Fertility
No clear evidence common embryo transfer techniques improve IVF success, review finds

Common IVF preparation techniques used before embryo transfer have no proven effect on pregnancy rates, according to a review.
Researchers said evidence for the widely used practices remains uncertain because available studies are limited and generally of low quality.
Embryo transfer is the final and most vulnerable stage of IVF, when an embryo is placed into the womb. Only around one in three transfers results in pregnancy.
Practice varies between clinics, with some routinely using preparation techniques such as adjusting bladder fullness while others do not consider them necessary.
Dr Ryosuke Akino, practising obstetrician-gynaecologist from Kato Ladies Clinic, said: “To an extent, this is a case of tradition driving practice rather than the evidence.
“Current practices in this area often reflect local protocols, clinician preference, and historical convention rather than strong, high-quality evidence.”
The Cochrane review analysed 11 studies involving 2,524 women undergoing embryo transfer.
Researchers looked at three preparation techniques used by fertility clinics: having women arrive with a full bladder to straighten the angle between the uterus and cervix, removing cervical mucus and using a technique called afterloading.
Afterloading is a technique used to guide the embryo through the cervix.
The review found no reliable evidence that any of the three approaches improved pregnancy rates compared with standard care.
Researchers rated the evidence as low or very low certainty because the trials were small and had methodological weaknesses. They found no grounds to recommend any of the techniques over standard care.
There was also limited information about possible side effects.
The review team, which included methodologists and practising obstetrician-gynaecologists, said full bladder preparation and cervical mucus removal were generally considered safe, with no clear evidence of harm or major complications.
Dr James Brown, obstetrician-gynaecologist from Women’s Health and Research Institute Australia, said: “While these techniques are generally considered safe, it’s still important to test their effectiveness.”
Akino and Brown added: “A full bladder can be uncomfortable, although it may ease catheter insertion in certain uterine positions and reduce procedural difficulty.
“Mucus removal is usually quick, but if done roughly and causes bleeding, it may affect the woman’s experience.
“Overall, the risks are minor and relate mostly to discomfort and procedural factors rather than clinical harm.”
The authors said embryo transfer has changed relatively little despite major advances elsewhere in IVF.
Research has instead focused more heavily on embryo quality and genetic factors, which have a greater bearing on treatment success than transfer technique.
Embryo transfer also depends heavily on the person carrying out the procedure and can be difficult to standardise, making large, rigorous clinical trials harder to design.
Researchers said women may also be reluctant to risk valuable embryos by taking part in randomised studies comparing different transfer techniques.
Dr Noyuri Yamaji from Showa Medical University in Japan said: “Sixteen years of research still haven’t answered a basic IVF technique question.
“This is a critical step in the IVF process and these small changes and techniques have the possibility to make a massive difference, but we won’t know more until more robust, better-quality trials are conducted.”
All the studies assessed were carried out in high-income countries, meaning the findings may not necessarily apply to other healthcare settings and populations.
The authors said further research could be particularly valuable in resource-limited settings, where these procedures are inexpensive and simple to change and basic procedural standardisation could matter more than advanced technical modifications.
Fertility
NHS IVF access review launched in Scotland
Fertility
Jersey PMOS clinic a ‘good start’

