Bed rest after an embryo transfer: a systematic review and meta-analysis

  • Mauro CozzolinoEmail author
  • Gianmarco Troiano
  • Ecem Esencan



Bed rest for the variable duration is commonly recommended after an embryo transfer (ET) carried out during an in vitro fertilization (IVF). This is based on beliefs that supine position and the reduction of physical activity—to the minimum—might prevent the risk of embryo expulsion once is transferred to the uterus. Therefore, we have designed a meta-analysis based exclusively on evidence from published randomized controlled trials (RCTs), in the attempt to analyze the effectiveness of bed rest after an ET to improve the chance for success in vitro fertilization.


The review protocol was registered in PROSPERO (CRD42019122758), and data extraction started before protocol publication. Five RCTs were included; 499 women were assigned to the intervention group and 503 to the control group.


The analysis of 1002 women did not show any significant change in clinical pregnancy rate between groups [RR 0.86, 95% CI (0.74–1.00), p = 0.06, I2 = 0%]. Likewise, no difference was found in live birth [RR 0.93, 95% CI (0.51–1.69) p = 0.81, I2 = 68%], ongoing pregnancy rate [RR 0.84, 95% CI (0.60–1.20), p = 0.34, I2 = 63%], miscarriage rate [RR 1.08, 95% CI (0.46–2.57), p = 0.86, I2 = 64%], multiple pregnancy rate [RR 0.08, 95% CI (0.50–1.04), p = 0.71, I2 = 0%] or implantation rate [RR 0.90, 95% CI (0.72–1.13), p = 0.38, I2 = 0%]. Subgroup analyses—considering only immediate mobilization or bed rest 24 h—did not show significant differences regarding the outcome.


Our findings showed that immediate mobilization after an ET does not have a negative influence over the success rates of IVF. Therefore, bed rest should not be recommended.


Bed rest Embryo transfer Clinical pregnancy rate Ongoing pregnancy Miscarriage 



I would like to warmly thank Mr. Herman David López Jimenez on behalf of Translinguo Global for reviewing the use of the English language of the manuscript and for valuable linguistic advice that greatly improved the paper.

Author contributions

MC designed the study, performed the literature search, defined inclusion criteria and selected studies for inclusion, participated in data extraction, performed the risk of bias assessment, performed the statistical analysis, and wrote the first and final drafts of the manuscript; GT performed the literature search, selected studies for inclusion, participated in the statistical analysis, EE critically revised the manuscript, participated in assessing the risk of bias within studies and the grading of evidence.



Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest. The complete disclosure form is available to view online as supporting information.

Supplementary material

404_2019_5296_MOESM1_ESM.docx (13 kb)
Supplementary file1 (DOCX 13 kb)


