscopy and tonsillectomy, were the most frequently reported (each 33.33%), while appendectomy and thyroidectomy were less common (each 16.67%). Most participants reported no known allergies (86.90%), although 10.12% had drug allergies and 2.98% had food allergies. Nearly all respondents had never smoked (99.40%), with only one participant (0.60%) being a former smoker. Regarding alcohol consumption, the majority reported no alcohol use (86.31%), while 13.69% reported occasional drinking of one to two drinks per week.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Medical History of Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eASA Physical status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eASA I (Normal healthy Patient)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003ePrevious surgery*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e61.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eAbdominal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e36.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eOther gynaecological surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eCaesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e32.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eMyomectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e46.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eSalpingectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e12.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eTubal excision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e9.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eOther surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eAppendicectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e16.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eLaparoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e33.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eThyroidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e16.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eTonsillectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e33.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eKnown allergies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eDrug allergies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eFood allergies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e86.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eSmoking history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eFormer smoker (quit \u0026gt;1 year ago)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eNever smoked\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e99.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eAlcohol consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e86.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eOccasional (1-2 drinks/week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e13.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: OAK, 2025\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent cycle information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 summarises the current cycle characteristics of the study participants. The majority of patients underwent the \u003cstrong\u003eLONG GnRH agonist protocol\u003c/strong\u003e (\u003cstrong\u003e70.24%; n = 118)\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e while both the \u003cstrong\u003eGnRH antagonist protocol\u003c/strong\u003e and the \u003cstrong\u003eSHORT GnRH agonist protocol\u003c/strong\u003e were used in \u003cstrong\u003e14.88% of cycles (n = 25\u003c/strong\u003e each). The mean \u003cstrong\u003etotal follicle-stimulating hormone (FSH) dose\u003c/strong\u003e administered was \u003cstrong\u003e3191 \u0026plusmn; 837.48 IU\u003c/strong\u003e, with \u003cstrong\u003e62.05% (n = 103)\u003c/strong\u003e of participants receiving doses \u0026le;3192 IU and \u003cstrong\u003e37.95% (n = 63)\u003c/strong\u003e receiving higher doses. The mean \u003cstrong\u003eduration of ovarian stimulation\u003c/strong\u003e was \u003cstrong\u003e12.08 \u0026plusmn; 2.00 days\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e with most participants \u003cstrong\u003e(\u003cstrong\u003e94.05%, n = 158\u003c/strong\u003e)\u003c/strong\u003e requiring stimulation for \u0026le;12 days, while only \u003cstrong\u003e5.95% (n = 10)\u003c/strong\u003e exceeded 12 days. Regarding the \u003cstrong\u003etrigger agent used\u003c/strong\u003e, the predominant method was \u003cstrong\u003eHCG TRIGGER\u0026nbsp;\u003c/strong\u003eutilised in \u003cstrong\u003e80.95% (n = 136)\u003c/strong\u003e of cycles, followed by \u003cstrong\u003eAGONIST\u0026nbsp;\u003c/strong\u003ein \u003cstrong\u003e18.45% (n = 31)\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e whereas \u003cstrong\u003edual trigger (hCG plus GnRH agonist)\u003c/strong\u003e was rarely employed \u003cstrong\u003e(\u003cstrong\u003e0.60%, n = 1\u003c/strong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Current cycle information \u003cstrong\u003eof Study Participants\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eStimulation protocol used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eGnRH antagonist protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e14.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eShort GnRH agonist protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e14.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Long GnRH agonist protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e70.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eTotal FSH dose (IU)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e3191\u0026plusmn;837.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026le;3192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e62.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026gt;3192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e37.