Clinical and Hormonal Determinants of Propofol Requirement During Oocyte Pick-Up: A Prospective Observational Study

Objectives: Oocyte pick-up (OPU) is commonly performed under propofol-based sedation during in vitro fertilization (IVF). However, considerable interindividual variability in propofol requirement has been observed. Controlled ovarian hyperstimulation results in supraphysiological levels of ovarian steroid hormones, which may influence anesthetic sensitivity. This study aimed to evaluate the relationship between preprocedural serum estradiol and progesterone levels and propofol requirement during OPU performed under bispectral index (BIS)-guided sedation. Methods: In this prospective observational study, 96 women undergoing OPU were included. Serum estradiol and progesterone levels measured on the day of the procedure were recorded. Sedation was performed using a standardized protocol with midazolam, fentanyl, and propofol titrated to maintain BIS values between 40 and 60. Propofol consumption was normalized to body weight (mg/kg) and procedure duration (μg/kg/min). Correlation analyses and multivariable linear regression models were used to evaluate associations. Results: Mean propofol consumption was 157.3 ± 53.1 mg (2.41 ± 0.83 mg/kg), corresponding to an infusion rate of 125.7 ± 69.6 μg/kg/min. In multivariable analysis, estradiol levels were independently associated with propofol requirement (β = 0.238, p = 0.014), whereas progesterone levels were not significantly associated with anesthetic dosing after adjustment. BMI (β = -0.305, p = 0.002) and procedure duration (β = 0.224, p = 0.021) were also identified as independent predictors. Conclusions: Estradiol levels were associated with propofol requirement during OPU performed under BIS-guided sedation. However, given the observational design and the modest magnitude of the observed associations, these findings should be interpreted cautiously. BMI and procedure duration appeared to be more consistent predictors of propofol administration.