A burning question in IVF !

Question # 5

" How are you doing? Hope you are having a good time. Going through second IVF cycle

Kindly help me answer few queries:

1.Could you please guide me if bed rest is recommended (or it has slightest impact) after frozen embryo transfer?

2.Can I go for mild stroll after 2-3 days and resume office?

3. Indian roads are bad and there are lot of bumps/potholes on the road, does travelling in the car negatively affect? "

Answer

I have already written a couple of posts regarding bed rest after embryo transfer. Even after that , I get repeated queries regarding bed rest !

Why are women afraid of carrying out their normal day - to - day activities after embryo transfer ? There are many reasons :

1.  Women turn to internet and online forums for advice - the suggestions they get there are very conflicting. They come across women who swear by bed rest for their IVF success.

2. Irrational fears are normal during IVF - ' what if the embryo falls down , is that light pink tissue on my toilet paper my embryo ! ' Couples who undergo IVF want their cycle to succeed  - their baby love cannot be fathomed. They fear failure , and want to do their best ( anything ! ) to find success. These factors play a major role in preferring bed rest.

3. Lack of knowledge about uterine and embryo morphology can lead to unnatural fears about embryo falling out from uterus .

4. Many clinics still send patients with an instruction to take strict bed rest. Even worse , there are doctors who immobilize their patients and keep them in hospital bed , until pregnancy test. If the pregnancy test comes out positive , and if all goes well ,  the bed rest continues until delivery.  These money - mongering medical professionals make good use of the ignorance and fear of their patients to fill their pockets  - shameful of course !

Why bed rest is not necessary ?

It is very natural to wonder  , " if embryos  can be kept inside the uterus via cervical opening , won't it descend down the same way ? " No , it won't.  Your embryo is microscopic , and is like an invisible dust particle - it can easily fit at the tip of a needle. Your uterus is a pear shaped organ. Assume that the widest part of the pear is the uterus , and the narrow region is the mouth of uterus , aka , cervix. If you cut the pear longitudinally there is no cavity in the upper part , the same applies to your uterus , too. Your uterus walls are like two bread slices touching each other. The endometrium where the embryo implants is akin to the jam applied inbetween the bread slices. Imagine keeping a microscopic dust particle inbetween the bread slices - is there any chance that the dust particle get dislodged or fall down ? The same applies for your embryo too. There is no free space in the uterus for your embryo to roll and fall down. There is no real cavity , the uterus only contains a potential cavity and the cavity develops only when the embryo implants and develops into a fetus. The growing fetus will push the walls of the uterus apart creating a cavity. Hence , gravity cannot act on your microscopic embryo.  The endometrium acts like a sticky jam. Endometrium and the embryo are made for each other ( they communicate with each other , a lot ) , and so they love sticking to each other. Walking , running , jumping , sneezing , coughing , falling down , your dog jumping over your lap , bumpy roads , and not even having sex , will push your embryo out of your uterus.

Won't uterus contractions squeeze the embryo out ?

Although , any increase in the frequency of uterus contractions has the potential to dislodge or expel the embryo , the progesterone which is present in large amounts after embryo transfer , doesn't allow the uterus to contract more than usual. Doctors aim for a very smooth embryo transfer. If the embryo transfer becomes difficult for some reason , it might lead to increased uterine contractions , and these contractions can affect IVF success , most probably due to dislodging of embryo or due to embryo expulsion via cervix. But , your normal day - to - day activities will not cause your uterus to contract , especially when such enormous amounts of progesterone is doing its job in your body.

Is orgasm OK ?

It should be OK. Couples who conceive in their bed room have sex after ovulation. If sex and orgasm could expel the embryo from the uterus , human population would have been a lot less. Once the embryo is inside the uterus , it doesn't remember how it came in. Once inside the uterus , they are as safe as the embryos formed during natural intercourse. There are women who orgasm in dream during their IVF 2WW and worry whether they have caused any harm. You can be very sure you haven't spoiled your chance of success.

What does scientific evidence say about bed rest ?

Studies showed no correlation between bed rest and IVF success. Some studies even pointed out that bed rest could actually decrease your chance of success. Even more , if you apply your common sense -  during and after IVF there are enormous amount of different hormones in our body ( much higher than what will be present during a natural cycle ) . This increased amount of hormones increases the risk of blood clots. If someone keeps on lying down without enough movements , it can actually cause much harm  - especially , in women who are prone to blood clots.

What about the ladies who swear by bed rest ?

Please remember that correlation doesn't mean causation ! I ate bananas today , I met with an accident - but that doesn't mean eating bananas lead to the accident !  Anecdotal stories are not proofs. For every lady who got success after lying down in bed all the time , there are ten more who didn't rest and got pregnant. Instead of searching ' bed rest and success ' , search for ' no bed rest and success ' . Google gives you what you want - always be aware of this ( never believe everything what Dr. Google says )  ! If you want a good advice which can be trusted , talk to someone who is knowledgeable (  most probably that person must be your doctor ! )

Shouldn't I rest at all ?

Take rest - but do not overdo it ! For the first 15 minutes after embryo transfer , lie down. Then for the next two days treat yourself like a queen ( don't do what you do routinely , for example , avoid laundry or anything you find difficult ) . After that ,  get on with your routine. Lying down 24*7 will only make you emotionally sick - it will allow your mind to play games with you. Keeping yourself busy , yet , not doing something which you will regret if the IVF fails , is the key.

I felt wet down after embryo transfer ? Is it the liquid within which my embryo was present ? Does that mean my embryo came along with that liquid ,  I found a red dot in the tissue paper after wiping - is it my embryo ?

No , that's not your embryo. You cannot see your embryo with naked eyes. And definitely , your embryo is not red in colour. So , do not panic. The liquid in which your embryo is present during transfer is just a minute drop of cell culture medium . That cannot flow out of your uterus and wet your inner pants. The liquid that comes out after embryo transfer is the one which is used to wash your vaginal canal. It is just a mixture of water and disinfectant. Any wet sensation you feel down doesn't come from any dripping from your uterus.

I wish , before embryo transfer , doctor or the embryologist shows the patient the embryos ,  embryo transfer catheter , the amount of liquid in which the embryo will be kept etc , so that the patient will have some piece of mind. There are many patients who are afraid to ask questions , and suffer the entire 2WW with unnatural fears about losing their precious embryos !

All I can say is , after embryo transfer , close your eyes , imagine a seed in a fertile soil and visualize it rooting and growing , everyday. Your embryos are within you - they are safe !