Estrogen Levels and Postoperative Recovery in IVF Patients

Postoperative recovery is a multidimensional and complex process influenced by pain, nausea and vomiting, emotional and functional factors. IVF (In Vitro Fertilization) treatments involve controlled ovarian hyperstimulation, which causes supraphysiologic increases in serum estrogen levels. Elevated estrogen is thought to affect pain modulation and inflammatory pathways and has been associated with increased symptoms such as nausea and mood fluctuations.

This prospective observational study aims to investigate the relationship between serum estrogen concentration and the quality of recovery in patients undergoing IVF-related transvaginal oocyte retrieval under general anesthesia. A total of 100 ASA I-II adult female patients between the ages of 18 and 45 will be enrolled.

Patients will be grouped based on their estradiol (E2) levels measured as part of the routine IVF procedure. E2 levels above 350 pg/ml will be defined as supraphysiologic. The primary outcome is the postoperative recovery quality assessed using the QoR-15 questionnaire at 24 and 72 hours postoperatively. Secondary outcomes include postoperative pain intensity (measured by the Numerical Rating Scale), nausea and vomiting (assessed by Verbal Descriptive Scale), and time to discharge (evaluated using the Modified Aldrete Score). Preoperative anxiety and depression will be assessed using the Hospital Anxiety and Depression Scale (HADS).

This study aims to contribute to improved anesthetic and perioperative management of IVF patients with elevated estrogen levels.

Inclusion criteria

• Female patients aged between 18 and 45 years
• ASA physical status I or II
• Scheduled for transvaginal oocyte retrieval under general anesthesia as part of an IVF procedure
• Willing and able to provide written informed consent
• Able to understand and complete study questionnaires (QoR-15, HADS)

Exclusion criteria

• ASA physical status III or IV
• History of severe renal, hepatic, respiratory, or cardiovascular disease
• Current or chronic use of psychotropic medications
• Chronic use of opioids or benzodiazepines
• Known psychiatric or neurological disorders that may interfere with study participation
• Inability to provide informed consent or complete study questionnaires