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and 19% in the embryo transfers with anesthesia. In this larger comparison, general anesthesia did not have a benefi- cial impact on pregnancy rate (24).
Summary statement:
There is insufficient evidence that anesthesia during embryo transfer improves pregnancy rates. Given that there is no clear benefit and that there are inherent risks associated with anesthesia, routine anesthesia is not recommended to improve IVF-embryo transfer out- comes. (Grade C)
Massage. Massage therapy is proposed as a way to relieve physical and psychological discomfort and has been sug- gested as a therapeutic modality without significant risk or side effects in an IVF cycle prior to embryo transfer. Only one study—a retrospective, observational analysis—assessed massage therapy before blastocyst transfer in cryopreserva- tion cycles and demonstrated evidence of improved preg- nancy and live-birth rates (25).
Summary statement:
There is insufficient evidence to recommend for or against massage therapy to improve IVF-embryo trans- fer outcomes. (Grade C)
Transcutaneous electrical acupoint stimulation. One pro- spective, randomized trial on the effect of transcutaneous electrical acupoint stimulation (TEAS) on embryo transfer in 309 patients showed that electrodes placed on acupoints instead of needles improved the clinical pregnancy and live-birth rates relative to controls (26). No statistically signif- icant demographic differences were noted among the three groups (group I, mock TEAS; group II, single TEAS; group III, double TEAS; all treatments 30 minutes after embryo transfer). Also, the authors state that the number of transfers were not different among the three groups, but did not include these data in the manuscript. Clinical pregnancy and live- birth rates increased significantly in patients who received TEAS on the day of embryo transfer; the clinical pregnancy rate was 29.3% with mock TEAS vs 42.7% with single TEAS treatment (P1⁄4.044), and the live-birth rate was 21.2% with mock TEAS vs 37.3% with single TEAS treatment (P1⁄4.011). In patients who received TEAS also on the day before embryo transfer, the clinical pregnancy rate further increased to 50% (P1⁄4.003) and live-birth rate increased to 42% (P1⁄4.002) (26). No additional studies of TEAS are available.
Summary statement:
There is fair evidence based on only one RCT that TEAS improves IVF-embryo transfer outcomes. (Grade B). However, given the lack of any other studies, a recom- mendation for or against TEAS to improve IVF-ET out- comes cannot be made.
Whole-systems traditional Chinese medicine. Whole-sys- tems traditional Chinese medicine (WS-TCM) as an approach to improve pregnancy rates in IVF can include acupuncture, Chinese herbal medications, diet, and lifestyle recommenda- tions. Only one observational study of 119 non-donor and
21 donor patients was identified assessing WS-TCM and IVF-embryo transfer outcomes. This retrospective cohort study showed an improved live-birth rate of 61.3% with WS-TCM relative to 50.8% in the acupuncture group and 48.2% among controls in non-donor cycles (P1⁄4.03) (27). However, a number of limitations existed, including the retro- spective nature of the study with lack of randomization, the fact that patients chose their treatment, and the lack of con- trol of differing embryo quality between the groups.
Summary statement:
There is insufficient evidence to recommend for or against WS-TCM to improve IVF-embryo transfer out- comes. (Grade C)
Prophylactic antibiotics. Another intervention that has been considered to improve embryo transfer success rates is the use of prophylactic antibiotics. Only one RCT has addressed this issue (28). In that trial, 350 patients were randomized to receive either prophylactic antibiotics or no antibiotics. Those ran- domized to the treatment group received amoxicillin and clav- ulanic acid on the day before and the day of transfer. The catheter tips were cultured after the transfer. While the antibi- otics significantly reduced catheter contamination rates, the clinical pregnancy rates between the two groups were not different. Live-birth rates were not an outcome of that trial. A systematic review of the literature in 2012 did not find any additional studies to help determine whether prophylactic an- tibiotics for embryo transfer were helpful, particularly for improving live-birth rates (29). Their conclusion was that the finding of this single study did not support the use of amoxi- cillin and clavulanic acid to improve IVF success rates and that the effect of other regimens on IVF outcomes is unknown.
Summary statement:
ThereisfairevidencebasedonasingleRCTthatananti- biotic regimen that includes amoxicillin and clavulanic acid given on the day before and the day of embryo transfer does not improve pregnancy rates. (Grade B). Given these results and the lack of other evidence in the literature to support prophylactic antibiotics at em- bryo transfer, a recommendation for routine prophylac- tic antibiotics cannot be made.
Does Physician Preparation, including the Use of Sterile Latex-free Gloves, before an Embryo Transfer Procedure Affect Pregnancy and Live- birth Rates?
Given that optimal handling of the embryo is imperative dur- ing embryo transfer, it is natural to consider the effect of the type of glove worn by the clinician performing the embryo transfer on outcome. There is no question that both powdered and unpowdered gloves are toxic when in direct contact with embryos. However, with the potential transmission of the powder from the gloves to the embryo transfer catheter through the air, particular concern has been raised regarding the use of powdered gloves during embryo transfer. Only one randomized controlled study addresses the impact of the type of glove utilized for embryo transfer on pregnancy rate. This
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Fertility and Sterility®
PRECONGRESS COURSE 14 I BARCELONA, SPAIN – 1 JULY 2018 61