Effect of class III and class IV obesity on oocyte retrieval complications and outcomes

Oocyte retrieval in class III and class IV obesity patients requires alterations to anesthetic and procedural approaches but can be safely performed in tertiary care settings.

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Volume 111, Issue 2, Pages 294–301.e1


Phillip A. Romanski, M.D., Leslie V. Farland, Sc.D., Lawrence C. Tsen, M.D., Elizabeth S. Ginsburg, M.D., Erin I. Lewis, M.D.



To assess the effect of class III (body mass index [BMI] 40–49.9 kg/m2) and class IV obesity (BMI ≥ 50 kg/m2) on oocyte retrieval complications and outcomes.


Cohort study.


Academic center.


Women who underwent an oocyte retrieval from January 1, 2012 to May 31, 2017. Women with BMI ≥ 40 kg/m2(n = 144) were age-matched to women with BMI <25, 25–29.9, 30–34.9, and 35–39.9 kg/m2 (n = 1,016).



Main Outcome Measure(s)

Anesthetic and procedural outcomes during oocyte retrieval.


Overall, 1,924 of 1,947 oocyte retrievals (98.8%) were performed under total intravenous anesthesia. No patients with BMI ≥ 40 kg/m2 required intraoperative conversion to endotracheal intubation or hospital admission. Two patients (0.8%) with BMI ≥ 40 kg/m2 required a laryngeal mask airway intraoperatively owing to oxygen desaturation. An oral/nasal airway was used to resolve oxygen desaturation in 16 patients (6.25%) with BMI ≥ 40 kg/m2, compared with in 17 patients (1.0%) with BMI < 40 kg/m2. As BMI increased, a statistically significant increase in propofol dose, fentanyl dose, and procedure time was observed. Eighteen patients (7.0%) with BMI ≥ 40 kg/m2 underwent a transabdominal retrieval, compared with 15 (0.9%) with BMI < 40 kg/m2.


Serious intraoperative and postoperative complications were uncommon across all BMI groups, though minor complications were more common with class III and class IV obesity. These patients were also more likely to require higher doses of propofol and fentanyl, have longer oocyte retrievals, and require a transabdominal retrieval. Overall, oocyte retrieval can be safely performed as an outpatient procedure in women with class III and class IV obesity.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.