The Effectiveness of Pelvic Floor Physiotherapy on Endometrial Thickness during Embryo Transfer in Infertile Women: A Systematic Review and Meta-analysis.

OBJECTIVE: Embryo transfer is a complex process that often fails due to poor endometrial growth. Pelvic floor physiotherapy improves endometrial thickness by enhancing pelvic blood circulation and stimulating uterine muscle with varied frequency flows, consequently boosting embryo implantation and pregnancy success rates. The present study aimed to assess the effectiveness of pelvic floor physiotherapy on endometrial thickness during embryo transfer. MATERIALS AND METHODS: We systematically reviewed databases with no time restriction (out of 574 retrieved records, 8 studies were meta-analysed). This study analyzed randomized controlled trials (RCTs) assessing pelvic floor physiotherapy effects on endometrial thickness in infertile women, compared to routine treatments such as estradiol valerate tablets with vaginal progesterone gel, and oral Progynova. Participants were infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) or frozen ET (FET). Outcomes included endometrial thickness (primary outcome), arterial resistance index (RI), pulsatility index (PI), and pregnancy rate (secondary outcomes). RESULTS: A total of 8 studies were meta-analyzed and we found that electrical physiotherapy combined with routine treatments, may increase the endometrial thickness versus controls [mean difference (MD)=0.93, 95% confidence interval (CI): 0.30 to 1.55; 7 trials, P=0.004; low-certainty evidence], but does not affect RI (MD=-0.03, 95% CI: -0.14 to 0.07; 4 trials, P=0.570; very low-certainty evidence) and PI (MD=-0.16, 95% CI: -0.41 to 0.09; 3 trials, P=0.210; very low-certainty evidence). However, physiotherapy with routine treatments may increase pregnancy rates with low-quality evidence (OR=2.72, 95% CI: 1.87 to 3.95; 6 trials, P<0.001; low-certainty evidence). CONCLUSION: Our study suggests that combining pelvic floor physiotherapy with standard infertility treatments may enhance endometrial thickness and boost fertility rates compared to standard treatments alone. Critically, this conclusion is based on low to very low-quality evidence, limiting confidence in the observed benefits. Furthermore, the effect of physiotherapy on uterine arterial resistance and pulsatility indices is currently undetermined due to insufficient data (Prospero ID: CRD42023442310).