Bed rest after embryo transfer negatively affect IVF success

 

pregnancy_test_positive1-495x236

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.

bed rest

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.

 

best rest 2

Catching My Baby Dust

OL_Catching My Baby Dust Cover FINAL_DrHelena-01.png

I am extremely pleased and excited to announce the arrival of my book: “Catching My Baby Dust’, which came to a reality after many months of hard work. This book consist of inspiring true stories on the journeys couples had been through in trying to have a baby. Many of these stories detailed the trials and tribulations of their Fertility journeys. These stories are deeply touching and in many ways humbled me as a Fertility Specialist.

Here is the small note I have written for the publication of this book:

Welcome to the first edition of ‘Catching My Baby Dust’.  As the Chief Editor of this book, I would like to thank you for taking your time to read this special book, which is extremely close to my heart.

 

As a Fertility Specialist, I have the opportunity to work with women who are from various backgrounds, ethinicities &  educational levels. They have one thing in common: They all want to have a baby.

 

As a mother of three, I can fully understand their desire to have these little bundle of joy in their arms, and how these tiny little babies would complete and fulfill their lives. However, the reason that they are sitting in my clinic is that pregnancies did not happen naturally, and therefore they are here to seek guidance and assistance.

 

I must say that I feel privileged that I can do something to help them. My greatest pleasue of my daily life is to help these patients to identify the issues which prevent them from conceiving naturally and rectify their problems. Some need just a little bit of reassurance and things happenned.  Unfortunately, some need much more than reassurance. And the good news is that most will eventually have a baby in their arms following fertility treatments.

 

Throughout these journeys, I have come across many women who had deeply touched me with their perserverance and determination which greatly humbled me. Some of these stories bring tears to my eyes and I hereby express my greatest gratitude to them by agreeing to share their stories with people out there who are trying to conceive.

 

I would like to thank my senior colleague, Dato Dr Prashant Nadkarni, the Medical Director of KL Fertility Centre for his valuable input. My co-editors, Dr Natasha Ain Mohd Nor & Dr Agilan Arjunan, who shared my passion in the field of fertility and had worked fervently in making this book a reality.

 

I would like to take this opportunity to thank Ms Sylvia Khoo, the director of Pitter Patter Sdn Bhd, Ms Adline A Ghani and Ms Lee Siew Fong helped us to co-ordinate the production of this book.

Last but not the least, I would like to thank all the readers for their constructive comment to further improve the quality of this book.

 

Dr Helena Lim Yun-Hsuen

Editor

Catching My Baby Dust

 

 

Ethnicity can affect IVF success rates

 

Estee_Lauder_Every_Woman_Beautiful_Campaign

The Unknown Factor

Ethnicity can affect IVF success rates

For many couples who struggle with infertility, artificial reproductive techniques (ART) like In-Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI) are their only options in the hopes of conception and starting a family of their own. However, if you are considering IVF, it is important for you to learn about IVF success factors that can either boost or hinder your chances at pregnancy.

 

The main factors that may impact IVF success are age, especially of the mother; a history of previous pregnancies or miscarriage with the same or different partner; the type of fertility problem; lifestyle habits; the use of donor eggs and the fertility clinic chosen. However, several studies have contributed another factor for IVF success – a woman’s ethnicity.

 

In an observational cohort study conducted by the Nottingham University Research and Treatment Unit in Reproduction (NURTURE), UK, it was found that live birth rates following IVF treatment was significantly lower in Asian and Black women, as compared with white European women.

The study involved 1517 women, of which 1291 were white Europeans and 226 belonged to ethnic minorities. All these women underwent their first cycle of assisted reproductive technology between 2006 and 2011.

Despite sharing favourable chances of conceiving, such as the quality of their egg reserves, only 35% of Asian and Black women successfully conceived and gave birth after IVF, as compared with 44% of white women who were treated at the same clinic during that period.

The researchers at NURTURE are unsure why this is, but suggest that it could be down to genetics, as well as social and environmental factors. According to lead researcher, Dr Walid Maalouf, “Further research into genetic background as a potential determinant of IVF outcome, as well as the influencing effects of lifestyle and cultural factors on reproductive outcomes is needed.”

3133388_orig
NURTURE’s findings are supported by a research conducted at the University of Kansas-Wichita, USA. The researchers there state that while the average birth rate after IVF using fresh eggs is 25.7%, this figure conceals the wide variation in the success rates for different ethnic groups.

After studying the records of more than 80,000 IVF treatment cycles carried out between 1999 and 2000, they found that the birth rate for black women was 18.7%, 20.7% for Asian women, 26.3% for white women and 26.7% for Hispanic women. They also learnt that black women had the highest miscarriage rate of 22%, compared to 13.9% for white women, 16.4% for Hispanic and 16.2% for Asian women.

group-women-people-all-different-races-professions-42385188

Another US study, by researchers at the University of California, confirmed that Asian women had a lower pregnancy rate than non-Asians. The study looked at 1,200 IVF treatment cycles and found that the birth rate for Japanese, Indian and Chinese patients is about 60 per cent that of white women. However, the team stressed that the differences did not apply to natural conception.

Like the NURTURE team, the US teams are unsure of the reasons for these differences. According to Marion Damewoood, president of the American Society for Reproductive Medicine (ASRM), “The findings were preliminary but important, and we need to further explore these apparent racial differences to see if we can better understand and hopefully address their causes.”

