OFFICE LAPAROSCOPY UNDER LOCAL-ANESTHESIA FOR GAMETE INTRAFALLOPIAN TRANSFER - TECHNIQUE AND TOLERANCE

Objective: To describe our technique for laparoscopic GIFT under local anesthesia and to evaluate patient tolerance and surgeon satisfaction in 175 consecutive procedures. Design: Prospective cohort study. Sett ing: University infertility practice. Patient(s): All GIFT candidates from 1992 to 1996 were offered the procedure. Of 119 patients, 119 cho se local anesthesia for 175 procedures and 1 patient elected to have g eneral anesthesia. Intervention(s): Transvaginal ultrasound-guided egg retrieval followed by GIFT in the clinic procedure room with a 5-mm l aparoscope and two accessory 3-mm trocars with local anesthesia and TV sedation. Main Outcome Measure(s): Patient tolerance and acceptance, duration of the procedure, amount of analgesics, surgeon satisfaction, and pregnancy rate (PR). Result(s): The laparoscopic portion lasted a n average of 27 minutes, with a mean dose of 1.41 mg of midazolam and 68 mu g of fentanyl used. Sixty-nine percent of the patients scored '' very good,'' 20% ''good,'' 9% ''acceptable,'' and 2% ''poor.'' All 38 patients undergoing 97 repeat procedures selected local anesthesia aga in. For women <40 years of age, clinical PR and delivery rate were 43% and 38%, respectively. Conclusion(s): Routine office GIFT under local anesthesia is effective and well accepted by the surgeon and is prefe rred by patients. It offers a significant cost containment and schedul ing flexibility in addition to high success rates. (C) 1997 by America n Society for Reproductive Medicine.