Risk factors for acute pain after transvaginal ultrasound-guided oocyte retrieval: a retrospective study (2023-2024)

BACKGROUND: Transvaginal ultrasound-guided oocyte retrieval is required for assisted reproductive technology. This is a short and minimally invasive, but painful procedure. There are no clinical guidelines on optimal pain management. We aimed to identify risk factors for acute post-procedural pain to help target individualized prevention strategies. METHODS: We conducted a one-year retrospective cohort study (June 30, 2023 to June 30, 2024) at Montpellier University Hospital (France), comparing clinical and procedural characteristics with post-procedural pain. Data were classified as patient-, anesthesia-, and procedure-related variables. The primary outcome was post-procedural pain, defined as a maximal NRS > 3 or requirement for rescue analgesia within 4 h. The secondary outcome was moderate to severe post-procedural pain, defined as a maximal NRS > 5 or morphine consumption within 4 h. RESULTS: A total of 1000 oocyte retrieval procedures were included. Post-procedural pain was observed in 608 of 986 patients (61.66%) and moderate to severe pain in 227 of 982 patients (23.12%), based on available outcome data. Independent risk factors for post-procedural pain (n=969) were age (OR 0.96, P = 0.020), pre-procedural pain (OR 5.84, P < 0.001) and procedure duration (OR 1.07, P < 0.001). For moderate to severe pain (n = 816), independent risk factors were pre-procedural pain (OR 4.12, P < 0.001), endometriosis (OR 2.23, P < 0.001), anti-Mullerian hormone levels (OR 1.11, P = 0.009) and procedure duration (OR 1.05, P = 0.001). CONCLUSIONS: Younger age, pre-procedural pain, procedure duration, endometriosis and high basal anti-Mullerian hormone levels are risk factors and should prompt prophylactic strategies for post-procedural pain management.