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eDuration of stimulation (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e12.08\u0026plusmn;2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026le;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e94.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u0026gt;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eTrigger agent used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eDual trigger (hCG + GnRH agonist)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eHCG TRIGGER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e80.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eAGONIST TRIGGER\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e18.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: OAK, 2025\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntraoperative Haemodynamic and Safety Profiles of Three Anaesthetic Regimens\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 presents the intraoperative haemodynamic and safety profiles of the three anaesthetic regimens. The adverse haemodynamic events were infrequent across all groups, with no statistically significant differences observed. Hypotension was rare, occurring in only 1 patient (1.59%) in Group B, whereas none were recorded in Groups A or C (\u003cem\u003ep\u003c/em\u003e = 1.00). Hypertension was more common than hypotension, affecting 35.29% of patients in Group A, 38.10% in Group B, and 25.86% in Group C; however, these differences were not statistically significant (\u003cem\u003ep\u003c/em\u003e = 0.340). Bradycardia was uncommon, with one case each in Groups B (1.59%) and C (1.72%) and none in Group A (\u003cem\u003ep\u003c/em\u003e = 1.00). Tachycardia occurred more frequently in Group B (44.44%) than in Group A (23.53%) or Group C (29.31%), although this trend did not reach statistical significance (\u003cem\u003ep\u003c/em\u003e = 0.072).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Intraoperative Haemodynamic and Safety Profiles of Three Anaesthetic Regimens\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eHypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1 (1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e34 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e62 (98.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e58 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e12 (35.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e24 (38.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e15 (25.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e22 (64.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e39 (61.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e43 (74.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eBradycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1 (1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1 (1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e34 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e62 (98.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e57 (98.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eTachycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8 (23.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e28 (44.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e17 (29.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e26 (76.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e35 (55.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e41 (70.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGroup A (Propofol + Fentanyl only using nasal prongs), Group B (Propofol + Fentanyl + Sevoflurane using Laryngeal Mask Airway), and Group C (Propofol + Fentanyl + Isoflurane using Laryngeal Mask Airway\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: OAK, 2025\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePost-Operative Recovery Profiles Across Anaesthetic Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 summarises the post-operative recovery profiles across the three anaesthetic groups. Mean time to eye opening was 1.61 \u0026plusmn; 0.75 minutes in Group A, 1.55 \u0026plusmn; 0.60 minutes in Group B, and 1.76 \u0026plusmn; 0.47 minutes in Group C. Time to verbal response ranged from 1.73 \u0026plusmn; 0.84 minutes in Group B to 2.02 \u0026plusmn; 0.79 minutes in Group C, while time to correctly state their name ranged from 2.36 \u0026plusmn; 1.03 minutes in Group A to 2.72 \u0026plusmn; 0.98 minutes in Group C. Total recovery room time varied slightly among groups (7.73 \u0026plusmn; 5.65, 8.38 \u0026plusmn; 6.99, and 8.15 \u0026plusmn; 5.72 minutes for Groups A, B, and C, respectively), and time to discharge readiness (Aldrete \u0026ge;9) ranged from 5.03 \u0026plusmn; 2.36 minutes in Group A to 7.16 \u0026plusmn; 6.23 minutes in Group B. None of these differences were statistically significant (all \u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05), and while Bartlett\u0026rsquo;s test indicated unequal variances for eye opening and discharge readiness, the overall recovery profiles were comparable across all three groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Post-Operative Recovery Profiles Across Anaesthetic Groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep -value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTime to eye-opening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.61 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1.55 (0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.76 (0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTime to verbal response\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.97 (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1.73 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.02 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTime to state the name correctly\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e2.36 (1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2.48 (1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.72 (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTotal recovery room time (\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e7.73 (5.