Ketorolac Use and Fresh Embryo Transfer Outcomes

Study Design: double-blind randomized controlled trial Intervention: Ketorolac (30mg intravenous) administration in the immediate post-operative period prior to leaving the procedure room and while patient is still under sedation

Allocation method: 1:1 statistician generated block randomization (blocks of 2, 4, and 6). Patients will be randomized immediately following consent and enrollment.

Materials and Methods: Patients undergoing an IVF autologous cycle at our institution where the female patient is planning on proceeding with a fresh embryo transfer 5 days following ultrasound guided oocyte retrieval will be recruited. Patients may undergo any of our standard controlled ovarian hyperstimulation protocols.

On the day of egg retrieval patients will:

• Sign the consent and be randomly assigned to one of two groups (usual care plus ketorolac OR usual care without ketorolac).
• At the end of the retrieval procedure while the patient is still under sedation, the anesthesiology team will administer either usual care plus ketorolac OR usual care without ketorolac through the pre-existing IV line.

Patients IVF care will otherwise remain the same as planned, including:

• Monitoring in the recovery area as per standard protocol
• Embryo transfer on day 5 post-retrieval

Investigators will continue to review and collect data from patients' medical records for up to 45 weeks. This will include demographic and medical information, including, but not limited to:

• age, medical diagnosis, physical exam findings such as height and weight, laboratory testing, and ultrasound results
• reproductive history including how long patients have been trying to conceive, infertility diagnoses, outcomes of past pregnancies, outcomes of prior infertility evaluation and treatments
• the types and doses of medications used, types of infertility treatments used, and information about patients' treatment cycles. Treatment cycle information will include, but is not limited to:
• response to ovarian stimulation,
• sperm count,
• embryo development and quality,
• any post-retrieval evaluations for pain and/or bleeding, and
• whether or not a pregnancy resulted.
• narcotic use during recovery, and time to discharge
• Outcomes from the fresh embryo transfer following retrieval. If patients conceive a pregnancy, then investigators will follow the pregnancy through its resolution. Investigators will collect information about patients:
• pregnancy hormone levels,
• confirmation or pregnancy ultrasound findings,
• information on implantation, clinical pregnancy, miscarriage, and live births.

Inclusion criteria

• IVF utilizing autologous oocytes and all sperm sources
• IVF cycles utilizing ICSI and standard insemination
• Plan to transfer embryo on day 5
• BMI below 50

Exclusion criteria

-allergies or medical contraindications to NSAIDs