Skip to main content
SpringerLink
Log in

Systematic review analyzing significance of endometrial cavity fluid during assisted reproductive techniques

  • Review
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

The objective of our study is to estimate the prevalence of endometrial cavity fluid (ECF) in Assisted Reproductive Techniques (ART) cycles and analyze its effects on pregnancy outcome in such cycles.

Data sources

PubMed, Cochrane Central, Scopus, and clinicaltrials.gov were searched for articles. The reference lists of relevant publications were explored for other studies.

Study eligibility criteria

Studies that had assessed the pregnancy outcome in ART cycles and had commented on ECF accumulation were included. Pregnancy outcomes were assessed in all ART cycles where ECF was observed and were compared to the non-ECF cycles.

Results

A total of nine studies were included in the meta-analysis for a total of 28,210 cycles. Pooled analysis of the prevalence of ECF cycles out of total cycles in females undergoing ART using a fixed effect model showed that it was 14% (95% CI is 13% to 14%; I2 = 99%, p =  < 0.01). The random effect model prevalence of ECF cycles was around 7% (95% CI: 4% to 10%). There was a statistically significant (25%) decrease in pregnancy rates per cycle transfer in the ECF cycle versus the non-ECF cycle group during ART [OR = 0.75, 95% CI = 0.67–0.84), p < 0.001; moderate quality evidence]. When ECF size was compared, there was a statistically significant increase in pregnancy rates if ECF size was less than 3.5 mm versus greater than or equal to 3.5 mm [OR = 13.67, 95% CI = 1.43–130.40), p = 0.02; high quality evidence].

Sub-group analysis revealed that the ECF present at the time of embryo transfer significantly decreased the pregnancy rates by 26% as compared to the group where the ECF was not present at the time of embryo transfer [OR = 0.74, 95% CI = 0.65–0.85), p < 0.001].

Conclusions

This meta-analysis proposes that the presence of ECF significantly decreases the implantation and pregnancy rates of ART cycles, and even more so if its size is greater than 3.5 mm. Interventions to decrease ECF formation or treat it have enhanced the pregnancy outcome in ART cycles.

Prospero registration

Date: 17th September 2020; Number: CRD42020182262.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Availability of supporting data

The datasets used and/or analyzed during the current study are available from the corresponding author on request.

Code availability

Not applicable.

Abbreviations

ECF:

Endometrial cavity fluid

ART:

Assisted reproductive technology

References

  1. Cavagna M, Petersen CG, Mauri AL, Oliveira JBA, Baruffi RRL, Franco JG Jr (2014) Administration of progesterone on the day of oocyte retrieval to reverse accumulation of fluid in the endometrial cavity during assisted reproductive techniques. JBRA Assist Reprod 18(4):136–138

    Article  PubMed  PubMed Central  Google Scholar 

  2. Na ED, Cha DH, Cho JH, Kim MK (2012) Comparison of IVF-ET outcomes in patients with hydrosalpinx pretreated with either sclerotherapy or laparoscopic salpingectomy. Clin Exp Reprod Med 39(4):182–186

    Article  PubMed  PubMed Central  Google Scholar 

  3. He RH, Gao HJ, Li YQ, Zhu XM (2010) The associated factors to endometrial cavity fluid and the relevant impact on the IVF-ET outcome. Reprod Biol Endocrinol 8:46

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chien LW, Au HK, Xiao J, Tzeng CR (2002) Fluid accumulation within the uterine cavity reduces pregnancy rates in women undergoing IVF. Hum Reprod 17(2):351–356

    Article  PubMed  Google Scholar 

  5. Al-Hussaini TK, Shaaban OM (2018) Aspiration of endometrial cavity fluid at the time of egg collection. Middle East Fertility Soc J 23(4):354–356

    Article  Google Scholar 

  6. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  8. McGuinness LA, Higgins JPT. (2020) Risk-of-bias VISualization (robvis): An r package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods

  9. R Core Team (2013). R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL http://www.R-project.org/.

  10. Higgins J, Green S, (Editors). Cochrane handbook for systematic reviews of interventions: The cochrane collaboration, 2011; 2011 [cited 2020 28 May]. Available from: www.handbook.cochrane.org.

  11. Kjaergard LL, Villumsen J, Gluud C (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135(11):982–989

    Article  CAS  PubMed  Google Scholar 

  12. Copenhagen: The nordic cochrane centre. The cochrane collaboration. Review manager (RevMan) [Computer program]. Version 5.3.

  13. Schünemann H, Brożek J, Guyatt G, Oxman A, (Editors). GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. 2013. Available from: guidelinedevelopment.org/handbook.

