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Meta-Analysis
. 2023 Dec 14;13(1):22188.
doi: 10.1038/s41598-023-49141-x.

The impact of difficult embryo transfer on the success of IVF: a systematic review and meta-analysis

Giulia Galati  1 , Marco Reschini  2 , Laura Mensi  2 , Camilla Di Dio  3 , Edgardo Somigliana  2   4 , Ludovico Muzii  3
Affiliations
Meta-Analysis

The impact of difficult embryo transfer on the success of IVF: a systematic review and meta-analysis

Giulia Galati et al. Sci Rep. .

Abstract

The procedure of embryo transfer (ET) must be as gentle as possible since any traumatism may cause uterine contractility that interferes with the implantation. However, this ideal conduct is not always possible, and additional measures may be necessary (difficult ET). Different studies have evaluated the impact of difficult ET on the clinical pregnancy rate (CPR), but results were not univocal. The present systematic review and meta-analysis was aimed to provide a precise estimate of the possible detrimental effects of difficult ET on CPR. The study protocol was registered online (PROSPERO number: CRD42023387197). An electronic database search was performed to identify articles published until September 2022. The primary outcome was CPR. Fifteen studies fulfilled the inclusion criteria. Difficult ET significantly reduced the CPR (OR 0.70; 95%CI: 0.64-0.76; p < 0.0001. All pre-planned subgroup analyses according to study design (retrospective vs prospective studies), historical period (studies published before and after 2010), type of catheter, frequency of difficult cases (> or < 19%) and pregnancy rate (> or < 38%) confirmed the significant association. Difficult ET is associated with a significant reduction of CPR. Further studies are warranted to understand how to prevent or manage this common clinical situation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
PRISMA flowchart for study identification and inclusion/exclusion.
Figure 2
Figure 2
The effect of Difficult Embryo Transfer on the clinical pregnancy rate.
Figure 3
Figure 3
The effect of Difficult Embryo Transfer on the live birth rate.
Figure 4
Figure 4
(A) mode of recruitment (retrospective or prospective); (B) study period (divided according to the date of publication, before and after 2010); (C) type of catheter (Cook or Wallace catheters); (D) frequency of difficult cases (using the median to divide into two groups); (E) CPR in the control group (using the median to divide into two groups).
Figure 4
Figure 4
(A) mode of recruitment (retrospective or prospective); (B) study period (divided according to the date of publication, before and after 2010); (C) type of catheter (Cook or Wallace catheters); (D) frequency of difficult cases (using the median to divide into two groups); (E) CPR in the control group (using the median to divide into two groups).
Figure 4
Figure 4
(A) mode of recruitment (retrospective or prospective); (B) study period (divided according to the date of publication, before and after 2010); (C) type of catheter (Cook or Wallace catheters); (D) frequency of difficult cases (using the median to divide into two groups); (E) CPR in the control group (using the median to divide into two groups).
See this image and copyright information in PMC

References

    1. Tyler B, et al. Interventions to optimize embryo transfer in women undergoing assisted conception: A comprehensive systematic review and meta-analyses. Hum. Reprod. Update. 2022;28:480–500. doi: 10.1093/humupd/dmac009. - DOI - PMC - PubMed
    1. Penzias A, et al. Performing the embryo transfer: A guideline. Fertil. Steril. 2017;107:882–896. doi: 10.1016/j.fertnstert.2017.01.025. - DOI - PubMed
    1. D’Angelo A, Panayotidis C, Alteri A, Mcheik S, Veleva Z. Evidence and consensus on technical aspects of embryo transfer. Hum. Reprod. Open. 2022;2022:4. doi: 10.1093/hropen/hoac038. - DOI - PMC - PubMed
    1. Busnelli A, Somigliana E, Cirillo F, Baggiani A, Levi-Setti PE. Efficacy of therapies and interventions for repeated embryo implantation failure: A systematic review and meta-analysis. Sci. Rep. 2021;11:1747. doi: 10.1038/s41598-021-81439-6. - DOI - PMC - PubMed
    1. Fanchin R, Ayoubi JM. Uterine dynamics: Impact on the human reproduction process. Reprod. Biomed. Online. 2009;18:S57–S62. doi: 10.1016/S1472-6483(10)60450-6. - DOI - PubMed