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Feasibility of elective single cleavage-stage embryo transfer: a meta-analysis

Bibliographic details: Wang ZH, La XL, Zhao J, Gong XY, Hu B, Wang P.  Feasibility of elective single cleavage-stage embryo transfer: a meta-analysis. Chinese Journal of Evidence-Based Medicine 2012; 12(6): 1251-1257

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Single or multiple embryo transfer following in vitro fertilisation for improved neonatal outcome: a systematic review of the literature

This review concluded that transferring one embryo during in vitro fertilisation does not alter the likelihood of a singleton pregnancy or birth compared with transferring two or more embryos, whilst transferring one or two embryos decreases the risk of a multiple pregnancy, pre-term birth and low birth weight. Given the variation and poor design and quality of the studies, the authors' conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles: a systematic review and meta-analysis

OBJECTIVE: To examine the available evidence to assess if cryopreservation of all embryos and subsequent frozen embryo transfer (FET) results in better outcomes compared with fresh transfer.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Bed rest after embryo transfer

In in vitro fertilization (IVF), embryo implantation is a very complex event influenced by embryo quality and endometrial receptivity. Many interventions have been used to increase the implantation rate, but bed rest is probably the most commonly prescribed. Since the etiology of implantation failure in most cases is not related to an excess of activity, however, it is unlikely that bed rest could be an effective strategy to improve pregnancy outcome. We performed a systematic review to evaluate the effect of prescription of bed rest to increase pregnancy rate. A systematic literature search in MEDLINE, EMBASE, and the Chinese Biomedical Database (CBM) was performed to identify articles reporting randomized controlled trials (RCTs) which compared different time length of bed rest in infertile women undergoing embryo transfer (ET). Two authors independently searched the abstracts, identified relevant papers, assessed inclusion and trial quality, and extracted the relevant data. Three trials involving three different comparison groups were included in the review and enrolled a total of 724 randomized subjects. The quality of the included studies was high. The conclusion was that there was insufficient evidence to support the routine use of bed rest to improve pregnancy outcome in women undergoing ET in IVF cycles.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

A review and meta-analysis of prospective trials comparing different catheters used for embryo transfer

OBJECTIVE: To determine the relative efficacy of different types of embryo transfer (ET) catheters.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

A meta-analysis of ultrasound-guided versus clinical touch embryo transfer

OBJECTIVE: To determine the relative efficacy of ultrasound-guided embryo transfer and embryo transfer by clinical touch alone.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Effect of passive uterine straightening during embryo transfer: a systematic review and meta-analysis

BACKGROUND: Part of the success of ultrasound-guided embryo transfer has been associated with the beneficial effect of uterine straightening by passive bladder distention. Even so, this has not been properly analysed in the literature.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Cervical mucus removal before embryo transfer in women undergoing in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE: To appraise critically the published randomized controlled trials (RCTs) reporting on the effectiveness of cervical mucus removal before embryo transfer.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

What is the optimal means of preparing the endometrium in frozen-thawed embryo transfer cycles? A systematic review and meta-analysis

BACKGROUND Frozen-thawed embryo transfer (FET) enables surplus embryos derived from IVF or IVF-ICSI treatment to be stored and transferred at a later date. In recent years the number of FET cycles performed has increased due to transferring fewer embryos per transfer and improved laboratory techniques. Currently, there is little consensus on the most effective method of endometrium preparation prior to FET. METHODS Using both MEDLINE and EMBASE database a systematic review and meta-analysis of literature was performed. Case-series, case-control studies and articles in languages other than English, Dutch or Spanish were excluded. Those studies comparing clinical and ongoing pregnancy rates as well as live birth rates in (i) true natural cycle FET (NC-FET) versus modified NC-FET, (ii) NC-FET versus artificial cycle FET (AC-FET), (iii) AC-FET versus artificial with GnRH agonist cycle FET and (iv) NC-FET versus artificial with GnRH agonist cycle FET were included. Forest plots were constructed and relative risks or odds ratios were calculated. RESULTS A total of 43 publications were selected for critical appraisal and 20 articles were included in the final review. For all comparisons, no differences in the clinical pregnancy rate, ongoing pregnancy rate or live birth rate could be found. Based on information provided in the articles no conclusions could be drawn with regard to cancellation rates. CONCLUSIONS Based on the current literature it is not possible to identify one method of endometrium preparation in FET as being more effective than another. Therefore, all of the current methods of endometrial preparation appear to be equally successful in terms of ongoing pregnancy rate. However, in some comparisons predominantly retrospective studies were included leaving these comparisons subject to selection and publication bias. Also patients' preferences as well as cost-efficiency were not addressed in any of the included studies. Therefore, prospective randomized studies addressing these issues are needed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Neonatal outcomes among singleton births after blastocyst versus cleavage stage embryo transfer: a systematic review and meta-analysis

