Do antibiotics affect In Vitro Fertilization (IVF) transfer?

Antibiotics and IVF Transfer: Impact on Outcomes

Antibiotics are not recommended for routine use during IVF embryo transfer as they do not improve live birth rates and may potentially disrupt the vaginal microbiome. 1, 2

Evidence on Antibiotics in IVF

The most recent and highest quality evidence from a 2023 Cochrane systematic review indicates uncertainty about whether antibiotics given prior to or at the time of embryo transfer improve live birth rates in women undergoing assisted reproductive technology 2. The review found:

• No significant improvement in clinical pregnancy rates with antibiotic administration
• Possible reduction in genital tract colonization, but this did not translate to improved pregnancy outcomes
• Insufficient evidence regarding adverse effects and other outcomes

Guidelines Specifically State:

Current guidelines explicitly state that antibiotic prophylaxis is not recommended for in vitro fertilization procedures 1. In the "Antibioprophylaxis in Surgery and Interventional Medicine" guidelines, IVF is specifically listed among procedures that do not require antibiotic prophylaxis.

Potential Negative Effects of Antibiotics

Research suggests that antibiotic use around the time of IVF may have unintended consequences:

• A 2020 study found that prophylactic azithromycin administration was associated with higher diversity of herpesviruses and α-papillomaviruses in the vaginal microbiome 3
• This study also observed a trend where women who received antibiotics but failed to achieve clinical pregnancy had higher viral diversity compared to those who did achieve pregnancy

Conflicting Evidence

There is some conflicting evidence regarding endometrial infection and IVF outcomes:

• A 1998 study suggested that endometrial infection might negatively impact implantation, with higher rates of positive endometrial cultures in non-conceptive cycles 4
• However, a 2004 randomized study found no benefit in implantation rates when amoxicillin + clavulanic acid was administered from oocyte retrieval through 6 days post-procedure 5

Antibiotic Use in Related Contexts

When considering the broader context of antibiotics in reproductive medicine:

• Guidelines recommend a washout period of at least 24 hours between the last dose of antibiotic and treatments like fecal microbiota transplant 1
• This suggests potential concerns about the impact of antibiotics on microbiome-dependent procedures

Recommendations for Clinical Practice

Based on the current evidence:

1. Do not routinely administer antibiotics before or during IVF embryo transfer 1, 2
2. Consider targeted antibiotic treatment only if there is documented infection requiring treatment
3. If antibiotics are necessary for other indications:
   • Be aware of the potential impact on the vaginal microbiome
   • Consider the timing of antibiotic administration relative to the IVF procedure

Common Pitfalls to Avoid

• Prescribing prophylactic antibiotics "just to be safe" - this practice is not supported by evidence and may be detrimental
• Failing to distinguish between prophylactic use and therapeutic use for documented infections
• Overlooking the potential negative impact of antibiotics on the vaginal microbiome, which may be important for implantation

In conclusion, while infection prevention is important in reproductive medicine, the routine use of antibiotics during IVF embryo transfer is not supported by current evidence and guidelines.