Live Birth Rate Following Bed Rest Versus Early Mobilization After Embryo Transfer: A Systematic Review And Meta-Analysis

Embryo transfer (ET) is the final step of in vitro fertilization (IVF). Different strategies have been proposed to increase the likelihood of implantation, such as post-transfer bed rest. The objective of this manuscript was to compare the clinical outcomes of embryo transfers after IVF of patients offered rest vs. early ambulation. The patient, intervention, comparison, and outcome(s) (PICO) model was used to select the study population, which included women/couples submitted to IVF and prescribed bed rest or early ambulation. Only studies including live birth (LB) as an outcome were included (www.crd.york.ac.uk/PROSPERO/CRD42020188716). A systematic search for studies was conducted on MEDLINE, ClinicalTrials.gov, PubMed, and the Cochrane Library. A librarian coordinated the searches in May 2020, which considered articles published since 1995. All original peer-reviewed articles in English were included, regardless of study design. The search retrieved 27 citations, of which 14 were eligible for full-text analysis and four accepted for inclusion. The studies included data on 21,598 patients/cycles (rest: 20,138; early ambulation: 1,460). Patients prescribed bed rest had an LB rate of 43.6% vs. 52.5% in the individuals not offered bed rest. The meta-analysis yielded an odds ratio of 0.77 (95% CI 0.5-1.2), which means patients on bed rest were 23% less likely to have a LB; nevertheless, this difference was not statistically significant. Considering that there is no difference between the two strategies, there is no evidence to recommend bed rest after embryo transfer.