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Optimal timing to transfer embryos for women who underwent hysteroscopy: a systematic review and meta-analysis

BMC Pregnancy and Childbirth volume 25, Article number: 453 (2025) Cite this article

Abstract

Objective

This study aimed to investigate the optimal time interval between hysteroscopy and embryo transfer.

Methods

Electronic databases including PubMed, Embase, and Cochrane Library were searched up to Jul 2021. Two authors selected the articles independently and extracted data regarding study characteristics, quality, and results. A random-effect model was employed, and summary risk ratios (RR) at 95% confidence intervals (CI) were calculated.

Results

A total of 2123 patients from 5 studies were included. Pooled results showed that no significant differences for clinical pregnancy rates within 50-day and 90-day time interval comparison groups (RR = 0.83, 95% CI 0.61–1.11, P = 0.21; and RR = 0.91, 95% CI 0.74–1.12, P = 0.38, respectively), whereas clinical pregnancy rate was significantly increased in patients with a waiting interval of ≤ 120 days (RR = 0.75, 95% CI 0.61–0.93, P = 0.009). Subgroup analysis demonstrated that transferring embryos within 50 days for patients with normal uterine cavities was associated with a higher live birth rate (RR = 0.71, 95% CI 0.54–0.95, P = 0.02).

Conclusion

This meta-analysis identified that performing embryo transfer within 120 days for patients who underwent adhesiolysis and polypectomy within 50 days for patients who underwent diagnostic hysteroscopy was associated with superior outcomes, respectively. These findings may provide evidence to guide clinical decisions for reproductive clinicians. The conclusions might be limited by the small publication numbers. Further studies with a larger sample size were recommended.

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Introduction

Embryo transfer is the final and most critical step of in vitro fertilization (IVF) treatment [1, 2]. Successful implantation requires a reciprocal interaction between the blastocysts and endometrium [3, 4]. The functional endometrium provides a suitable microenvironment for the early development of embryos [5, 6]. Thus, assuring the intact and receptivity of endometrium before embryo transfer is a prerequisite for successful implantation [7, 8].

Accumulating evidence indicated that intrauterine pathologies, including endometrial polyps and submucosal myomas, exerted negative influences on fertility via distorting the uterine cavity and impairing endometrial receptivity [9,10,11]. Hysteroscopy is regarded as one of the most efficient approaches for cavity evaluation and correcting intracavity abnormalities [9, 12]. Moreover, emerging evidence proposed that endometrial scratching/injury could enhance endometrial receptivity and decidualization [3, 4, 13]. Therefore, the potential clinical value of hysteroscopy was gradually recognized for women who underwent IVF treatments [9, 14, 15]. However, the optimal timing (immediate transfer vs. transfer after one or more cycles) to perform embryo transfer after hysteroscopy treatment has not reached a consensus [16].

When is the optimal timing to start transferring embryos for women who underwent hysteroscopy has been discussed intensively [16]. Several studies suggested performing hysteroscopy within the IVF-ET (in vitro fertilization and embryo transfer) cycle was beneficial to clinical outcomes [17, 18]. Meanwhile, delaying IVF cycles could not yield superior outcomes, and even bring detrimental effects, especially for women with advanced age [19, 20]. Whereas other researchers hold opposite opinions. For example, previous literature reported that performing hysteroscopy at the oocyte retrieval day or concurrent to the embryo transfer contributed to a decreased implantation rate [21, 22]. This phenomenon might be attributed to the divergent endometrial healing time following different hysteroscopic procedures [16]. Therefore, identifying the optimal waiting period between hysteroscopy and embryo transfer regarding different indications for hysteroscopy, is quite important for fertility outcomes.

Accordingly, in the current study, we performed a systematic review and meta-analysis to evaluate whether the waiting period affected clinical outcomes to determine the optimal timing for embryo transfer following hysteroscopy.

Materials and methods

We performed this review according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and a protocol (PROSPERO registration number: CRD42021266714).

Search strategy

Electronic databases including Pubmed, Embase, and Cochrane Library were used for searching published studies on the associations between hysteroscopy and embryo transfer up to July 2021. No restrictions on date or type of publication were applied to the search. Regarding the exclusion criteria, non-English studies were not included for the review. The detailed search strategy was displayed in the Supplemental Table 1. The current systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA).

Study selection

Titles and abstracts of all identified publications were screened and the full text of the pre-selected articles was reviewed by two researchers (C.L. and Z.L.). If the consensus could not be reached, the disagreements were settled by a discussion with a third author (X.G.).