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e8.38 (6.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e8.15 (5.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTime to discharge readiness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e5.03 (2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e7.16 (6.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6.30 (5.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSD = standard deviation. F and p values are from one-way ANOVA; Bartlett\u0026rsquo;s test indicated unequal variances for time to eye opening, time to verbal response, time to state name correctly, total recovery room time, and time to discharge readiness \u0026chi;\u0026sup2;(2) = 8.62, p = 0.013, \u0026chi;\u0026sup2;(2) = 2.04, p = 0.360, \u0026chi;\u0026sup2;(2) = 2.53, p = 0.282, \u0026chi;\u0026sup2;(2) = 2.85, p = 0.240, and \u0026chi;\u0026sup2;(2) = 28.84, p \u0026lt;0.001 respectively.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: OAK, 2025\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncidence and Severity of Post-Operative Side Effects Across Anaesthetic Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePost-operative side effects were generally mild and varied slightly across the three anaesthetic groups (Table 6).\u003c/strong\u003e The incidence of vomiting differed significantly among groups (\u003cem\u003ep\u003c/em\u003e = 0.031), with Group A reporting 2 patients (6.06%) experiencing a single episode and Group C reporting 1 patient (1.85%) with 2\u0026ndash;3 episodes; no vomiting was observed in Group B. Dizziness was the most commonly reported side effect, predominantly of low severity, affecting 66.07\u0026ndash;81.48% of participants across groups, though differences were not statistically significant (\u003cem\u003ep\u003c/em\u003e = 0.202). Sore throat was rare and mostly mild, reported by 3.03% of Group A and 1.85% of Group C, with no cases in Group B (\u003cem\u003ep\u003c/em\u003e = 0.520). Pain scores at 5 and 10 minutes post-operatively were mostly low to moderate across all groups, with no significant differences observed (5 minutes: \u003cem\u003ep\u003c/em\u003e = 0.658; 10 minutes: \u003cem\u003ep\u003c/em\u003e = 0.329). Nausea was uncommon, affecting 1\u0026ndash;2 participants per group at moderate or severe levels, with no significant differences (\u003cem\u003ep\u003c/em\u003e = 0.694).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Incidence and Severity of Post-Operative Side Effects Across Anaesthetic Groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eVomiting (episode)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e31 (93.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e56 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e53 (98.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eDizziness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e22 (66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e37 (66.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e44 (81.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 (27.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e17 (30.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (12.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3 (5.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSore throat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e32 (96.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e56 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e53 (98.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (3.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003ePain score at 5 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e27 (81.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e43 (76.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e44 (81.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e4 (12.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e5 (8.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3 (5.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 (14.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (12.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003ePain score at 10 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e31 (93.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e52 (92.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e46 (85.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (12.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eNausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e31 (93.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e53 (94.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e52 (96.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGroup A (Propofol + Fentanyl only using nasal prongs), Group B (Propofol + Fentanyl + Sevoflurane using Laryngeal Mask Airway) and Group C (Propofol + Fentanyl + Isoflurane using Laryngeal Mask Airway)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: OAK, 2025\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffects of Three Anaesthetic Protocols on Oocyte Retrieval Efficiency, Embryological Outcomes, and Patient Satisfaction with Anaesthetic Experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 7 compares oocyte retrieval efficiency, embryological outcomes, and patient satisfaction across the three anaesthetic protocols. The mean number of oocytes used differed significantly among the groups (F = 9.16, p = 0.001), with Group C recording the highest mean, followed by Group B and Group A. Similarly, the normal fertilisation rate varied significantly across the groups (F = 4.97, p = 0.009), with Group B having the highest rate and Group C the lowest. However, there were no statistically significant differences in the number of normal fertilisations (p = 0.171), blastocyst rate (p = 0.223), total number of blastocysts (p = 0.076), or number of failed fertilisations (p = 0.148), although Group C tended to show higher mean values for blastocyst-related outcomes.