Jersey is launching a pilot PMOS health check clinic for women to improve follow-up care and access to specialist support.
The clinic will operate at the Assisted Reproductive Unit in St Brelade from October, providing health checks rather than diagnosing or treating the condition.
Women with polyendocrine metabolic ovarian syndrome (PMOS) will need to see their GP before being referred to the service.
Jessica Pinel, chair of PMOS Jersey, described the service as “a good start” but said more could be done.
She said the clinic was in line with draft guidance from the UK’s National Institute for Health and Care Excellence (NICE), which advises annual checks to identify health issues associated with the condition.
Pinel was diagnosed with PMOS in 2023 after spending more than £3,100 on treatment.
She said: “We need to realise that cost may be a barrier to people getting support, even if the cost is going to their GP. But I think we do have to be grateful that we have had this service approved.
“Because the clinic is part of the government health system, it allows for referrals to be made into different pathways like endocrinology, dermatology, so it could actually allow for better support and reduce costs for women with PMOS.
“I think it’s great to see things moving forward and, for women who are newly diagnosed, there’s going to be a more joined-up approach and we’re now taking the long-term health consequences of PMOS more seriously.”
PMOS, which was renamed from polycystic ovary syndrome (PCOS) in May, is a metabolic condition that changes how the ovaries work and affects up to one in eight women, according to the UK’s NHS.
The new name was introduced to reflect the condition’s effects across the body. PMOS has been linked to infertility and weight gain.
The Jersey government said the clinic would help women access further care for PMOS and associated conditions, including type 2 diabetes.
Screening clinic nurse Corrinne Purdy said reviews would take a holistic approach, covering medication, height and weight, sleep, management of the condition, fertility aspirations and mental health.
She said: “We will see whether they’re getting on alright with their medication, how they’re feeling about themselves; we will do height and weight reviews, we will ask them questions about their sleep, how they’re managing their condition.
“We will also speak to them about any particular fertility aspirations and how they’re getting with their mental health as well.”
Purdy said PMOS had been “overlooked” for a long time and that many women struggle with associated symptoms.
The government said women who require specialist management for heavy menstrual bleeding, fertility concerns or other gynaecological conditions would be referred to the appropriate specialist service.
It said existing waiting lists for gynaecology or surgical capacity would not be affected because additional clinical capacity had been identified.
Assistant Minister for Health and Social Services Andy Howell said many women “have been suffering” with PMOS and that the trial was intended to show “that we’re taking them seriously and they’re not going to be dismissed”.
Howell said funding for the clinic would be “managed within the budget that we have at the moment, so it’s not going to cost us any more”.
The Health Department was allocated £381m for 2026 as part of the government’s 2026-2029 budget.
The clinic will also offer investigations including ultrasound scans and endometrial biopsies during the same visit.
Howell said Jersey would base its review of the service on NICE guidance, while Pinel said feedback from women using the clinic would be shared with practitioners to help improve the support provided.
Fertility
Scotland’s birth rate hits record low for third year running

Scotland recorded its lowest number of births for a third consecutive year in 2025, with 45,067 live births registered.
The total was almost 696 fewer than the previous year and the lowest annual figure since records began in 1855.
Deaths also outnumbered births for the 11th consecutive year, with the gap between the two generally widening since 2014.
Registrar General and National Records of Scotland chief executive Alison Byrne said: “This is the eleventh year in a row where deaths have outnumbered births and the third in a row where we have a new record low for the number of births in Scotland.
“Generations of change are captured in these figures.
“This data will inform debate and decision-making across the public and private sectors, as we consider what this means for our future.”
Figures published by the National Records of Scotland (NRS) show the country’s total fertility rate fell to 1.23 in 2025, from 1.24 in 2024.
The total fertility rate measures the average number of children born to each woman. A rate of around 2.1 is needed for a population to replace itself without migration.
Scotland’s 2025 figure was the lowest since the start of the NRS-published time series in 1951. The country’s fertility rate was last above 2.1 in 1973.
Despite the decline in births, Scotland’s population increased slightly in the year to June 2025, driven by migration.
The annual figures also showed an increase in stillbirths, from 159 in 2024 to 188 in 2025.
This represented 4.2 stillbirths for every 1,000 live and stillbirths, compared with 3.5 in 2024. The 2024 figure was the joint lowest stillbirth rate recorded for any year and remains historically low.
The infant death rate fell from 3.5 per 1,000 live births in 2024 to 3.3 in 2025.
Adoptions declined from 369 in 2024 to 340 in 2025.
Meanwhile, 27,191 marriages took place in Scotland during 2025, 236 more than the previous year. Four per cent were same-sex marriages and 96 per cent were mixed-sex marriages.
Civil partnerships increased to 944, the highest number since 2006, the first full year in which civil partnerships were available.
The figures form part of the NRS annual release covering births, marriages, deaths and other vital life events in Scotland.
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