  14. GRADEpro GDT: GRADEpro guideline development tool [Software]. McMaster University, 2015 (developed by Evidence Prime, Inc.). [Internet]. Available from: gradepro.org.

  15. Akman MA, Erden HF, Bahceci M (2005) Endometrial fluid visualized through ultrasonography during ovarian stimulation in IVF cycles impairs the outcome in tubal factor, but not PCOS, patients. Hum Reprod 20(4):906–909

    Article  PubMed  Google Scholar 

  16. Chen QL, Hong YE, Zeng PH, Liu DY, Pei L, Huang GN (2009) Clinical analysis on 106 cases of endometrial cavity fluid visualized through ultrasound during IVF-ET [In Chinese]. J Pract Obstet Gynecol 25(3):178–180

    Google Scholar 

  17. Lee RK, Yu SL, Chih YF, Tsai YC, Lin MH, Hwu YM et al (2006) Effect of endometrial cavity fluid on clinical pregnancy rate in tubal embryo transfer (TET). J Assist Reprod Genet 23(5):229–234

    Article  PubMed  PubMed Central  Google Scholar 

  18. Levi AJ, Segars JH, Miller BT, Leondires MP (2001) Endometrial cavity fluid is associated with poor ovarian response and increased cancellation rates in ART cycles. Hum Reprod 16(12):2610–2615

    Article  CAS  PubMed  Google Scholar 

  19. Liu DE, Li YP, Lv QF, Ma YL, Zhou QE, Deng L (2004) Endometrial cavity fluid in ART cycles: analysis of 25 cases [in Chinese]. Chin J Pract Gynecol Obstet 20(4):213–214

    Google Scholar 

  20. Zhang WX, Cao LB, Zhao Y, Li J, Li BF, Lv JN et al (2021) Endometrial cavity fluid is associated with deleterious pregnancy outcomes in patients undergoing in vitro fertilization/intracytoplasmic sperm injection: a retrospective cohort study. Ann Transl Med 9(1):9

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mansour RT, Aboulghar MA, Serour GI, Riad R (1991) Fluid accumulation of the uterine cavity before embryo transfer: a possible hindrance for implantation. J In Vitro Fert Embryo Transf 8(3):157–159

    Article  CAS  PubMed  Google Scholar 

  22. Griffiths AN, Watermeyer SR, Klentzeris LD (2002) Fluid within the endometrial cavity in an IVF cycle–a novel approach to its management. J Assist Reprod Genet 19(6):298–301

    Article  PubMed  PubMed Central  Google Scholar 

  23. Liu S, Shi L, Shi J (2016) Impact of endometrial cavity fluid on assisted reproductive technology outcomes. Int J Gynaecol Obstet 132(3):278–283

    Article  PubMed  Google Scholar 

  24. Lu S, Peng H, Zhang H, Zhang L, Cao Q, Li R et al (2013) Excessive intrauterine fluid cause aberrant implantation and pregnancy outcome in mice. PLoS ONE 8(10):e78446

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I et al (1999) Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod 14(5):1243–1249

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the GRADE Pro team [McMaster University and Evidence Prime Inc., available from: https://gradepro.org/] for letting us use the software for the synthesis, overall assessment, and grading of systematic review.

Funding

None.

Author information

Author notes

  1. Priyanka Kathuria and Surjit Singh has contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India

    Priyanka Kathuria, Navdeep Kaur Ghuman, Garima Yadav, Pratibha Singh & Vrushti Solanki

  2. Kirti IVF Centre, Jodhpur, India

    Nayanika Gaur

  3. The Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India

    Surjit Singh

Authors
  1. Priyanka Kathuria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Navdeep Kaur Ghuman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Garima Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pratibha Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vrushti Solanki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nayanika Gaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Surjit Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by SS, PK, The first draft of the manuscript was written by SS and PK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Study design and planning of systematic review—All of the authors. PK: Literature search, Roles/Writing, Data collection and analysis, review & editing. SS: Literature search, Figures, ROB, GRADE, Data collection and analysis, review & editing. NKG: Literature search, Data collection and analysis, review & editing. GY: Project administration, Tables. PS: Final approval of Manuscript, Project administration. VS: Tables, Data collection and analysis. NG: Resources, Approval of final manuscript. Corrections and Final approval of Manuscript—All of the authors.

Corresponding author

Correspondence to Surjit Singh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 65 KB)

Supplementary file2 (Pdf 981 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kathuria, P., Ghuman, N.K., Yadav, G. et al. Systematic review analyzing significance of endometrial cavity fluid during assisted reproductive techniques. Arch Gynecol Obstet 309, 413–425 (2024). https://doi.org/10.1007/s00404-023-07072-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-023-07072-y

Keywords

Search

Navigation