\u003c/p\u003e\n\u003cp\u003eRegarding patient-reported anaesthetic and procedural experiences, no statistically significant differences were observed among the three groups. Overall satisfaction with the anaesthetic experience (p = 0.474), comfort during the procedure (p = 0.969), adequacy of pain management (p = 0.965), and recovery experience (p = 0.667) were comparable across all groups, with mean scores consistently high, indicating generally positive experiences irrespective of group assignment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7: Effects of Three Anaesthetic Protocols on Oocyte Retrieval Efficiency, Embryological Outcomes, and Patient Satisfaction with Anaesthetic Experience\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of oocytes used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.76(5.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.43 (8.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.79 (8.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of normal fertilisations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.38(4.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.92 (6.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.77 (4.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNormal fertilisation rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.47(31.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.85 (26.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.06 (21.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.009*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBlastocyst rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.52(39.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65.74 (38.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77.00 (40.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal number of blastocysts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.83 (2.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.19 (4.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.81 (3.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of failed fertilisations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.59 (3.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.51 (4.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.67 (4.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOverall satisfaction with anaesthetic experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.24 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.27 (0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.09 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComfort during the procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.97 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.96 (1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.93 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.969\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePain management adequacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.24 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.20 (0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.22 (0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.965\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRecovery experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.30 (0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.45 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.39 (0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGroup A (Propofol + Fentanyl only using nasal prongs), Group B (Propofol + Fentanyl + Sevoflurane using Laryngeal Mask Airway) and Group C (Propofol + Fentanyl + Isoflurane using Laryngeal Mask Airway\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: OAK, 2025\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective comparative cohort study found that while TIVA, sevoflurane-based, and isoflurane-based anesthesia are all safe and effective for oocyte retrieval in terms of hemodynamic stability and recovery [13], they have significantly different impacts on embryological outcomes and post-operative side effects. The finding that all three regimens provided stable hemodynamics and rapid recovery aligns with previous studies showing the safety of modern anesthetic agents in an outpatient setting [14, 15]. The quick emergence from anesthesia across all groups highlights their suitability for high-turnover day-case procedures.\u003c/p\u003e\n\u003cp\u003eA key finding was the notably lower rate of post-operative vomiting in the sevoflurane group (0%). This contrasts with the traditional belief that volatile agents are more likely to cause nausea than propofol, which has known antiemetic effects[6, 16]. The brief procedure duration and the avoidance of nitrous oxide probably contributed to this positive result, indicating that in this setting, sevoflurane maintenance may be better than propofol TIVA for preventing PONV.\u003c/p\u003e\n\u003cp\u003eThe most clinically important findings were in the embryological outcomes. The higher oocyte yield in the volatile anesthetic groups (B and C) may be due to better surgical conditions, such as deeper immobility, provided by maintenance anesthesia through an LMA compared to lighter sedation with TIVA. However, a high oocyte count is meaningless without oocyte quality. The sevoflurane group (B) showed a significantly higher normal fertilization rate than the isoflurane group (C). This strongly suggests that isoflurane may have a direct gonadotoxic effect, supported by animal studies showing it can inhibit DNA synthesis and impair cellular cleavage [5]. Its accumulation in the follicular fluid seems to reduce the developmental potential of human oocytes. Conversely, sevoflurane appears to create a more favorable microenvironment for oocytes, combining the benefits of a stable anesthetic plane for maximum oocyte retrieval with the absence of the cytotoxic effects associated with isoflurane [9].