Studies regarding women who experienced embryo transfer after hysteroscopy treatment were selected for eligibility. Studies were included if they investigated the time interval between hysteroscopy and embryo transfer on pregnancy outcomes. Moreover, studies published in other languages or without clear outcome definitions were excluded, as were literature reviews, case studies, editorials, conference abstracts, and commentaries.

Outcome measurement

The primary outcome was the clinical pregnancy rate. Clinical pregnancy was defined as fetal cardiac activity by sonography. The clinical pregnancy rate was calculated as the number of women with clinical pregnancy divided by the number of women who experienced embryo transfer, per group. The secondary outcomes included live birth rate and miscarriage rate. Live birth rate was calculated as the number of patients who delivered live births divided by the number of patients who had embryo transfer, per group. Miscarriage was defined as women who experienced pregnancy loss after clinical pregnancy, and its rate was calculated as the number of occurrences divided by the number of women with clinical pregnancy, per group.

Data extraction and quality assessment

Both researchers (C.L. and Z.L.) extracted data from the selected articles independently according to a standard protocol. The following information was collected from the eligible studies: author’s name, year of publication, study design, number of patients, number of patients achieved clinical pregnancy, number of patients who gave live birth, number of patients who experienced miscarriages, the time intervals between hysteroscopy and embryo transfer, and the status of transferred embryos.

The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the observational studies included in this review. It is a validated scoring system for evaluating the bias from selection, the comparability, and the outcomes assessment. One or two stars were awarded to each item and studies that met all criteria of NOS would receive a score of up to 9 points. Studies with ≥ 7 points were considered as high-quality. Studies with 5 ~ 7 points were considered as medium quality. Besides, studies with < 5 points were regarded as low quality and excluded from this study. The quality of each included study was independently evaluated by two investigators (C.L. and Y.C.), and discrepancies between the two authors were resolved by two other investigators (L.C. and X.G.).

Assessment of quality of evidence—GRADE pro GDT analysis

For analyzing the overall quality of evidence, GRADE pro GDT (guideline development tool) software was used. The final overall evidence quality as per the GRADE was classified as high, moderate, low, or very low. The GRADE pro GDT software was accessed online from the site: https://gradepro.org/.

Statistical analysis

The time intervals between hysteroscopy and embryo transfer varied among studies. To investigate the optimal timing for embryo transfer, we selected 50 days, 90 days, and 120 days as cut-off points and assassedthe pregnancy outcomes of such points. For meta-analysis on the primary and secondary outcomes, studies were considered comparable if they contained the same time intervals for embryo transfer. For studies where individual patient data or original data were available, outcomes were recalculated according to the time frames discussed in the current review. The summary risk ratios (RR) at 95% confidence intervals (CI) were calculated with a random effect model. Meta-analyses were performed using Review Manager software (version 5.2). To assess the publication bias, a funnel plot analysis using the Egger test was performed. Heterogeneity was assessed using the Q statistic and the I2 statistics. Where I2 was more than 50% or P < 0.05 signifying significant heterogeneity [23]. Results were expressed as forest plots. All P values were two-sided.

Results

Study selection and characteristics

A total of 730 publications were identified by bibliographic researches. Of these, 307 duplicates, 11 published in other languages, 34 abstracts, 117 reviews, and 162 not relevant to the topic were excluded after screening titles (Fig. 1). Next, the remaining publications were screened by abstracts, and 4 reviews/comments, as well as 84 irrelevant articles, were excluded. Then, full-text reading of the remained 11 studies was retrieved for review. Of these, 6 records were conference abstracts. The detailed information of these abstracts and reasons for exclusion were listed in the Supplemental Table 2. Finally, 5 studies were included [20, 24,25,26,27].

Fig. 1
figure 1

Flow diagram of study identification and selection process for systematic review and meta-analysis

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Table 1 displays the characteristics and the quality assessment scores of the included studies published from 2012 to 2020. All 5 studies were retrospective in nature and varied in indications for hysteroscopy. All the included study were of high quality (≥ 7 points in NOS). (The detailed scoring of each included studies was displayed in Supplemental Table 3). Additionally, GRADE pro-GDT was used to assess the influence of the waiting period on the clinical pregnancy outcome (Supplemental Table 4). The results indicated that the quality of the evidence is critical for the outcome. In the studies of Karayalçin et al. and Pillai et al., women who presented with normal hysteroscopic findings were enrolled [24, 25], and hysteroscopy was performed for endometrial injury (microtrauma), which might improve the clinical outcomes. In Aharon’s research, the indications for hysteroscopy included polypectomy, myomectomy, lysis of adhesions, septum resection, and retained products of conceptions (POC) [20]. Deng et al. offered hysteroscopy treatment for patients with uterine adhesion [26]. Moreover, in the research of Tu et al., women were indicated with hysteroscopy for polypectomy [27].

