It is uncertain whether the use of mechanical closure of the cervical canal following embryo transfer has any effect.
There is considerable evidence that prolonges bed rest (more than 20 minutes) after embryo transfer is associated with reduced chances of clinical pregnancy.
Using hyaluronic acid as an adherence medium for the embryo may increase live birth rates. There may be little or no benefit in having a full bladder, removal of cervical mucus, or flushing of the endometrial or endocervical cavity at the time of embryo transfer. Adjunctive antibiotics in the form of amoxicillin plus clavulanic acid probably does not increase the clinical pregnancy rate compared with no antibiotics. The use of Atosiban, G-CSF and hCG around the time of embryo transfer showed a trend towards increased clinical pregnancy rate.
For frozen-thawed embryo transfer or transfer of embryo from egg donation, no previous ovarian hyperstimulation is required for the recipient before transfer, which can be performed in spontaneous ovulatory cycles. Still, various protocols exist for frozen-thawed embryo transfers as well, such as protocols with ovarian hyperstimulation, protocols in which the endometrium is artificially prepared by estrogen and/or progesterone. There is some evidence that in cycles where the endometrium is artificially prepared by estrogen or progesterone, it may be beneficial to administer an additional drug that suppresses hormone production by the ovaries such as continuous administration of a gonadotropin releasing hormone agonist (GnRHa). For egg donation, there is evidence of a lower pregnancy rate and a higher cycle cancellation rate when the progesterone supplementation in the recipient is commenced prior to oocyte retrieval from the donor, as compared to commenced day of oocyte retrieval or the day after.
Seminal fluid contains several proteins that interact with epithelial cells of the cervix and uterus, inducing active gestational immune tolerance. There are significantly improved outcomes when women are exposed to seminal plasma around the time of embryo transfer, with statistical significance for clinical pregnancy, but not for ongoing pregnancy or live birth rates with the limited data available.