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

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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.

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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.



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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.

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Correspondence to Mauro Cozzolino.

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Cozzolino, M., Troiano, G. & Esencan, E. Bed rest after an embryo transfer: a systematic review and meta-analysis. Arch Gynecol Obstet 300, 1121–1130 (2019).

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