Table 1 Characteristics of the included studies
Full size table

The cut-off value of the time interval between hysteroscopy and embryo transfer was different among studies. Two of them regarded 50- and 180-day as cut-off points [24, 25]. One study looked at time intervals in months [20], while another looked at time intervals in seasons [26]. The left study provided raw data for all individual patients and identified a cut-off value of 120-day using the ROC curve [27]. Primary (Fig. 2A) and secondary outcomes (Fig. 2B-C) as reported by the original studies were displayed.

Fig. 2
figure 2

Data for primary and secondary outcomes according to time intervals, as provided by the included studies. Values in parentheses were percentages

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In the study of Aharon et al. [20], the definition of ongoing pregnancy and early pregnancy loss was corresponded to clinical pregnancy and miscarriage of other articles, respectively. Therefore, five studies provided data on clinical pregnancy rate [20, 24,25,26,27], four on live birth rate [24,25,26,27], and three on miscarriage rate [20, 26, 27].

Clinical pregnancy rate

All 5 studies provided data on clinical pregnancy rates. The meta-analysis demonstrated that clinical pregnancy rate was significantly increased in patients with a waiting interval of ≤ 120 days compared to patients with a waiting interval of > 120 days (RR = 0.75, 95% CI 0.61–0.93, P = 0.009; heterogeneity: P = 0.45, I2 = 0%; Fig. 3C). However, no significance was found in the clinical pregnancy rate in the comparison of ≤ 50 days versus > 50 days (RR = 0.83, 95% CI 0.61–1.11, P = 0.21; heterogeneity: P = 0.05, I2 = 67%; Fig. 3A) and < 90 days versus ≥ 90 days (RR = 0.91, 95% CI 0.74–1.12, P = 0.38; heterogeneity: P = 0.19, I2 = 40%; Fig. 3B).

Fig. 3
figure 3

Forest plots presenting the association of time interval between hysteroscopy and embryo transfer with clinical pregnancy rate. (A) Clinical pregnancy rates of patients who underwent embryo transfer ≤ 50 days versus > 50 days following hysteroscopy. (B) Clinical pregnancy rates of patients who underwent embryo transfer < 90 days versus ≥ 90 days following hysteroscopy. (C) Clinical pregnancy rates of patients who underwent embryo transfer ≤ 120 days versus > 120 days following hysteroscopy

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Live birth rate

The live birth rate displayed no differences in patients with a waiting interval of > 50 days compared to patients with a waiting interval of ≤ 50 days (RR = 0.82, 95% CI 0.58–1.15, P = 0.25; heterogeneity: P = 0.11, I2 = 56%; Fig. 4A), or ≥ 90 days versus < 90 days (RR = 0.97, 95% CI 0.76–1.22, P = 0.77; heterogeneity: P = 0.74, I2 = 0%; Fig. 4B).

Fig. 4
figure 4

Forest plots presenting the association of time interval between hysteroscopy and embryo transfer with live birth rate. (A) Live birth rates of patients who underwent embryo transfer ≤ 50 days versus > 50 days following hysteroscopy. (B) Live birth rates of patients who underwent embryo transfer < 90 days versus ≥ 90 days following hysteroscopy

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Miscarriage rate

Three studies exhibited original data regarding miscarriage. The meta-analysis demonstrated that the miscarriage rate was not different between patients with a time interval of < 90 days compared to patients with a time interval of ≥ 90 days (RR = 0.66, 95% CI 0.35–1.24, P = 0.19; heterogeneity: P = 0.17, I2 = 44%; Fig. 5A), or ≤ 120 days versus > 120 days (RR = 0.62, 95% CI 0.08–4.85, P = 0.65; heterogeneity: P = 0.12, I2 = 59%; Fig. 5B).

Fig. 5
figure 5

Forest plots presenting the association of time interval between hysteroscopy and embryo transfer with miscarriage rate. (A) Miscarriage rates of patients who underwent embryo transfer < 90 days versus ≥ 90 days following hysteroscopy. (B) Miscarriage rates of patients who underwent embryo transfer ≤ 120 days versus > 120 days following hysteroscopy

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Subgroup analysis

Subgroup analysis was performed according to the indications for hysteroscopy. Two studies enrolled patients with normal uterine cavities and received hysteroscopy treatment for detecting uterine cavity and endometrial injury (micro-traumas). Two studies performed hysteroscopy for women with polyps and uterine adhesion, respectively, while the other study included multiple conditions, including polyps, myomas, adhesion, septum, and retained POC.

