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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

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

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

Adherence compounds in embryo transfer media for assisted reproductive technologies

Cochrane review authors assessed the effect of the addition of adherence compounds in embryo transfer media on fertility outcomes.

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

Version: 2015

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

We wanted to learn whether ultrasound‐guided embryo transfer (UGET) improves pregnancy outcomes compared with clinical touch. The traditional method of embryo transfer, clinical touch relies on the clinician's tactile senses to judge when the transfer catheter is in the correct position.

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

Version: 2016

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

Cochrane review authors investigated whether transferring an embryo on Day two or on Day three of development makes a difference to pregnancy outcomes in women having in vitro fertilisation or intracytoplasmic sperm injection.

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

Version: 2017

Blastocyst versus cleavage stage embryo transfer in assisted conception

We aimed to determine whether blastocyst stage (day 5 to 6) embryo transfer improves live birth rates following fresh transfer and cumulative pregnancy rates (following fresh and frozen‐thawed cycles) compared with cleavage stage (day 2 to 3) transfer.

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

Version: 2016

Ectopic pregnancy rates in frozen versus fresh embryo transfer in in vitro fertilization: a systematic review and meta-analysis

Bibliographic details: Acharya KS, Provost MP, Yeh JS, Acharya CR, Muasher SJ.  Ectopic pregnancy rates in frozen versus fresh embryo transfer in in vitro fertilization: a systematic review and meta-analysis. Middle East Fertility Society Journal 2014; 19(4): 233-238

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

Version: 2014

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

Endometrial preparation for egg donor recipients or for frozen embryo transfers

Couples undergo in vitro fertilisation (IVF) after a long period of subfertility, because women have blocked fallopian tubes or severe endometriosis, where the male partner has a reduced semen count, or when pregnancy has not resulted after previous less invasive fertility treatment. Subsequent to an unsuccessful fresh embryo IVF cycle, a frozen‐thawed embryo transfer can be performed when frozen embryos are available. Alternatively for women who have:ovarian insufficiency (premature menopause), poor ovarian capacity to respond to stimulation, or or have had several unsuccessful IVF cycles, oocyte donation is a frequent treatment option, particularly for older women. Adequate hormonal preparation of the endometrium is of outmost importance in both egg donor and frozen embryo replacement cycles to provide the optimal chances of pregnancy. Many drugs and various modes of administration have been tried by several investigators in order to optimise implantation rates and consequently improve the success rates of the embryo transfer procedures. A total of 22 randomised controlled trials were included in this review. There is insufficient evidence from these trials to be able to identify one particular intervention for endometrial preparation that clearly improves the treatment outcome for women receiving embryo transfers with either frozen embryos or embryos derived from donated oocytes. Better quality studies are needed to more accurately evaluate each treatment.

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

Version: 2010

Interventions to prevent embryos from being expelled after transfer in women undergoing in vitro fertilisation and intracytoplasmic sperm injection

In recent years assisted reproduction has become more evidence based in an attempt to determine what techniques truly work. 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 rate 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, Cochrane authors decided to systematically locate and review the best available evidence regarding interventions for the prevention of embryo expulsion in women undergoing IVF and ICSI.

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

Version: 2014

Number of embryos for transfer in women undergoing assisted reproductive technology (ART)

Multiple pregnancy creates serious health risks for the mother (such as premature labour, diabetes and high blood pressure) and for the babies, who are at much higher risk than single babies of problems including premature birth, low birth weight, cerebral palsy and perinatal death. Single embryo transfer is now being seriously considered in order to reduce multiple pregnancies but this needs to be balanced against the risk of lowering the overall live birth rate. Researchers in The Cochrane Collaboration reviewed the evidence about the number of embryos transferred in women undergoing ART. The search is current to July 2013.

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

Version: 2013

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

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

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 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

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

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

Ultrasound guidance during embryo transfer: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To summarize the current evidence on the effect of using ultrasound (US) guidance during embryo transfer (ET).

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

Version: 2014

Systematic Reviews in PubMed

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