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.
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.
Baby in the making- Study shows 3 out of 4 couples undergoing IVF will have a baby within five years
There are various causes for infertility, including endometriosis, polycystic ovary syndrome, damaged fallopian tubes and ovulatory problems in women, and low sperm count and motility or problems with erections or ejaculating in men. Unhealthy lifestyle habits such as smoking, illnesses like diabetes, as well as being overweight are also contributing factors.
In most cases, infertility can be treated, but for many couples who are struggling with infertility, In-Vitro Fertilisation (IVF) is their best option. Couples undergoing IVF are often faced with uncertainty and wonder – What are our chances? When will we have a baby? Some undergo IVF multiple times without success, and as they are unsure of their chances, they end up giving up.
There has always been a debate on how best to measure the success of fertility treatments, however, now a Danish study is providing realistic information that’s reliable for the long-term prediction of treatment.
The long-term study was conducted by researchers at the Copenhagen University Hospital, who referred to rigorous registry records. Denmark is one of the few countries in the world where such a study could be carried out, due to their practice of keeping detailed records that link all fertility treatments to all live births.
The researchers analysed nearly 20,000 Danish couples from 2007 and 2010, following them from the moment they started their fertility treatments. The study’s findings were recently presented at the European Society of Human Reproduction and Embryology (July 2016).
The team found that more than half of the women (57%) had their baby as a result of treatment within two years, 65% had children within three years and 71% within five years. This means that almost 3 out of 4 couples undergoing IVF will eventually become parents within five years, whether as a result of the treatment or following natural conception.
The study also found that while most causes of infertility can be overcome, the odds of conception are heavily influenced by a woman’s age. They found that in women under the age of 35, about one in three IVF cycles were successful and 80% had children within five years.
However, the total birth rates fell to 61% in those between 35 and 40 years old; and fell again to 26% in women aged 40 and over. The study also revealed that women with a Body Mass Index under 30 and didn’t smoke also had better outcomes.
These figures provide encouraging news for couples who are seeking or embarking on fertility treatments, as they reveal that their chances of having a baby are good. According to study presenter, Dr Sara Malchau, “We are now able to provide couples with a reliable, comprehensible, age-stratified long-term prognosis at start of treatment”.
Although individual prognosis and factors play a role in the success of IVF treatments, this study has shown that overall, IVF treatments are working, but they take time. Therefore, couples may need several treatment cycles for their best chance at conception.
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
Catching My Baby Dust
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.”
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.
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.
Hard facts on a common bean
The impact of soy-based foods on fertility
Soy-based food products, like soy milk and tofu, are often considered a healthy alternative to meat and dairy. However, numerous scientific studies have shown that soy can actually cause unwanted side effects and more alarmingly, negatively impact fertility.
The main reason why soy is bad for fertility is that it contains phytoestrogens. This plant-based chemical mimics estrogen and disrupts the body’s endocrine function. Although few people realise the dangers of soy, this knowledge is not exactly new. Scientists have known about the ill-effects of soy since at least the early 1990s.
A study conducted in 1992 by the Swiss Health Service estimated that drinking two cups of soy milk per day has the same effect as taking one birth control pill. Then, a study published in 2000 by the Departments of Preventive Medicine and Obstetrics and Gynecology, University of Southern California, Los Angeles, USA found that soy decreases luteal estrogen levels and lengthens menstrual cycles.
Meanwhile, a 2005 study conducted by researchers at the National Institute of Environmental Health Sciences, North Carolina, USA found that soy causes miscarriage and infertility in mice. Another study, conducted by the Harvard Public School of Health in 2008, found that men who drank one cup of soy milk per day had a 50% lower sperm count than men who didn’t take soy.
Because soy has been proven to cause abnormal menstrual cycles, altered ovarian function, early reproductive deterioration and subfertility/infertility, it is considered particularly harmful for women and men who are trying to conceive. Women who are pregnant or breastfeeding and infants are also discouraged from consuming soy-based products.
But even if you rarely eat tofu or drink soy milk, you’re not completely out of the woods. In fact, you may be consuming soy in other forms. These days, many processed and refined foods contain soybean oil, soy flour, soy lecithin or soy protein. Therefore, you may not know that you’re actually eating soy-based foods as they’re hidden away in the ingredients list.
It is important to note, however, that traditional fermented soy products, like miso and tempeh, may be beneficial to health. But the high intake of processed soy has a less desirable effect on health. Therefore, if you’re trying to get pregnant, it is best for both you and your partner to exclude soy from your diets. If you have any doubts or questions, as always, be sure to consult with your fertility consultant.
The right balance
Benefits of a high protein, low carb diet on fertility
Maintaining a well-balanced and healthy diet is highly recommended, especially when you’re trying to have a baby. But did you know that a high protein, low carb diet could help to boost your fertility? That is precisely what a study by the Delaware Institute for Reproductive Medicine (DIRM) in Newark, New Jersey, USA has found.
The study, which was conducted between January 2010 and December 2011, looked at 120 patients who participated in assisted-reproduction therapy programmes at the DIRM. The patients were asked to keep diet diaries and document what they ate, prior to undergoing an embryo transfer.
According to the head researcher, Dr Jeffrey B. Russell, they wanted to understand why their thin and healthy patients had poor quality embryos. After analysing his patients’ diet diaries, he was surprised to see that a large percentage of the women were eating more than 60% carbs each day and 10% (or less) protein. Those who ate like this were found to have poor quality embryos.
Meanwhile, patients whose daily protein intake was 25% or more of their diet and whose carbohydrate intake was 40% or less of their diet, had four times the pregnancy rates of other patients who ate less protein and more carbs daily.
While no differences were found in the body mass index (BMI) of either group, there was a significant difference in egg and embryo quality. “Protein is essential for good quality embryos and better egg quality, it turns out,” said Dr. Russell.
This conclusion was made after the research team assessed embryo development after five days of culture or at the blastocyst stage. It was found that 54.3% of patients whose daily protein intake was greater than 25% had an increased blastocyst formation. Meanwhile, patients whose daily protein intake was less than 25% had 38% blastocyst formation. The study also found that pregnancy rates significantly improved in patients with greater than 25% daily protein intake.
Due to these findings, Dr. Russell and his colleagues at DIRM have made it a requirement for their patients to eat a diet consisting of 25% to 35% protein and 40% or less carbs for three months, before beginning their IVF cycles. So if you are looking to ensure the health and quality of your eggs, it is best to start changing your diet to include more proteins and less carbs.
However, it is important to keep in mind that it’s not just about the right amount of protein, but the right kinds too. It is best for you to load up on low mercury fish and seafood like pomfret, sardine, salmon, tilapia, shrimp, shellfish, tuna (canned light) and cod; skinless chicken or turkey; eggs and lean beef, as well as fresh and full cream milk, cheese and yogurt. If you’re vegetarian, your best sources of protein are legumes like beans and lentils; nuts and seeds; as well as organic soy products like edamame and tofu.