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We have recently published a meta-analysis of 8 randomized controlled trials (RCTs) including 2,128 women and described that intravaginal or intracervical application of ejaculate and seminal plasma (SP) around the time of oocyte aspiration and/or embryo transfer in IVF therapies significantly increased clinical pregnancy rate (RR 1.20, 95% CI 1.04–1.39) (1). These results confirmed and extended an earlier meta-analysis which had also shown significantly improved outcomes when women are exposed to SP around the time of ovum pick-up or embryo transfer with statistical significance for clinical pregnancy rate (2). In our meta-analysis, we had added a subgroup analysis with 4 RCTs including 780 participants in which prepared undiluted SP was injected intravaginally/ intracervically just after oocyte aspiration. This analysis revealed an increased pregnancy rate in women treated with SP (RR 1.23, 95% CI 1.05–1.45) (1), an effect that seems to be independent from the quality of sperm count (3). By contrast, intrauterine application of diluted SP did not show any positive effect (4). Therefore, local application of undiluted SP or its constituents can now be considered as a straightforward, non-invasive, and rather cheap treatment to improve implantation in IVF. The rationale of this treatment is the modulation of endometrial function (5), which has been shown to be negatively affected in IVF (6). Furthermore, SP might positively modulate the maternal immune system to better accept the semi-allogenic embryo (7). Therefore, this approach could be considered to be integrated in daily practice in IVF with fresh embryo transfer. However, this raises the question of which approach would most reasonably be expected to yield the highest effect with the lowest cost and burden for the couple, the IVF laboratory, and the physician. Four options could be considered:

Seminal Plasma Activity to Improve Implantation in In Vitro Fertilization—How Can It Be Used in Daily Practice?