  1. 1.
    Edwards RG, Steptoe PC, Purdy JM (1980) Establishing full-term human pregnancies using cleaving embryos grown in vitro. Br J Obstet Gynaecol 87:737–756CrossRefPubMedGoogle Scholar
  2. 2.
    Amarin ZO, Obeidat BR (2004) Bed rest versus free mobilisation following embryo transfer: a prospective randomised study. BJOG 111:1273–1276CrossRefPubMedGoogle Scholar
  3. 3.
    Hawkins LK, Rossi BV, Correia KF, Lipskind ST, Hornstein MD, Missmer SA (2014) Perceptions among infertile couples of lifestyle behaviors and in vitro fertilization (IVF) success. J Assist Reprod Genet 31:255–260CrossRefPubMedGoogle Scholar
  4. 4.
    Merari D, Feldberg D, Elizur A, Goldman J, Modan B (1992) Psychological and hormonal changes in the course of in vitro fertilization. J Assist Reprod Genet 9:161–169CrossRefPubMedGoogle Scholar
  5. 5.
    McLaughlin M, Cassidy T (2018) Psychosocial predictors of IVF success after one year: a follow-up study. J Reprod Infant Psychol 2018:1–11Google Scholar
  6. 6.
    Orvieto R, Ashkenazi J, Bar-Hava I, Ben-Rafael Z (1998) Bed rest following embryo transfer—necessary? Fertil Steril 70:982CrossRefPubMedGoogle Scholar
  7. 7.
    Sharif K, Afnan M, Lenton W, Khalaf Y, Ebbiary N, Bilalis D et al (1995) Do patients need to remain in bed following embryo transfer? The Birmingham experience of 103 in-vitro fertilization cycles with no bed rest following embryo transfer. Hum Reprod 10:1427–1429CrossRefPubMedGoogle Scholar
  8. 8.
    Sharif K, Afnan M, Lashen H, Elgendy M, Morgan C, Sinclair L (1998) Is bed rest following embryo transfer necessary? Fertil Steril 69:478–481CrossRefPubMedGoogle Scholar
  9. 9.
    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:14053-4-1Google Scholar
  10. 10.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558CrossRefPubMedGoogle Scholar
  11. 11.
    Botta G, Grudzinskas G (1997) Is a prolonged bed rest following embryo transfer useful? Hum Reprod 12:2489–2492CrossRefPubMedGoogle Scholar
  12. 12.
    Gaikwad S, Garrido N, Cobo A, Pellicer A, Remohi J (2013) Bed rest after embryo transfer negatively affects in vitro fertilization: a randomized controlled clinical trial. Fertil Steril 100:729–735CrossRefPubMedGoogle Scholar
  13. 13.
    Purcell KJ, Schembri M, Telles TL, Fujimoto VY, Cedars MI (2007) Bed rest after embryo transfer: a randomized controlled trial. Fertil Steril 87:1322–1326CrossRefPubMedGoogle Scholar
  14. 14.
    Rezábek K, Koryntová D, Zivný J (2001) Does bedrest after embryo transfer cause a worse outcome in in vitro fertilization. Ceska Gynekol 66(3):175–178PubMedGoogle Scholar
  15. 15.
    Cozzolino M, Vitagliano A, Di Giovanni MV, Lagana AS, Vitale SG, Blaganje M et al (2018) Ultrasound-guided embryo transfer: summary of the evidence and new perspectives. A systematic review and meta-analysis. Reprod Biomed Online 36:524–542CrossRefPubMedGoogle Scholar
  16. 16.
    Kwon H, Choi DH, Kim EK (2015) Absolute position versus relative position in embryo transfer: a randomized controlled trial. Reprod Biol Endocrinol 13:78015-0072-6CrossRefGoogle Scholar
  17. 17.
    Sallam HN (2005) Embryo transfer: factors involved in optimizing the success. Curr Opin Obstet Gynecol 17:289–298CrossRefPubMedGoogle Scholar
  18. 18.
    Groeneveld E, de Leeuw B, Vergouw CG, Visser OW, Lambers MJ, Heymans MW et al (2012) Standardization of catheter load speed during embryo transfer: comparison of manual and pump-regulated embryo transfer. Reprod Biomed Online 24:163–169CrossRefPubMedGoogle Scholar
  19. 19.
    Waterstone J, Parsons J, Bolton V (1988) Recumbent rest after embryo transfer. Lancet 2:1318–1319CrossRefPubMedGoogle Scholar
  20. 20.
    Lambers MJ, Lambalk CB, Schats R, Hompes PG (2009) Ultrasonographic evidence that bedrest after embryo transfer is useless. Gynecol Obstet Invest 68:122–126CrossRefPubMedGoogle Scholar
  21. 21.
    Custers IM, Flierman PA, Maas P, Cox T, Van Dessel TJ, Gerards MH et al (2009) Immobilisation versus immediate mobilisation after intrauterine insemination: randomised controlled trial. BMJ 339:b4080CrossRefPubMedGoogle Scholar
  22. 22.
    Cordary D, Braconier A, Guillet-May F, Morel O, Agopiantz M, Callec R (2017) Immobilization versus immediate mobilization after intrauterine insemination: a systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 46:747–751CrossRefPubMedGoogle Scholar
  23. 23.
    Saleh A, Tan SL, Biljan MM, Tulandi T (2000) A randomized study of the effect of 10 min of bed rest after intrauterine insemination. Fertil Steril 74:509–511CrossRefPubMedGoogle Scholar
  24. 24.
    Oddens BJ, den Tonkelaar I, Nieuwenhuyse H (1999) Psychosocial experiences in women facing fertility problems—a comparative survey. Hum Reprod 14:255–261CrossRefPubMedGoogle Scholar
  25. 25.
    Gallinelli A, Roncaglia R, Matteo ML, Ciaccio I, Volpe A, Facchinetti F (2001) Immunological changes and stress are associated with different implantation rates in patients undergoing in vitro fertilization-embryo transfer. Fertil Steril 76:85–91CrossRefPubMedGoogle Scholar
  26. 26.
    Klonoff-Cohen H, Chu E, Natarajan L, Sieber W (2001) A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertil Steril 76:675–687CrossRefPubMedGoogle Scholar
  27. 27.
    Cheung C, Saravelos SH, Chan T, Sahota DS, Wang CC, Chung PW et al (2019) A prospective observational study on the stress levels at the time of embryo transfer and pregnancy testing following in vitro fertilisation treatment: a comparison between women with different treatment outcomes. BJOG 126:271–279CrossRefPubMedGoogle Scholar
  28. 28.
    Porcu-Buisson G, Lambert M, Lyonnet L, Loundou A, Gamerre M, Camoin-Jau L et al (2007) Soluble MHC Class I chain-related molecule serum levels are predictive markers of implantation failure and successful term pregnancies following an IVF. Hum Reprod 22:2261–2266CrossRefPubMedGoogle Scholar
  29. 29.
    Goldenberg RL, Cliver SP, Bronstein J, Cutter GR, Andrews WW, Mennemeyer ST (1994) Bed rest in pregnancy. Obstet Gynecol 84:131–136PubMedGoogle Scholar
  30. 30.
    Kucuk M, Doymaz F, Urman B (2010) Assessment of the physical activity behavior and beliefs of infertile women during assisted reproductive technology treatment. Int J Gynaecol Obstet 108:132–134CrossRefPubMedGoogle Scholar
  31. 31.
    Craciunas L, Tsampras N (2016) Bed rest following embryo transfer might negatively affect the outcome of IVF/ICSI: a systematic review and meta-analysis. Hum Fertil (Camb) 19:16–22CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.IVIRMA MadridAravacaSpain
  2. 2.Rey Juan Carlos UniversityMadridSpain
  3. 3.Department of Obstetrics, Gynecology and Reproductive SciencesYale School of MedicineNew HavenUSA
  4. 4.University of SienaSienaItaly

Personalised recommendations