Page 67 - PCC14

Summary statement:
There is good evidence not to recommend bed rest after embryo transfer. (Grade A)
SUMMARY
Good Evidence (Grade A)
Thereisgoodevidencebasedon10RCTstorecommendTA ultrasound guidance during embryo transfer to improve clinical pregnancy rate and live-birth rate. (Grade A)
There is good evidence to recommend the use of a soft em- bryo transfer catheter to improve IVF-embryo transfer pregnancy rates. (Grade A). Data on live-birth rates and specific types of soft catheters are limited.
Thereisgoodevidencenottorecommendbedrestafterem- bryo transfer. (Grade A)
Fair Evidence (Grade B)
There is fair evidence that acupuncture performed around the time of the embryo transfer does not improve live- birth rates in IVF. (Grade B)
There is fair evidence based on only one RCT that transcu- taneous electrical acupoint stimulation (TEAS) improves IVF-embryo transfer outcomes. (Grade B). Given the lack of any other studies, a recommendation for or against TEAS to improve IVF-embryo transfer outcomes cannot be made.
There is fair evidence based on a single RCT that an anti- 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 embryo transfer, a recommendation for routine prophylactic antibiotics cannot be made.
There is fair evidence based on one, single-center RCT that powdered gloves worn during embryo transfer do not have an adverse effect on pregnancy rates. (Grade B) No specific type of glove is recommended for embryo transfer.
There is fair evidence based on one RCT and one prospec- tive cohort study that there is a benefit to removing cervical mucus at the time of embryo transfer to improve clinical pregnancy and live-birth rates. (Grade B)
There is fair evidence based on six studies (two RCTs and four cohort studies) that embryo transfer catheter place- ment affects implantation and pregnancy rates. (Grade B)
There is fair evidence based on seven studies (three RCTs and four cohort studies) that placement of the catheter tip in the upper or middle (central) area of the uterine cavity, greater than 1 cm from the fundus for embryo expulsion, optimizes pregnancy rates. (Grade B)
There is fair evidence based on one RCT and one cohort study to recommend immediate withdrawal of the embryo transfer catheter after embryo expulsion. (Grade B)
There is fair evidence based on seven cohort studies that the presence of mucus on the embryo transfer catheter, once it
is withdrawn, is not associated with a lower clinical preg-
nancy rate or live-birth rate. (Grade B)
There is fair evidence based on the secondary outcome of
one RCT, nine cohort studies, and one series that retained embryos in the transfer catheter and immediate re- transfer do not affect implantation, clinical pregnancy, or spontaneous abortion rates. (Grade B)
Insufficient Evidence (Grade C)
There is insufficient evidence to recommend for or against analgesics to improve IVF-embryo transfer outcomes. (Grade C)
There is insufficient evidence that anesthesia during em- bryo transfer improves pregnancy rates. Given that there is no clear benefit and that there are inherent risks associ- ated with anesthesia, routine anesthesia is not recommen- ded to improve IVF-embryo transfer outcomes. (Grade C).
There is insufficient evidence to recommend for or against massage therapy to improve IVF-embryo transfer out- comes. (Grade C)
There is insufficient evidence to recommend for or against whole systems–traditional Chinese medicine to improve IVF-embryo transfer outcomes. (Grade C)
While selected ultrasound guidance for an anticipated difficult embryo transfer may be an alternative to routine ultrasound guidance, there is insufficient evidence to recommend for or against this practice. (Grade C)
There is insufficient evidence for more specific recommen- dations regarding the positioning of the catheter at the time of embryo transfer. (Grade C)
Given the mixed results of studies, there is insufficient ev- idence to conclusively state that the presence of blood on the catheter, once it is withdrawn, is associated with lower implantation or pregnancy rates. (Grade C)
Given the paucity of data, there is insufficient evidence to recommend any specific injection speed of the catheter at the time of embryo transfer. (Grade C)
RECOMMENDATIONS
Embryo transfer is considered a critical step in the IVF pro- cess. Extensive literature exists regarding all aspects of em- bryo transfer, which supports its importance to overall IVF success. While there are insufficient data to provide guidance on a number of techniques used during embryo transfer, the literature does provide guidance for many aspects of this crit- ical component of IVF.
The following interventions are supported by the litera- ture for improving pregnancy rates:
Abdominal ultrasound guidance for embryo transfer
Removal of cervical mucus
Use of soft embryo transfer catheters
Placement of embryo transfer tip in the upper or middle
(central) area of the uterine cavity, greater than 1 cm
from the fundus, for embryo expulsion
Immediate ambulation once the embryo transfer procedure
is completed
Page 60 of 69
VOL. 107 NO. 4 / APRIL 2017 891
Fertility and Sterility®
PRECONGRESS COURSE 14 I BARCELONA, SPAIN – 1 JULY 2018 67