In recent years assisted reproduction has become more evidence based in an attempt to determine what techniques truly work compared to what does not. This has led to major changes in the way embryos are transferred and what therapies are given to women before and after the transfer. Even so, one aspect that is still not well established is whether or not there are ways to decrease the movement or expulsion of embryos from the uterus following transfer. Based on this lack of information, combined with the need to clearly improve outcomes by reducing the risk of losing embryos following transfer, we decided to systematically locate and review the best available evidence regarding post-embryo transfer (ET) interventions for women undergoing IVF and intracytoplasmic sperm injection (ICSI). Following meticulous searches of major databases and conference proceedings we were able to locate four trials. These were all prospective, randomised controlled trials comparing two competing post-ET interventions or an intervention versus no treatment on clinical outcomes in women undergoing IVF and ICSI.
Our primary outcome measure, live birth rate, was not reported in any of the included trials. In addition, the ongoing pregnancy and or live birth rate was only reported in one trial that compared immediate ambulation to 30 minutes of bed rest following embryo transfer, with no clear difference reported. Clinical pregnancy rate was reported in all 4 trials. It was not clearly affected by different amounts of bed rest (more and less) following embryo transfer, nor was there any significant difference between the use of a fibrin sealant and no intervention. Forcibly closing the cervix resulted in a significantly higher chance of pregnancy compared with no intervention. The reporting of a proper method of randomisation and allocation concealment was demonstrated in the majority of trials, while only one trial was reported to have used blinding. In conclusion, there is insufficient evidence to support any certain amount of time for women to remain recumbent, if at all, following embryo transfer. Also there is insufficient evidence to support the addition of fibrin sealants to the embryo transfer media. Finally, there is limited evidence to support the use of mechanical pressure to close the cervical canal following embryo transfer. Further well-designed and powered studies are required to determine the true effect, if any, of post ET interventions on women undergoing IVF and ICSI.