Bed rest after embryo transfer negatively affect IVF success

 

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A good reason to keep moving

Bed rest after embryo transfer negatively affect IVF success

After every embryo transfers, my patients are generally surprised when I ask them to get up from bed to walk almost immediately. Most of them looked at me with disbelief: ‘Doctor, will my embryos fall out?’. Some of them refuted me by telling me that their friends had to lie on bed for 2 weeks after the embryo transfers to ensure that the embryos ‘sticks’. There are some who refused to get out from my operating bed and few had demanded to be warded for 2 weeks.

Well, I can’t blame them for asking that, can I? After all, the internet is full of stories of having to lie in bed to ensure the best outcome for the IVF.

However, is this really true? Does bed rest positively influence the outcome of the IVF? Is this scientifically proven?

Since the birth of the first IVF baby back in 1978, numerous medical advancements have been made to help IVF patients achieve the best outcomes. Among them are procedures like ovulation induction, egg retrieval and sophisticated laboratory techniques. While these primary procedures have been tried and tested, some of the simpler procedures, such as bed rest immediately after an embryo transfer, have not been scientifically proven.

It is generally believed that bed rest, or the reduction of physical activity right after an embryo transfer procedure, is beneficial as it can reduce a woman’s stress levels and aid implantation. However, there is a study that shows bed rest after embryo transfer can be potentially detrimental!

The 2011 study, which was conducted by a team of researchers from Universidad de Valencia, Valencia, Spain, involved 240 patients between the ages of 25 and 49 years old.  They were undergoing their first IVF cycle using donated eggs at a private IVF centre. The objective of the study was to evaluate the influence of just 10 minutes of bed rest after embryo transfer on the achievement of live births, as well as implantation and miscarriage rates.

The patients were divided into two groups – the R (Rest) and NR (No Rest) groups. Those in the R group were given ten minutes of bed rest after embryo transfer by being moved from the operating room with the help of a stretcher or in a lying-down position. Meanwhile, those in the NR group had no bed rest and were allowed to ambulate (move around) immediately after their procudure.

The study’s findings revealed that the live birth rates were significantly higher in the NR group (56.7%) than in the R group (41.6%). The NR group also had lower miscarriage rates (18.3%) as compared to the R group (27.5%). Although the implantation rate was higher in the NR than in the R group, the researchers noted that the difference did not reach statistical significance. Meanwhile, neonatal characteristics like height, weight and Apgar score were similar in both groups.

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Therefore, the researchers concluded that bed rest immediately after embryo transfer has no positive effect, and in fact can be negative for the outcome of IVF. They surmised that this could be due to the common anatomical position of the uterus, as concluded by another study.

It is believed that the force of gravity could cause the loss of newly-transferred embryos. However, since the cavity of the uterus is in a more horizontal position when a woman is standing than when she is lying down, a horizontal position after embryo transfer would not be beneficial.

As a result of their findings, the researchers suggest that IVF clinics change their practice of encouraging bed rest after embryo transfer. They also call for more research to be conducted on the physiological or psychological reasons for the benefits of no bed rest after embryo transfer.

The results of such studies provide us with more clues on how best to maximise IVF success. Should you have any questions or concerns about IVF procedures, as well as what to do or not do after an embryo transfer, don’t hesitate to speak to your fertility specialist.

 

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Exercise and how it affects pregnancy rates

 

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Getting it just right

Exercise and how it affects pregnancy rates

We all know that staying physically active is beneficial to our overall health and wellbeing. But did you know that the right amount of exercise can also improve your chances of conceiving? Here’s why.

Firstly, regular exercise is known to help optimise the reproductive system. It does this by stimulating the endocrine glands, which releases hormones that help your eggs to grow. Secondly, exercise can enhance your metabolism and circulation, which in turn optimises your egg production.

Thirdly, exercise can help you manage or achieve an ideal body weight. Since being overweight or obese can impair fertility in both men and women, weight management is widely known and used to prevent and treat infertility. And lastly, regular workouts also help to relieve stress, which in itself can inhibit fertility.

While regular moderate exercise can have positive effects on fertility and conception, the opposite is true for vigorous exercise.  According to a 2009 study in Human Reproduction, and a Harvard study of elite athletes, vigorous exercise is linked to reduced fertility and pregnancy rates. Therefore, when it comes to exercise and fertility, it is possible to have too much of a good thing.

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While there are no guidelines for women to follow when it comes to workout intensity for fertility, there is a way to strike a balance. Studies have shown that women who exercised moderately for at least 30 minutes a day can reduce their risk of infertility due to ovulation disorders. Evidence also suggests that moderate regular exercise can positively influence assisted reproductive technology (ART) outcomes. But what is the right amount of exercise?

If you’re already at your ideal weight, it is safe to stick to your regular routine, but keep it to half an hour maximum per day. Studies had shown that vigorous aerobic exercise of more than 4 hours per week reduces the chance of pregnancy in women going through IVF. If your cycle is still irregular and you haven’t conceived after a few months, you might want to cut back on the intensity of your workouts. However, if you’re underweight, focus on gaining weight and increasing your body fat to the recommended amount of over 12%. If you exercise regularly, cut back on the frequency and opt for a less vigorous routine.

Meanwhile, if you’re overweight, work on cutting down on your calories with healthy eating. You can also increase your exercise routine gradually to achieve your ideal weight. Lastly, if you’re undergoing fertility treatments, it is best to avoid high-impact exercises, as they can be detrimental to your ovaries, which have been enlarged by fertility drugs.

Still have doubts on where to begin? Before you step up your exercise routine, start by speaking to your doctor. If you’ve been having trouble conceiving, your doctor will need to assess your condition first. This includes your age, cycles, ovulatory status, the condition of your uterus and tubes, as well as your partner’s sperm. Once certain conditions have been identified or ruled out, your doctor will be able to advise you on whether the underlying cause may be too little or too much exercise.

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