\u003c/p\u003e\n\u003cp\u003eThe superior performance of sevoflurane over propofol-only TIVA in fertilization rates may be due to its effects on the neuroendocrine stress response. Propofol is known to suppress stress hormones like cortisol, while sevoflurane might better maintain the delicate intrafollicular hormonal balance necessary for final oocyte maturation [10]. This combination of higher yield than TIVA and higher fertilization rates than isoflurane makes the sevoflurane-based protocol the preferred choice.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAn anaesthetic regimen of propofol induction followed by sevoflurane maintenance is clinically and biologically superior for oocyte retrieval. This protocol significantly increases the normal fertilisation rate compared to an isoflurane-based regimen and eliminates post-operative vomiting compared to propofol-only TIVA, without compromising patient safety, haemodynamic stability, or recovery time. To maximise the success of IVF cycles, the adoption of sevoflurane-based anaesthesia should be strongly considered over traditional propofol-only and isoflurane-based techniques.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study was conducted at a single centre, which may limit the generalizability of the findings. The use of consecutive sampling, while practical, is not as robust as true randomization in eliminating all potential confounders. Finally, this study did not track long-term outcomes such as cumulative live birth rates.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003cstrong\u003ecknowledgments\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors thank the staff of Oak Specialist Hospital and the study participants for their invaluable contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Funding Source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors receive no source of funding for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Conflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAuthors declare no conflict of interest.\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e3. Ethical approval and consent to participant\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the\u0026nbsp;Committee on Human Research, Publications, and Ethicsof the\u0026nbsp;Kwame Nkrumah University of Science and Technology, with reference number (CHRPE/AP/1334/24)\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants after providing detailed information about the purpose, procedures, potential risks, and benefits of the study. Participation was entirely voluntary, and participants were informed of their right to withdraw at any point without any consequences. Confidentiality and anonymity of respondents were strictly maintained throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Consent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from all participants. Participants were assured that no personally identifiable information would be included in any publication or dissemination of the study findings. All data presented in this manuscript are anonymized to protect participants\u0026rsquo; privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6. Availability of Data and Materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to ethical and confidentiality considerations, but are available from the corresponding author on reasonable request. Data sharing will be subject to approval by the relevant ethics committee and in accordance with institutional guidelines to ensure participant confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7. Code Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis for this study was conducted using Stata version 17. Standard statistical procedures and commands available within the software were utilized. Any additional details regarding the analytical procedures can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8. Authors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRMKD: data curation, methodology, review and editing, WKJSA: write-up and editing. NAB: write-up and editing. IB: write-up and editing. AT: write-up and editing. EAA: review and editing. KAN: write-up and editing. RMKD: methodology, review, and editing. JAK: write up, methodology, OA: write-up and editing. APV-editing, AP-editing, AAO- writeup, all authors approved the version to be published and agreed to be accountable for all aspects of the work.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMesfin MD, Galgallo DA, Atmaca L, et al. Systematic review of challenges and prospective recommendations of medically assisted reproductive technology in developing countries. \u003cem\u003eFront Reprod Health\u003c/em\u003e; 7. Epub ahead of print 27 November 2025. DOI: 10.3389/frph.2025.1678033.\u003c/li\u003e\n\u003cli\u003eDamalie FJMK, Senaya CM, Damalie EA, et al. Assisted Reproductive Technologies (art) Equity, Justice and Autonomy in Ghana. 2024; 2024.10.19.24315805.\u003c/li\u003e\n\u003cli\u003eDamalie FJMK, Senaya CM, Damalie EA, et al. Barriers to assisted reproductive technology (ART) services in Ghana: a countrywide cross-sectional quantitative survey of fertility health workers and women with infertility. \u003cem\u003eBMC Health Serv Res\u003c/em\u003e 2025; 25: 1228.\u003c/li\u003e\n\u003cli\u003eSharma A, Borle A, Trikha A. Anesthesia for in vitro fertilization. \u003cem\u003eJournal of Obstetric Anaesthesia and Critical Care\u003c/em\u003e 2019; 5: 62\u0026ndash;72.\u003c/li\u003e\n\u003cli\u003eMatsota P, Kaminioti E, Kostopanagiotou G. Anesthesia Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof. \u003cem\u003eBiomed Res Int\u003c/em\u003e 2020; 2015: 475362.