This was a retrospective cohort study of subjects undergoing SER at an academic fertility clinic January 2021 to March 2022. Patients received either 0mg, 15mg, or 30mg of ketorolac at the completion of the SER based on anesthesiologist preference. Subjects were excluded for missing covariate data. Primary outcome was average post operative pain scores (scale 1-10). Secondary outcomes included need for pain medications (morphine milligram equivalents; MME), need for heating pad). For those undergoing fresh embryo transfer, ongoing/delivery rate (either delivery or IUP with confirmed fetal heartbeat on two ultrasounds in the first trimester prior to initiating obstetrical care) was assessed based on dose of ketorolac. Demographic and clinical variables were compared between groups using Student’s t-test for medians, chi square test for discrete variables, logistic regression, and Pearson correlation.

A total of 308 SERs (evaluated for post-operative pain) were performed with 224 fresh embryo transfers (evaluated for pregnancy outcomes). The average age of subjects was 34.36 +/- 4.54. There was no statistically significant difference in post-operative PACU pain (2.37 ± 2.4-3.4 for 0mg vs. 1.78 ± 1.9-4.1 for 15mg vs. 2.52 ± 2.4-3.0 for 30mg) and post-operative opioids need in PACU. Higher BMI was found to be significantly associated with increased post-op pain among all BMI classes except class 3 when compared with normal BMI (overweight (n = 117) 2.54, p = 0.0088, class 1 (n=91) 2.07, p = 0.0419, and class 2 (n=59), 1.98 p=0.146). The peak estradiol levels showed weak but statistically significant association with PACU pain (Rho=0.15, p=0.012). However, higher dose of total gonadotropins decreased the intensity of PACU pain (Rho=0.18, p=0.001). There was no relationship between different doses of ketorolac and ongoing/delivery rates.

In this study we found similar post-operative SER pain scores regardless of ketorolac dose. However, we were unable to look at “at-home” pain scores or pain medication use that may have been affected. Importantly, the use of ketorolac did not affect ongoing/delivery rates, as was previously hypothesized. Therefore, ketorolac can be safely used post SER without significantly affecting reproductive outcomes and in hopes of decreasing narcotic use.