Subgroup analysis for patients with adhesion showed a trend towards an increase in clinical pregnancy rate in the ≤ 120 days group compared to > 120 days group (RR = 0.79, 95% CI 0.62-1.00, P = 0.05; heterogeneity: not applicable, Fig. 6B), however, statistical significance was not reached. Whereas, the miscarriage rate was similar for patients with adhesion were similar between time groups (Fig. 7).

Fig. 6
figure 6

Subgroup meta-analysis by indications for hysteroscopy of clinical pregnancy rate for patients who underwent embryo transfer (A) ≤ 50 days versus > 50 days or (B) ≤ 120 days versus > 120 days following hysteroscopy

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Fig. 7
figure 7

Subgroup meta-analysis by indications for hysteroscopy of miscarriage rate for patients who underwent embryo transfer ≤ 120 days versus > 120 days, following hysteroscopy

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For the polyp subgroup, there was a trend toward a higher clinical pregnancy rate in the time interval of ≤ 120 days compared to > 120 days (RR = 0.65, 95% CI 0.41–1.01, P = 0.06; heterogeneity: not applicable; Fig. 6B). Whereas, the clinical pregnancy rate was similar between the time interval of ≤ 50 days vs. >50 days (RR = 0.85, 95% CI 0.60–1.22, P = 0.39; heterogeneity: not applicable; Fig. 6A). Moreover, no significances of live birth rate (≤ 50 days vs. >50 days, RR = 0.84, 95% CI 0.52–1.36, P = 0.48, heterogeneity: not applicable, Fig. 8A; ≥90 days vs. <90 days, RR = 0.91, 95% CI 0.60–1.38, P = 0.66, heterogeneity: not applicable, Fig. 8B) and miscarriage rate (Fig. 7) were found in time groups.

Fig. 8
figure 8

Subgroup meta-analysis by indications for hysteroscopy of live birth rate for patients who underwent embryo transfer (A) ≤ 50 days versus > 50 days or (B) < 90 days versus ≥ 90 days following hysteroscopy

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For endometrial injury subgroup, clinical pregnancy rate was similar between the time groups (≤ 50 days vs. >50 days, RR = 0.84, 95% CI 0.52–1.36, P = 0.48; heterogeneity: P = 0.02, I2 = 81%; Fig. 6A), while the live birth rate significantly favored the time interval ≤ 50 days (RR = 0.71, 95% CI 0.54–0.95, P = 0.02; heterogeneity: P = 0.22, I2 = 32%; Fig. 8A).

For patients with myoma, septum, and retained POC, only data regarding clinical pregnancy were available. Subgroup analysis showed no significance in the clinical pregnancy rate between time groups in women with such pathologies (Suppl Fig. 1). To be specific, for patients with myoma, clinical pregnancy rate was similar between the time groups (< 90 days vs. ≥90 days, RR = 1.29, 95% CI 0.61–2.70, P = 0.51; heterogeneity: not applicable; Suppl Fig. 1). For patients with septum, clinical pregnancy rate was comparable between the time groups (< 90 days vs. ≥90 days, RR = 0.97, 95% CI 0.30–3.18, P = 0.96; heterogeneity: not applicable; Suppl Fig. 1). For women with retained POC, no significance was found regarding clinical pregnancy rate between groups (< 90 days vs. ≥90 days, RR = 2.29, 95% CI 0.37–14.03, P = 0.37; heterogeneity: not applicable; Suppl Fig. 1).

Publication bias

Funnel plots for publications included in different time interval groups were shown in Suppl Fig. 2–4. Results showed no evidence of significant publication bias (Egger test not significant).

