This study examined predictors of pain experienced during oocyte retrieval among 837 women undergoing IVF or ICSI treatment. The mean reported pain level was 1.95 on a 7-point scale. High pain (5-6) was reported by 7% of women. Negative gynecological experiences and hormonal side effects predicted high pain before retrieval, while anxiety, low perceived control, and longer procedure duration predicted high pain after retrieval according to multiple logistic regression. The findings suggest psychological factors like anxiety and perceived control influence pain levels during oocyte retrieval and should be considered in pain management.

1. Predictors of pain
- During oocyte retrieval
Introduction
Despite the development of elaborate pain management pro-
tocols, the experience of pain during procedures such as oocy-
te retrieval remains a challenge for a subgroup of patients. The
present study examined: a) the prevalence of pain and b)
possible medical and psychosocial risk factors for experiencing
severe pain in a sample of women going through in vitro
fertility or intracytoplasmic sperm injection treatment.
Materials and Methods
The present study included 837 women (mean age: 31.2
years, SD: 3.9) in their first IVF/ICSI treatment cycle. The
women completed three questionnaires on their 21st day of
the cycle (t1), before the oocyte retrieval surgery (t2), and
after the oocyte retrieval when the effect of sedation and
analgesics had subsided (t3). Sixty-nine women were lost to
follow-up. Pain intensity was measured on a 7-point Likert
scale (range 0–6) and dichotomized into either low pain (0-4)
or high pain (5-6) as the dependent variable. The independent
variables; negative gynecological experiences, hormonal side
effects, anxiety and perceived control were also measured on a
7-point Likert scale.
Results
The mean pain level was 1.95 (SD: 1.43) for the total sample.
High pain intensity (scores ≥ 5) was reported by 50 (7%)
women, with the remaining 690 women (93%) reporting low
to moderate pain (0-4).
Multiple logistic regression indicated that the significant
predictors of high pain intensity, measured before the oocyte
retrieval, were negative gynecological experiences and hor-
monal side effects. Variables independently associated with
high pain levels after the oocyte retrieval were: anxiety, low
levels of perceived control and duration of the procedure.
Conclusions
Previous negative gynecological experience, hormonal treat-
ment side effects, anxiety levels, and perceived lack of control
were significantly associated with high pain intensity during
oocyte retrieval.
The findings may help identifying women who are at risk of
experiencing unacceptable pain levels during oocyte retrieval
procedures. Targeting and understanding the role of psycho-
logical factors such as pain catastrophizing and rumination
associated with previous negative gynecological examinations
may help improve individual pain management. Also, factors
such as anxiety and feelings of lack of control are commonly
associated with higher pain levels, which may also be the case
for clinical populations awaiting sub-acute, minor surgery.
Medical staff is advised to take psychological factors into
account.
Acknowledgments
This research received financial support from
the Centre for preimplantation Genetic
Diagnosis/The Fertility Clinic, Aarhus
University Hospital, Aarhus, Denmark.
Contact
Yoon Frederiksen, MSc Psychology
Email: yoonf@psy.au.dk
Figure 1. Mean pain scores for the total sample (N=740),
the low pain (N=690), and high pain group (N=50).
Yoon Frederiksen, Mimi Y. Mehlsen, Signe MS Matthiesen, Robert Zachariae & Hans Jakob Ingerslev
1) Psychooncology and Health Psychology Research Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
2) Department of Psychology, Aarhus University, Aarhus, Denmark
3) Family, children and youth, Department of projects and development, Interventions for children and family, Aarhus municipality, Aarhus, Denmark
4)Centre for Preimplantation Genetic Diagnosis/The Fertility Clinic, Aarhus University Hospital, Aarhus N, Denmark;
5) Department of Health, Aarhus University, Aarhus, Denmark
Predictor OR P 95 %CI
Before the oocyte retrieval:
Negative gynecological
experiences
1.099 0.001 1.029, 1.173
Hormonal side effects 1.619 0.001 1.232, 2.128
After the oocyte retrieval:
Anxiety 1.296 0.021 1.040, 1.615
Perceived control 0.621 0.000 0.492, 0.784
Duration of the
procedure
1.084 0.001 1.035, 1.136
Table 1. Predictors of pain during oocyte retrieval.
Results of adjusted multiple logistic regression analyses
measured before and after the oocyte retrieval
* R-square statistics: Nagelkerke R2=0.287