Randomized controlled study on the use of virtual reality for pain relief in oocyte retrieval under transvaginal ultrasound guidance using paracervical block and conscious sedation

Abstract

STUDY QUESTION Does the use of virtual reality (VR) reduce pain levels experienced by women during transvaginal oocyte retrieval using paracervical block and conscious sedation? SUMMARY ANSWER The use of VR did not reduce pain levels during oocyte retrieval using paracervical block and conscious sedation. WHAT IS KNOWN ALREADY Conscious sedation is commonly used for pain relief during oocyte retrieval, and the concurrent use of more than one method of sedation and analgesia resulted in better pain relief than a single modality. Many studies have shown promising results in reducing anxiety and pain with the use of VR during medical procedures. STUDY DESIGN, SIZE, DURATION This is a randomized controlled trial of 160 infertile women undergoing transvaginal oocyte retrieval using paracervical block and conscious sedation between December 2022 and October 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was conducted in a university-affiliated assisted reproduction unit. Recruited women were randomly assigned into the VR group (n = 80) and the standard care group (n = 80). Pain levels upon vaginal puncture and oocyte retrieval were recorded using a 100-point visual analogue scale. MAIN RESULTS AND THE ROLE OF CHANCE Both groups were comparable in terms of demographic parameters, ovarian stimulation responses, and the anxiety trait and state scores. There was no significant difference in maximal pain level at vaginal puncture (50.8 ± 23.6 vs. 54.8 ± 25.4; 95% CI -11.7, 3.7; P = 0.30) and oocyte retrieval (56.4 ± 24.6 vs. 60.3 ± 26.8; 95% CI -12.0, 4.2; P = 0.34) between the VR group and standard care group. The satisfaction score was similar in both groups. LIMITATIONS, REASONS FOR CAUTION The small sample size of the study was a limitation. Blinding participants and researchers were not feasible due to the nature of the study. The degree of immersion was also affected when viewing the VR headset from a prone perspective, and the experience was also limited by the standardization of VR scenario and audio. The pain score recorded by the visual analogue scale was a subjective measurement. WIDER IMPLICATIONS OF THE FINDINGS Although the use of VR was otherwise well tolerated without major side effect, its routine use for pain relief during oocyte retrieval cannot be supported. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by an internal grant (Professor P.C. Ho Research and Development Fund in Reproductive Medicine). None of the authors has conflicts of interest to declare. TRIAL REGISTRATION NUMBER ClinicalTrials.gov with identifier NCT05218382 TRIAL REGISTRATION DATE 18 December 2021 DATE OF FIRST PATIENT'S ENROLMENT 1 December 2022.