Discussion

In the current study, we performed a systematic review and meta-analysis to investigate the optimal time for embryo transfer for women who experienced hysteroscopy. This review was performed in compliance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA), and a total of 2123 patients from five retrospective cohort studies were included. The time interval between hysteroscopy and embryo transfer varied among studies. Therefore, in the current study, we evaluated the pregnancy outcomes of the recommended time to perform embryo transfer after hysteroscopy: >50 days versus ≤ 50 days (which allowed patients to undergo embryo transfer within that IVF cycle [24]); ≥90 days versus < 90 days (Three months after the hysteroscopy might enable the endometrial healing complete [20]); and > 120 days versus ≤ 120 days. Besides, the optimal time for embryo transfer might be different for women with distinct pathologies. Thus, subgroup analysis was performed. The included publications were of high quality (≥ 7 points), which might improve the reliability of meta-analysis. The heterogeneity was evident in several studies, therefore, the random-effects model (DerSimonian and Laird method) was used for data analysis to reduce its effects [28]. No significant publication bias was found. The pooled results indicated that transferring embryos within 50 days for patients with normal uterine cavity was associated with a higher live birth rate compared to delayed embryo transfer (over 50 days). Moreover, transferring embryos within 120 days posed a higher clinical pregnancy rate for patients with uterine adhesion or endometrial polyps in the current study.

The construction of pregnancy is a highly coordinated process whereby functional embryos attach and invade the maternal endometrium [29]. Thus, uterine endometrium, which provides an appropriate microenvironment for the early development of embryos, is a critical factor for the success of implantation [5, 6]. Uterine pathologies, including polyps, submucous myomas, and adhesion were great threats to embryo implantation and pregnancy. However, even after correcting the intracavitary uterine pathologies via hysteroscopy, the optimal time to perform embryo transfer was still under debate. Therefore, in the present study, we compared the pregnancy outcomes of women who experienced different time intervals between hysteroscopy treatments and embryo transfer. Results indicated no statistically significant differences for the clinical pregnancy rate within the 50-day or 90-day and their comparison groups. Whereas, the clinical pregnancy rate was significantly increased in women who underwent embryo transfer within 120 days after hysteroscopy in this study. This result was not surprising. Prior studies suggested the effect of operative hysteroscopy on endometrial receptivity might display a bimodal pattern [27]. Initially, hysteroscopy treatment disturbed endometrial completion, whereas the sequential inflammation, which induced angiogenesis and promoted cytokines, was beneficial to implantation [30, 31]. Therefore, performing embryo transfer within a shorter time (less than 50 days or 90 days) exhibiting no benefits to clinical pregnancy, was reasonable.

Given the various indications for hysteroscopic treatment, we conducted subgroup analysis to identify the optimal time to transfer embryos for patients with normal uterine cavity, endometrial polyps, or uterine adhesion. In our study, results showed that women with endometrial polyps or uterine adhesion were favored for embryo transfer within 120 days, although no significance was found. This phenomenon was in accordance with our hypothesis, stated above. Moreover, data showed that performing embryo transfer within 50 days was associated with a higher live birth rate for women with normal uterine cavities. Hysteroscopy is considered an excellent approach to evaluate the uterine cavity and correct intrauterine pathologies [32, 33]. Recent evidence suggested that endometrial scratching facilitated endometrial repair, cytokine production, and angiogenesis [22]. Thus, endometrial scratching has been regarded as a potent resort to enhance implantation, especially for women with recurrent implantation failure [34, 35]. Unlike operative hysteroscopy correcting intracavity uterine pathologies, office hysteroscopy performed for women with normal uterine cavity caused microtraumas, which were not visible [24]. Besides, previous literature reported a higher prevalence of endocervical and endometrial damage for women who were difficult for embryo transfer [1, 36]. It had been postulated that hysteroscopy allowed an opportunity to dilate the cervical canal, which, in return, enabled further optimization of embryo transfer procedure [37]. Therefore, commencing embryo transfer soon after office hysteroscopy, which promoted immunological response without disturbing intact endometrium, was favored for the construction of pregnancy.

In this study, our data evaluated the optimal time for embryo transfer after hysteroscopy regarding women with different conditions. The present study, to the best of our knowledge, was the first meta-analysis to address these issues. In this meta-analysis, results showed that a longer waiting period prior to embryo transfer did not favor the clinical pregnancy rates for women who underwent hysteroscopy for different indications, including uterine septum. Generally speaking, hysteroscopic metroplasty would correct the uterine anatomy for women with intrauterine septum [28, 38], however, it also injured the inner face of the myometrium as well as the endometrium, taking quite a time for recovery [16, 39]. According to this point, a longer time following hysteroscopic metroplasty promised uterine recovery and might facilitate reproductive outcomes. Although our results did not support this point, we assumed two possibilities might be responsible for this discrepancy. Firstly, the endometrial layer would not regenerate in the operation zone. A wide area lacking endometrial covering are left on the anterior and posterior uterine walls following surgery [39], decreasing the odds for embryos to implant. On the other hand, the facing wounds were prone to adhere to each other during endometrial rebuilding [16]. Secondary adhesion following metroplasty is another risk for fecundity [39, 40]. In addition, a recent meta-analysis indicated septum resection did not improve the reproductive outcomes for women with a septate uterus [41], which seemed to support our results, stated above.

