Performing The Embryo Transfer

Publication Date: April 1, 2017
Last Updated: March 14, 2022

Summary

There is good evidence based on 10 RCTs to recommend TA ultrasound guidance during embryo transfer to improve clinical pregnancy rate and live-birth rate. (, A)
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There is good evidence to recommend the use of a soft embryo transfer catheter to improve IVF-embryo transfer pregnancy rates. (, A)
Data on live-birth rates and specific types of soft catheters are limited.
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There is good evidence not to recommend bed rest after embryo transfer. (, A)
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There is fair evidence that acupuncture performed around the time of the embryo transfer does not improve live-birth rates in IVF. (, B)
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There is fair evidence based on only one RCT that transcutaneous electrical acupoint stimulation (TEAS) improves IVF-embryo transfer outcomes. (, B)
Given the lack of any other studies, a recommendation for or against TEAS to improve IVF-embryo transfer outcomes cannot be made.
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There is fair evidence based on a single RCT that an antibiotic regimen that includes amoxicillin and clavulanic acid given on the day before and the day of embryo transfer does not improve pregnancy rates. (, 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.
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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. (, B)

No specific type of glove is recommended for embryo transfer.

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There is fair evidence based on one RCT and one prospective 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. (, B)
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There is fair evidence based on six studies (two RCTs and four cohort studies) that embryo transfer catheter placement affects implantation and pregnancy rates. (, B)
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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. (, B)
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There is fair evidence based on one RCT and one cohort study to recommend immediate withdrawal of the embryo transfer catheter after embryo expulsion. (, B)
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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 pregnancy rate or live-birth rate. (, B)
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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. (, B)
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There is insufficient evidence to recommend for or against analgesics to improve IVF-embryo transfer outcomes. (, C)
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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 outcomes. (, C)
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There is insufficient evidence to recommend for or against massage therapy to improve IVF-embryo transfer outcomes. (, C)
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There is insufficient evidence to recommend for or against whole systems–traditional Chinese medicine to improve IVF-embryo transfer outcomes. (, C)
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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. (, C)
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There is insufficient evidence for more specific recommendations regarding the positioning of the catheter at the time of embryo transfer. (, C)
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Given the mixed results of studies, there is insufficient evidence to conclusively state that the presence of blood on the catheter, once it is withdrawn, is associated with lower implantation or pregnancy rates. (, C)
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Given the paucity of data, there is insufficient evidence to recommend any specific injection speed of the catheter at the time of embryo transfer. (, C)
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Recommendations

Embryo transfer is considered a critical step in the IVF process. Extensive literature exists regarding all aspects of embryo 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 critical component of IVF.
The following interventions are supported by the literature 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
The following interventions have been shown not to be beneficial for improving pregnancy rates:
  • Acupuncture
  • Analgesics, massage, general anesthesia, whole systems–traditional Chinese medicine
  • Prophylactic antibiotics to improve embryo transfer outcomes
  • Waiting after expulsion of embryos for any specific period of time before withdrawing the embryo transfer catheter
(, )
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Recommendation Grading

Overview

Title

Performing The Embryo Transfer

Authoring Organization

Publication Month/Year

April 1, 2017

Last Updated Month/Year

June 5, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this guideline for performing embryo transfer is to examine the various steps of the Common Practice Protocol by a systematic review of the literature to determine which of the steps, if any, are supported by sufficient data.

Target Patient Population

Women undergo embryo transfer

Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory, Laboratory services, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D007246 - Infertility, D007247 - Infertility, Female, D005307 - Fertilization in Vitro, D066298 - In Vitro Techniques, D004624 - Embryo Transfer, D010064 - Embryo Implantation

Keywords

infertility, in vitro fertilization, embryo transfer

Supplemental Methodology Resources

Data Supplement