\u003c/li\u003e\n\u003cli\u003eLiu X-M, Zhang F, Lu X-S, et al. Effects and safety of propofol intravenous anesthesia in transvaginal oocyte retrieval on outcomes of in vitro fertilization and embryo transplantation. \u003cem\u003eFront Endocrinol\u003c/em\u003e; 15. Epub ahead of print 16 December 2024. DOI: 10.3389/fendo.2024.1497948.\u003c/li\u003e\n\u003cli\u003eMatsota P, Sidiropoulou T, Vrantza T, et al. Comparison of two different sedation protocols during transvaginal oocyte retrieval: Effects on propofol consumption and IVF outcome: A prospective cohort study. \u003cem\u003eJournal of clinical medicine\u003c/em\u003e 2021; 10: 963.\u003c/li\u003e\n\u003cli\u003eMatsota P, Sidiropoulou T, Vrantza T, et al. Comparison of Two Different Sedation Protocols during Transvaginal Oocyte Retrieval: Effects on Propofol Consumption and IVF Outcome: A Prospective Cohort Study. \u003cem\u003eJournal of Clinical Medicine\u003c/em\u003e 2021; 10: 963.\u003c/li\u003e\n\u003cli\u003ePiroli A, Marci R, Marinangeli F, et al. Comparison of different anaesthetic methodologies for sedation during \u003cem\u003ein vitro\u003c/em\u003e fertilization procedures: effects on patient physiology and oocyte competence. \u003cem\u003eGynecological Endocrinology\u003c/em\u003e 2012; 28: 796\u0026ndash;799.\u003c/li\u003e\n\u003cli\u003e Orak Y, Tolun Fİ, Bakacak M, et al. Effects of Propofol versus Sevoflurane on Postoperative Pain and Neuroendocrine Stress Response in Oocyte Pickup Patients. \u003cem\u003ePain Res Manag\u003c/em\u003e 2021; 2021: 5517150.\u003c/li\u003e\n\u003cli\u003e Cooper B, Reed J, Morris S, et al. Evaluation of Postoperative Recovery Duration across Different Anesthesia Techniques in Ghana, https://www.researchgate.net/profile/Ilesanmi-Michael-2/publication/397009852_Evaluation_of_Postoperative_Recovery_Duration_across_Different_Anesthesia_Techniques_in_Ghana_Authors/links/6901c7e3368b49329fa7e5a1/Evaluation-of-Postoperative-Recovery-Duration-across-Different-Anesthesia-Techniques-in-Ghana-Authors.pdf (2024, accessed 22 February 2026).\u003c/li\u003e\n\u003cli\u003e Djokoto RMK, Owusu VB, Agana EA, et al. Lifestyle factors and prevalence of semen abnormalities among men undergoing infertility evaluation at oak specialist hospital: A retrospective cohort study. \u003cem\u003ePLoS One\u003c/em\u003e 2026; 21: e0340902.\u003c/li\u003e\n\u003cli\u003e Farzi F, Mehrafza M, Mirmansouri A, et al. Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil\u0026ndash;A randomized clinical trial. \u003cem\u003eTaiwanese Journal of Obstetrics and Gynecology\u003c/em\u003e 2019; 58: 536\u0026ndash;540.\u003c/li\u003e\n\u003cli\u003e Juckenh\u0026ouml;fel S, Feisel C, Schmitt HJ, et al. [TIVA with propofol-remifentanil or balanced anesthesia with sevoflurane-fentanyl in laparoscopic operations. Hemodynamics, awakening and adverse effects]. \u003cem\u003eAnaesthesist\u003c/em\u003e 2019; 48: 807\u0026ndash;812.\u003c/li\u003e\n\u003cli\u003e Dhungana A, Baral P, Singh SN, et al. Comparison between total intravenous anesthesia (TIVA) with propofol\u0026ndash;fentanyl and balanced anesthesia with sevoflurane\u0026ndash;fentanyl in terms of hemodynamic changes and recovery profiles during laparoscopic cholecystectomy. \u003cem\u003eJournal of Chitwan Medical College\u003c/em\u003e 2022; 12: 63\u0026ndash;67.\u003c/li\u003e\n\u003cli\u003e Saravanaperumal G, Udhayakumar P. Opioid-free TIVA Improves Post- operative Quality of Recovery (QOR) in Patients Undergoing Oocyte Retrieval. \u003cem\u003eJ Obstet Gynaecol India\u003c/em\u003e 2022; 72: 59\u0026ndash;65.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Anaesthesia, Oocyte Retrieval, In Vitro Fertilization, Sevoflurane, Fertilisation Rate, Post-Operative Nausea and Vomiting","lastPublishedDoi":"10.21203/rs.3.rs-9248000/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9248000/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 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 (\u003cem\u003ep\u003c/em\u003e\u0026gt; 0.05). Post-operative vomiting was significantly lower in Group B (0%) than in the other groups (\u003cem\u003ep\u003c/em\u003e = 0.031). While oocyte yield was highest in Group C (\u003cem\u003ep\u003c/em\u003e = 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%) (\u003cem\u003ep\u003c/em\u003e = 0.009).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e 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.\u003c/p\u003e","manuscriptTitle":"Anaesthesia for Transvaginal Oocyte Retrieval in IVF: A Prospective Comparative Cohort Study from Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-06 08:25:47","doi":"10.21203/rs.3.rs-9248000/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-20T06:24:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T08:54:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T17:52:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T09:19:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96626377887681161318338338737693165934","date":"2026-04-04T16:45:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6118685884046140144616155936949981811","date":"2026-04-04T08:14:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317191936543762772053215664241635730152","date":"2026-04-01T11:19:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245202266858075946156429244158529659753","date":"2026-04-01T07:29:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-01T07:17:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T11:34:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-31T10:02:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"SN Comprehensive Clinical Medicine","date":"2026-03-27T19:45:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ef0aa0bc-6df6-4230-aa15-f7aa8a78c41c","owner":[],"postedDate":"April 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T11:54:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-06 08:25:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9248000","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9248000","identity":"rs-9248000","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}