While Asian couples may find these results worrying, it is crucial for all couples to be counselled on their realistic probabilities for IVF success. Based on these findings, Asian women are encouraged to seek treatment earlier to improve their chances of pregnancy.

 

Food for Pregnancy

SHK_0820

 

Some of you may have known that one of my interest in the field of Fertility is the impact of Nutrition on Fertility & Pregnancy.

Some of the research work which I am involved in surrounds this unique aspect of Fertility.

Recently, I was invited to speak to a group of O& G and Paediatric doctors on this topic. The most interesting thing is that I was asked to speak on a platform erected on a beach and my dress code was white and a flower in my hair!!!! So, the picture above was definitely NOT a singing contest but a actual scientific lecture.

I had lots of fun researching for the talk and here is some of the interesting findings I wish to share about Nutrition and Pregnancy:

The Importance of Nutrition
Lessons from the Dutch Famine Birth Cohort Study

In this post, I’ll discuss another topic related to fertility and nutrition – the findings of the Dutch Famine Birth Cohort Study. Prior to the study, very little was known about the role and effects of a maternal diet on a baby’s health. However, using the medical records collected during the famine, scientists have been able to measure the adverse effects of fetal malnutrition.

 

Background of the Study

The Dutch famine of 1944, also known as “Hunger winter,” was a famine that took place in the Nazi-occupied part of the Netherlands. Affecting some 4.5 million people, the famine was caused by the shortage of food supplies in the Netherlands towards the end of World War II. Although the Allied Forces had liberated the south, their efforts to free the western parts of the Netherlands were repeatedly thwarted, worsening the situation.

This was followed by the Nazi embargo on all food transport to western Netherlands and the onset of an unusually early and harsh winter. During the period, which lasted until the Allies liberated the area in May 1945, rations were as low as 400-800 calories a day. This is less than a quarter of the recommended adult caloric intake. Though estimations vary, as many as 22,000 people are believed to have died due to the famine.

 

The findings

The Dutch Famine Birth Cohort Study was conducted by the departments of Clinical Epidemiology and Biostatistics, Gynecology and Obstetrics and Internal Medicine of the Academic Medical Centre in Amsterdam, in collaboration with the MRC Environmental Epidemiology Unit of the University of Southampton in Britain. They based their study on the antenatal and maternity records of babies born at the Wilhelmina Gasthuis in Amsterdam between November 1943 and February 1947. The first results of the study were published in 1976 and the study is still ongoing.

Here is a summary of some of their findings:

  1. The children of pregnant women exposed to famine were more susceptible to diabetes, obesity, cardiovascular disease, microalbuminuria and other health problems.
  2. The children were smaller and their children were also thought to also be smaller than average.
  3. Early gestation appeared to be the most vulnerable period.
  4. Children affected in the second trimester of their mother’s pregnancy had an increased incidence of schizophrenia and neurological defects.
  5. Famine exposure in utero causes transgenerational effects.
  6. The effects of famine varied according to its timing during gestation, especially during critical periods of organ and tissue development.
  7. Undernutrition during any period of gestation is associated with reduced glucose tolerance and raised insulin concentrations at age 50 and 58.
  8. People exposed to famine in mid gestation had an increased prevalence of obstructive airways disease.

The most well-known survivor of the Dutch famine is perhaps Audrey Hepburn. Often admired for her gamine figure, Hepburn spent her childhood in the Netherlands during the famine. Throughout her life, she suffered from a series of health problems, including anemia, respiratory illnesses, edema and clinical depression, which were attributed to the malnutrition suffered in her early years.

 

download

Conclusion
The Dutch famine study has shown us that poor maternal nutrition during gestation can have detrimental effects on the health of children and even subsequent generations. Therefore, we cannot ignore the importance of maternal nutrition during pregnancy, especially in preventing chronic degenerative diseases in future generations. We must also be wary of the possible detrimental consequences of undernourishment in mothers due to unbalanced diets, rigorous fasting and severe morning sickness, especially during the first trimester.

MyEndosis Walk: Stand Up, Speak Up, Let’s Unite

Are you suffering from Endometriosis and do not know what to do and where to turn to?

Here is some good news:

Selangor and Kuala Lumpur Endometriosis Association (MyEndosis) will be holding an event called ‘MyEndosis Walk: Stand Up, Speak Up, Let’s Unite’ on  28 March 2015 from 7.30am to 11am. The venue is at Concourse area JayaONE,  Jalan Universiti, Petaling Jaya & PC 203, Faculty of Creative Industries, UTAR, No 3, Jalan 13/6, 46200, Petaling Jaya.

Come and join us to stand up and unite against endometriosis

Endo Walk

Speaker - Dr Helena Lim (2)

Speaker -Dr Natasha Ain Mohd Nor

MELODY FM 十方斌管 – 斌纷一家 (12月17日) 不孕须知的事项

cropped-marie-claire1.jpg

不孕须知的事项:导因和治疗

 

http://www.klfertility.com/cn/%E5%85%B6%E4%BB%96%E5%85%B3%E4%BA%8E%E4%B8%8D%E5%AD%95%E4%B8%8D%E8%82%B2%E7%9A%84%E4%BF%A1%E6%81%AF/melody-fm-%E5%8D%81%E6%96%B9%E6%96%8C%E7%AE%A1-%E6%96%8C%E7%BA%B7%E4%B8%80%E5%AE%B6-12%E6%9C%8817%E6%97%A5-%E4%B8%8D%E5%AD%95%E9%A1%BB%E7%9F%A5%E7%9A%84%E4%BA%8B%E9%A1%B9-part-1/