The effect of ketorolac on pregnancy rates when used immediately after oocyte retrieval

Capsule:
An analysis of ketorolac use after oocyte retrieval over a 5-year period in a population undergoing in vitro fertilization found no differences in pregnancy outcomes.

Authors:
Tolga B. Mesen, M.D., Lamya Kacemi, M.D., Paul B. Marshburn, M.D., Rebecca S. Usadi, M.D., Michelle Matthews, M.D., H. James Norton, Ph.D., Bradley S. Hurst, M.D.

Volume 100, Issue 3, Pages 725-728, September 2013

Abstract:

Objective:
To study the effect of ketorolac, a potent anti-inflammatory medication, on in vitro fertilization (IVF) pregnancy outcomes when used at the time of oocyte retrieval.

Design:
Retrospective review of 454 patients from 2003–2009.

Setting:
Tertiary hospital-affiliated fertility center.

Patient(s):
Consecutive subfertile women undergoing their first IVF cycle.

Intervention(s):
Ketorolac administration immediately after oocyte retrieval.

Main Outcome Measure(s):
Pregnancy, implantation, live-birth, and miscarriage rates, and postsurgical visual analog pain score.

Result(s):
Of the 454 patients undergoing their first IVF cycle for all indications, 103 received intravenous ketorolac immediately after oocyte retrieval, based on anesthesiologist preference. Patient and procedural characteristics were similar between both groups. The use of ketorolac had no effect on the rates of implantation, miscarriage, pregnancy, live birth, or multiple pregnancy. The patients receiving ketorolac experienced statistically significantly less pain.

Conclusion(s):
This study suggests ketorolac has no apparent detrimental effect on IVF pregnancy outcomes when administered immediately after oocyte retrieval. Ketorolac appears to be a safe and effective analgesic to use at the time of oocyte retrieval.

  • This study addresses the use of a single dose of 30 mg ketorolac / Toradol IV post-retrieval. In addition to the fact that the authors found no significant difference in pregnancy parameters, it is reassuring that no episodes of excessive bleeding were noted (this concern is often given as a reason for not giving it). The study suffers from being retrospective and from potential selection bias – the decision whether to give Toradol was made by the anesthesiologist. But it provides preliminary reassurance to consider it as an option to treat post-retrieval pain, until randomized prospective data become available.

  • Lauren Johnson

    Congratulations to the authors for this intriguing article. In addition to improvement in post-retrieval pain, it would also be interesting to see if use of ketorolac correlates with shorter post-retrieval recovery time or improved patient satisfaction. Were you able to look at either of these outcomes?

  • Amanda N. Kallen

    Very interesting clinically relevant study as it would be great to have NSAIDs as an option for post-retrieval pain control. The discussion about the half-life of ketorolac in regards to the window of implantation is particularly helpful. Notably, as the authors point out, there were more flare cycles in the “no-ketorolac” group. The groups are matched for age, but I’m wondering if there were any differences in AMH/FSH/AFC that led to the initial selection of a flare protocol in some of these patients (that ended up in the “no-ketorolac” group? Such differences might cause this group to perform a little more poorly than expected, and thus mask a difference in outcomes…?

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