This meta-analysis explored the optimal timing to transfer embryos for women who underwent hysteroscopy, which was really needed to answer critical questions raised by patients and clinicians. It might provide more evidence for making decisions and provide more chances to attach better clinical outcomes. However, there were several limitations to this review. Firstly, only 5 publications were included for meta-analysis. A lack of studies meant that the number of patients in the subgroup analysis was small. Additionally, several results displayed higher heterogeneity, which might be partly attributed to the limited number of included studies. Subsequent analysis of a greater number of studies could further strengthen these conclusions. Meanwhile, only English language articles were included, thereby, relevant studies published in other languages might be missed. Secondly, there was substantial heterogeneity between two studies evaluating the role of hysteroscopic endometrial injury and its timing prior to IVF outcomes. This was likely derived from discrepancies among the population, or interventions varied among clinicians. However, the high heterogeneity might restrain our conclusion from extrapolating to the general population. Besides, the study design of the included articles was retrospective in nature, which also limited conclusions. Additionally, the time interval of the hysteroscopy and embryo transfer varied among studies. Moreover, the original data, which allowed authors to fully assess the effects of time interval on the pregnancy outcomes, were not available in several studies. Thus, we could not narrow down the optimal time interval precisely. Recent evidence indicated that the transvaginal or transabdominal ultrasound guidance during embryo transfer also affected clinical outcomes [42, 43]. Thus, future discussions on how to perform embryo transfer may improve the current clinical guidelines. Overall, our review suffered from small publication numbers. Further studies with a larger sample size were recommended.

In conclusion, our data showed that performing embryo transfer within 120 days for patients who underwent adhesiolysis or polypectomy could gain a higher clinical pregnancy rate. Besides, transferring embryos within 50 days for patients who underwent diagnostic hysteroscopy was associated with a higher live birth rate in this meta-analysis. These findings might be useful to revise current guidance.

a Data regarding the miscarriage rate was displayed in the supplemental files of the original study. b Miscarriage rate was calculated with the use of original data of all participates that were provided in the supplemental materials of the original study.

Data availability

In this study, all pertinent information is given. However, the corresponding author will provide more information upon reasonable request.

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Acknowledgements

None.

Funding

The current study was funded by the National Natural Science Foundation of China (NSFC 82201811 and NSFC 82201758) and Jiangsu Natural Science Foundation (No. BK20220173).

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Centre for Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China

    Chang Liu & Yunan He

  2. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China

    Chang Liu & Yunan He

  3. Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Zhiqi Liao, Lei Cai, Xueqi Gong & Yinwei Chen

  4. Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China

    Yanan Li

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  1. Chang Liu
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Contributions

C.L. designed the study. C.L., Z.L., and X.G. contributed to the article selection, data acquisition, and analysis. C.L., Y.L., Y.H. and Y.C. prepared the manuscript, which was edited by Y.C., L.C., and C.L.

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Correspondence to Yunan He or Yinwei Chen.

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12884_2025_7511_MOESM1_ESM.tif

Supplemental Figure 1. Subgroup meta-analysis by indications for hysteroscopy of clinical pregnancy rate for patients who underwent embryo transfer <90 days versus ≥90 days following hysteroscopy

12884_2025_7511_MOESM2_ESM.tif

Supplemental Figure 2. Funnel plots for publication bias evaluation for the clinical pregnancy rate for women who underwent embryo transfer ≤50 days versus >50 days following hysteroscopy

12884_2025_7511_MOESM3_ESM.tif

Supplemental Figure 3. Funnel plots for publication bias evaluation for the clinical pregnancy rate for women who underwent embryo transfer <90 days versus ≥90 days following hysteroscopy

12884_2025_7511_MOESM4_ESM.tif

Supplemental Figure 4. Funnel plots for publication bias evaluation for the clinical pregnancy rate for women who underwent embryo transfer ≤120 days versus >120 days following hysteroscopy

Supplementary Material 5

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Liu, C., Liao, Z., Cai, L. et al. Optimal timing to transfer embryos for women who underwent hysteroscopy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 25, 453 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12884-025-07511-5

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Keywords

BMC Pregnancy and Childbirth

ISSN: 1471-2393

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