Lower pregnancy rate in women with high uterine peristalsis before embryo transfer: a systematic review and meta-analysis

Abstract Background Uterine contractions, also known as peristalsis, have been shown to affect fertility. However, despite previous studies, most clinicians have not paid sufficient attention to uterine peristalsis. Recent studies have recognised its importance and evaluated contractility parameters...

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Main Authors: Angela Vidal, Valeria Trejos, Janna Pape, Tanya Karrer, Gürkan Yilmaz, Michael von Wolff
Format: Article
Language:English
Published: BMC 2025-03-01
Series:Reproductive Biology and Endocrinology
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Online Access:https://doi.org/10.1186/s12958-025-01380-5
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author Angela Vidal
Valeria Trejos
Janna Pape
Tanya Karrer
Gürkan Yilmaz
Michael von Wolff
author_facet Angela Vidal
Valeria Trejos
Janna Pape
Tanya Karrer
Gürkan Yilmaz
Michael von Wolff
author_sort Angela Vidal
collection DOAJ
description Abstract Background Uterine contractions, also known as peristalsis, have been shown to affect fertility. However, despite previous studies, most clinicians have not paid sufficient attention to uterine peristalsis. Recent studies have recognised its importance and evaluated contractility parameters prior to embryo transfer. Method A systematic literature search was conducted in Medline, Embase and Cochrane CENTRAL up to January 2024. Inclusion criteria were studies involving patients undergoing in vitro fertilization (IVF) or other infertility treatments in which uterine contractility was assessed. Studies were excluded if they included therapeutic interventions that affected contractility, or if they focused on uterine pathologies such as adenomyosis or fibroids. The meta-analysis included trials with IVF treatments that compared clinical pregnancy rates in women with high versus low frequent uterine contractions. Results A total of 2587 women (17 studies) were included in the systematic review, of whom 1134 (43.1%) (5 studies) underwent embryo transfer and were eligible for meta-analysis. The review found that elevated contractility on the day of embryo transfer is associated with a negative impact on pregnancy rates. The meta-analysis showed that women with two or more uterine contractions at the time of the embryo transfer had a significantly lower clinical pregnancy rate than with women with two or fewer contractions (OR 0.52, 95% CI: 0.38- 0.69). There was moderate heterogeneity between studies (I2 = 55, p < 0.01). Conclusions The lower clinical pregnancy rate in women with high uterine contractility, highlights the role of uterine peristalsis around the time of embryo implantation. However, due to the limited and heterogeneous data available, the influence of uterine peristalsis on reproductive outcomes such as live birth rates remains unclear.
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spelling doaj-art-89f1b3f3a13a4b8390e39e350dbe92cb2025-08-20T02:49:16ZengBMCReproductive Biology and Endocrinology1477-78272025-03-0123112110.1186/s12958-025-01380-5Lower pregnancy rate in women with high uterine peristalsis before embryo transfer: a systematic review and meta-analysisAngela Vidal0Valeria Trejos1Janna Pape2Tanya Karrer3Gürkan Yilmaz4Michael von Wolff5Division of Gynecological Endocrinology and Reproductive Medicine, Women’s University Hospital, Inselspital Bern, University of BernDivision of Psychiatry, Integrated Psychiatry Winterthur - Zürcher UnterlandDivision of Gynecological Endocrinology and Reproductive Medicine, Women’s University Hospital, Inselspital Bern, University of BernMedical Library, University Library of Berne, University of BernCentre Suisse d’Electronique Et de Microtechnique CSEM SA, 2002Division of Gynecological Endocrinology and Reproductive Medicine, Women’s University Hospital, Inselspital Bern, University of BernAbstract Background Uterine contractions, also known as peristalsis, have been shown to affect fertility. However, despite previous studies, most clinicians have not paid sufficient attention to uterine peristalsis. Recent studies have recognised its importance and evaluated contractility parameters prior to embryo transfer. Method A systematic literature search was conducted in Medline, Embase and Cochrane CENTRAL up to January 2024. Inclusion criteria were studies involving patients undergoing in vitro fertilization (IVF) or other infertility treatments in which uterine contractility was assessed. Studies were excluded if they included therapeutic interventions that affected contractility, or if they focused on uterine pathologies such as adenomyosis or fibroids. The meta-analysis included trials with IVF treatments that compared clinical pregnancy rates in women with high versus low frequent uterine contractions. Results A total of 2587 women (17 studies) were included in the systematic review, of whom 1134 (43.1%) (5 studies) underwent embryo transfer and were eligible for meta-analysis. The review found that elevated contractility on the day of embryo transfer is associated with a negative impact on pregnancy rates. The meta-analysis showed that women with two or more uterine contractions at the time of the embryo transfer had a significantly lower clinical pregnancy rate than with women with two or fewer contractions (OR 0.52, 95% CI: 0.38- 0.69). There was moderate heterogeneity between studies (I2 = 55, p < 0.01). Conclusions The lower clinical pregnancy rate in women with high uterine contractility, highlights the role of uterine peristalsis around the time of embryo implantation. However, due to the limited and heterogeneous data available, the influence of uterine peristalsis on reproductive outcomes such as live birth rates remains unclear.https://doi.org/10.1186/s12958-025-01380-5Uterine peristalsisUterine contractilityImplantation ratePregnancy rateEmbryo transfer
spellingShingle Angela Vidal
Valeria Trejos
Janna Pape
Tanya Karrer
Gürkan Yilmaz
Michael von Wolff
Lower pregnancy rate in women with high uterine peristalsis before embryo transfer: a systematic review and meta-analysis
Reproductive Biology and Endocrinology
Uterine peristalsis
Uterine contractility
Implantation rate
Pregnancy rate
Embryo transfer
title Lower pregnancy rate in women with high uterine peristalsis before embryo transfer: a systematic review and meta-analysis
title_full Lower pregnancy rate in women with high uterine peristalsis before embryo transfer: a systematic review and meta-analysis
title_fullStr Lower pregnancy rate in women with high uterine peristalsis before embryo transfer: a systematic review and meta-analysis
title_full_unstemmed Lower pregnancy rate in women with high uterine peristalsis before embryo transfer: a systematic review and meta-analysis
title_short Lower pregnancy rate in women with high uterine peristalsis before embryo transfer: a systematic review and meta-analysis
title_sort lower pregnancy rate in women with high uterine peristalsis before embryo transfer a systematic review and meta analysis
topic Uterine peristalsis
Uterine contractility
Implantation rate
Pregnancy rate
Embryo transfer
url https://doi.org/10.1186/s12958-025-01380-5
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