BACKGROUND: Several studies have evaluated outcomes of singleton pregnancies after blastocyst versus cleavage stage embryo transfer. Higher incidences of preterm birth (PTB), very preterm birth (VPTB), low birthweight (LBW) and congenital malformations were identified in a few of them. The objective of our study was to systematically review and meta-analyze pregnancy and neonatal outcomes among singleton births following blastocyst versus cleavage stage embryo transfer. METHODS EMBASE, MEDLINE, EBM Reviews and bibliographies of included studies were searched from their inception until March 2013. Observational studies or clinical trials comparing blastocyst with cleavage stage embryo transfer and reporting on outcomes of PTB (<37 weeks), VPTB (<32 weeks), LBW (<2500 g), very low birthweight (VLBW) (<1500 g) and/or congenital anomalies in singleton neonates were included. Data on the outcomes were extracted by two reviewers. Statistical heterogeneity among studies was evaluated by calculating I(2) values and χ(2) statistics. Meta-analyses were conducted to estimate the pooled unadjusted odds ratio (OR) and the adjusted OR (AOR) with a 95% confidence interval (CI) using the random effect model. RESULTS Six observational studies, of low to moderate risk of bias, were included in this review. There were significantly higher odds of PTB (four studies, 54 792 cleavage stage and 20 724 blastocyst stage births; AOR 1.32, 95% CI 1.19-1.46) and congenital anomalies (two studies, 22 068 cleavage stage and 4517 blastocyst stage births; AOR 1.29, 95% CI 1.03-1.62) among births after blastocyst transfer compared with cleavage stage transfer. There was no difference in the adjusted odds of VPTB (four studies, 54 792 cleavage stage and 20 724 blastocyst stage births; AOR 1.18, 95% CI 0.93-1.49), LBW (four studies, 54 109 cleavage stage and 20 392 blastocyst stage births; AOR 1.06, 95% CI 0.99-1.15) or VLBW (three studies, 22 088 cleavage stage and 5772 blastocyst stage births; AOR 1.01, 95% CI 0.73-1.38). CONCLUSIONS Risk of PTB in IVF singleton pregnancies is significantly higher following blastocyst transfer compared with cleavage stage transfer. Risk of congenital anomalies may also be higher but further studies are needed to confirm this finding and to identify reasons for such outcomes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Among women undergoing embryo transfer, is the probability of pregnancy and live birth improved with ultrasound guidance over clinical touch alone: a systemic review and meta-analysis of prospective randomized trials

OBJECTIVE: To investigate the theory that ultrasound guidance during ET improves clinical outcomes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

The likelihood of live birth and multiple birth after single versus double embryo transfer at the cleavage stage: a systematic review and meta-analysis

OBJECTIVE: To determine whether a policy of elective single-embryo transfer (e-SET) lowers the multiple birth rate without compromising the live birth rate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Techniques for preparation prior to embryo transfer

Embryo transfer (ET) is the final and most vulnerable step in in vitro fertilisation (IVF) treatment. In vitro fertilisation outcomes could be improved by preparation techniques such as straightening the utero‐cervical angle, cervical and endometrial preparation, the performance of a dummy transfer and embryo afterloading. This review found no evidence from randomised controlled trials that any of these techniques benefit the outcomes in IVF.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection

Although an increase in clinical pregnancy rate with day three embryo transfer was demonstrated, at present there is not sufficient good quality evidence to suggest an improvement in live birth when embryo transfer is delayed from day two to day three.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis

The use of elective single embryo transfer had a decreased risk of low birth weight and preterm birth compared with double embryo transfer, but higher risks of preterm birth than spontaneous conceptions. The authors' conclusions should be interpreted cautiously due to the potential for language and publication bias and variation between studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

This review concludes that there is insufficient evidence to support the use of one menstrual cycle regimen over another in frozen‐thawed embryo transfer (FET).

Women with regular spontaneous cycles may be offered any of the cycle regimens to prepare the womb lining for FET. If artificial cycles are used there is some evidence to support the use of an additional drug that suppresses hormone production by the ovaries (gonadotrophin releasing hormone agonist (GnRHa)). There is a need for additional well‐designed studies to be performed, to determine whether a specific cycle regimen is linked with higher pregnancy and live birth rates.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women

The inability to achieve a live birth for some women undergoing fertility treatment can be due to a number of factors such as lack of good quality embryo/s, problems with the uterus, or the transfer technique itself. This review looks at one aspect of the transfer technique and whether ultrasound guidance improves pregnancy rates compared with clinical judgement. Although clinical pregnancies and ongoing pregnancies were increased for the ultrasound guided group compared with the clinical touch group; there was no evidence of a difference between ultrasound guided embryo transfer and clinical touch for the outcome of live birth. The risks of harm using ultrasound guided transfer, including miscarriage, ectopic pregnancies and multiple pregnancies, are no different to when clinical judgement is used.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Effectiveness of GnRH antagonist in vitro fertilization-embryo transfer (IVF): a systematic review

Bibliographic details: Xiao JS, Chen SY, Zhang CL, Chang S.  Effectiveness of GnRH antagonist in vitro fertilization-embryo transfer (IVF): a systematic review. Chinese Journal of Evidence-Based Medicine 2010; 10(12): 1432-1438

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomised trials

This individual patient data meta-analysis concluded that there was a lower pregnancy rate with elective fresh single embryo transfer compared to double transfer; this difference was overcome by an additional frozen single embryo transfer cycle. The multiple pregnancy rate following single embryo transfer was comparable to that in spontaneous pregnancies. The authors' conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Antibiotics prior to embryo transfer in ART

In vitro fertilisation (IVF) describes an assisted reproductive technology (ART) during which a woman undergoes ovarian stimulation, surgical retrieval of eggs, fertilisation of eggs outside of the body, and finally the transfer of resulting embryo(s) into the uterus by an embryo transfer (ET) procedure. During an ET, the embryo(s) is passed through the cervix by means of a catheter. Many variables affect the chance of pregnancy after ET, including embryo quality, uterine factors and the embryo transfer technique. High levels of bacteria and other organisms in the upper genital tract have a detrimental effect on pregnancy rate after ET. Administration of antibiotics prior to ET may reduce the growth of these organisms and improve the outcomes of IVF. This review considered the question of whether antibiotics given at any time prior to ET affect pregnancy rates and other important outcomes of IVF.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Medical Encyclopedia

  • In vitro fertilization (IVF)
    In vitro fertilization (IVF) is the joining of a woman's egg and a man's sperm in a laboratory dish. In vitro means outside the body. Fertilization means the sperm has attached to and entered the egg.
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