The effect of Nifedipine on embryo transfer outcomes: A randomized clinical trial


Background: Endometrial receptivity is crucial for embryo implantation, and excessive uterine contraction reduces success. Nifedipine which is a calcium channel blocker, could decrease uterine contraction and improve pregnancy outcomes.

Objective: This study aimed to assess the effect of Nifedipine before embryo transfer on the pregnancy outcome in women undergoing in vitro fertilization (IVF) in a tertiary center in Iran.

Materials and Methods: 150 women who were candidates for IVF were randomly assigned into 2 groups: group 1 received 20 mg Nifedipine 30 min before embryo transfer, and group 2 received no intervention. Blood pressure of the participants was monitored every 10 min for 1 hr under the supervision of an anesthesiologist. Finally, implantation rate and chemical and clinical pregnancy rates were compared between groups.

Results: At the end of the study, 140 participants were included in the final analyses. No significant difference was observed in clinical pregnancy rates between groups (20% vs. 22%, p = 0.51)

Conclusion: Nifedipine administration before embryo transfer does not improve the implantation and clinical pregnancy rates in women undergoing IVF.

Key words: Nifedipine, In vitro fertilization, Uterus, Contraction.

[1] Davari Tanha F, Mohseni M, Ghajarzadeh M. Sexual function in women with primary and secondary infertility in comparison with controls. Int J Impot Res 2014; 26: 132–134.

[2] Ng KK, Rozen G, Stewart T, Agresta F, Polyakov A. A doubleblinded, randomized, placebo-controlled trial assessing the effects of Nifedipine on embryo transfer: Study protocol. Medicine 2017; 96: e9194.

[3] Enciso M, Aizpurua J, Rodriguez-Estrada B, Jurado I, Ferrandez-Rives M, Rodriguez E, et al. The precise determination of the window of implantation significantly improves ART outcomes. Sci Rep 2021; 11: 13420.

[4] Gunther V, Otte SV, Freytag D, Maass N, Alkatout I. Recurrent implantation failure - an overview of current research. Gynecol Endocrinol 2021; 37: 584–590.

[5] Waclawik A, Kaczmarek MM, Blitek A, Kaczynski P, Ziecik AJ. Embryo-maternal dialogue during pregnancy establishment and implantation in the pig. Mol Reprod Dev 2017; 84: 842– 855.

[6] Chung CHS, Wong AWY, Chan CPS, Saravelos SH, Kong GWS, Cheung LP, et al. The changing pattern of uterine contractions before and after fresh embryo transfer and its relation to clinical outcome. Reprod Biomed Online 2017; 34: 240–247.

[7] Davar R, Poormoosavi SM, Mohseni F, Janati S. Effect of embryo transfer depth on IVF/ICSI outcomes: A randomized clinical trial. Int J Reprod BioMed 2020; 18: 723–732.

[8] Zhu L, Che HS, Xiao L, Li YP. Uterine peristalsis before embryo transfer affects the chance of clinical pregnancy in fresh and frozen-thawed embryo transfer cycles. Hum Reprod 2014; 29: 1238–1243.

[9] Kim SK, Han EJ, Kim SM, Lee JR, Jee BC, Suh CS, et al. Efficacy of oxytocin antagonist infusion in improving in vitro fertilization outcomes on the day of embryo transfer: A metaanalysis. Clin Exp Reprod Med 2016; 43: 233.

[10] Xu A, Li Y, Zhu L, Tian T, Hao J, Zhao J, et al. Inhibition of endometrial fundocervical wave by phloroglucinol and the outcome of in vitro fertilization. Reprod Biol 2013; 13: 88–91.

[11] Amro FH, Moussa HN, Ashimi OA, Sibai BM. Treatment options for hypertension in pregnancy and puerperium. Expert Opin Drug Saf 2016; 15: 1635–1642.

[12] Shekhar S, Gupta N, Kirubakaran R, Pareek P. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: A systematic review and meta-analysis. BJOG 2016; 123: 40–47.

[13] Alavifard S, Chase R, Janoudi Gh, Chaumont A, Lanes A, Walker M, et al. First-line antihypertensive treatment for severe hypertension in pregnancy: A systematic review and network meta-analysis. Pregnancy Hypertens 2019; 18: 179– 187.

[14] Ng KKL, Rozen G, Stewart T, Agresta F, Polyakov A. Does nifedipine improve outcomes of embryo transfer?: Interim analysis of a randomized, double blinded, placebocontrolled trial. Medicine 2019; 98: e14251.

[15] Sohrabvand F, Haghollahi F, Maasomi M, Asgarpoor L, Shariat M, Hamedani M. The effect of administrating indomethacin or hyoscine before embryo transfer on ART outcome (a pilot study). Iran J Reprod Med 2009; 7: 169– 173.

[16] Gardner DK, Balaban B. Assessment of human embryo development using morphological criteria in an era of time-lapse, algorithms and ‘OMICS’: Is looking good still important? Mol Hum Reprod 2016; 22: 704–718.

[17] Bhandari Sh, Ganguly I, Agarwal P, Munaganuru N, Gupta N, Singh A. Relationship of number of embryos transferred with perinatal outcome of singleton pregnancy. J Reprod Infertil 2017; 18: 179–184.

[18] Saravelos SH, Li T-Ch. Embryo transfer techniques. Best Pract Res Clin Obstet Gynaecol 2019; 59: 77–88.

[19] Coksuer H, Akdemir Y, Ulas Barut M. Improved in vitro fertilization success and pregnancy outcome with autologous platelet-rich plasma treatment in unexplained infertility patients that had repeated implantation failure history. Gynecol Endocrinol 2019; 35: 815–818.

[20] Armstrong S, MacKenzie J, Woodward B, Pacey A, Farquhar C. GM-CSF (granulocyte macrophage colony-stimulating factor) supplementation in culture media for women undergoing assisted reproduction. Cochrane Database Syst Rev 2020; 7: CD013497.

[21] Sohrabvand F, Haghollahi F, Maasomi M, Shariat M. Effect of piroxicam on ART outcome: A pilot study. Int J Fertil Steril 2014; 8: 243–248.

[22] Pierzynski P. Oxytocin and vasopressin V1A receptors as new therapeutic targets in assisted reproduction. Reprod Biomed Online 2011; 22: 9–16.