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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Catching My Baby Dust

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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

 

 

The History of Monash IVF in Malaysia

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Some of my colleagues and friends were curious: how did my life change after the IVF unit I was working at became part of Monash IVF, one of the oldest and prestigious IVF in the world?

I must admit that I was very proud to be one of the members of such distinguished establishment. I started working at KL Fertility Centre way before this unit merged with Monash IVF and I was here to witness this transition and was feeling very blessed to be involved in the whole journey.

First and foremost, let us look through the history of Monash IVF and how this humble little unit had made such significant impacted to the world of IVF:

With over 40 years of experience, over 20,000 babies and pregnancy rates among the best in the world, Monash IVF is the leading fertility research and treatment centre in Australia. They continue to achieve many world firsts in IVF and related technologies since the work of their pioneers who achieved the first IVF pregnancy in the world in 1973. Amazingly, 12 out of the first 15 IVF babies in the world are Monash babies. Some of the team’s groundbreaking achievements of Monash IVF include:

(1)World’s first IVF pregnancy in 1973. This was the first time scientist had proven that conception can be achieved outside human body and the resulting embryos can be placed back into the womb and resulted a pregnancy. However, this pregnancy ended with an ectopic and had to be terminated. Following this breakthrough, the Cambridge group in the UK used the similar technique to achieve the first IVF life birth. Louise Brown was the first baby born through IVF.

(2) World’s first microinjection (ICSI was developed as a result of this work) in 1980

(3) World’s first frozen embryo birth in 1984

(4) World’s first frozen embryo twins in 1985

(5) World’s first donor egg baby in 1983

(6) World’s first pregnancy and birth from a sperm retrieval operation for azoospermia in 1986

(7) Australia’s first surrogate birth

(8) Australia’s first open testicular biopsy twins

(9) Australia’s first blastocyst baby

Having boasted so much on the history of Monash IVF, so what does it mean to the unit I am working at? How does it change my life for the better? how does it assist me in helping my patients to improve their chance of pregnancy? I asked myself the same questions as the unit was going through the process of merging. Then came 1st of January 2013, the truth unveil itself.

(1) Improvement in recording, reporting and self-auditing for Quality Control

The unit was required to do thorough reporting on monthly basis. The Head Quarters in Australia requires us to report every cases of Fertility Treatment (IUI, IVF, ICSI) and to report the statistics of our success rates. The Headquarter pay meticulous attention to the success rates of the unit and will flag up unusual occurrences and this is most important for our quality control.

(2) Setting standards

Another important aspect of Monash IVF’s involvement in our daily practice is to standardize our practice and to set standards on the process of performing IVF, including the patients’ treatment cycle as well as the standard of the laboratory. This is to ensure that our standard of care is comparable to the standard of care in Australia.

(3) Technology transfer especially for the embryology laboratory

Regulation and transfer of technology for the embryology laboratory is one of the key component of involvement Monash IVF. The chief scientific director, Dr Tiki Osianlis from Monash IVF came and spent some time in our laboratory to look through the laboratory workflow and process. Her enthusiasm and her professionalism was inspiring and encouraging for our embryologists. Her continuous involvement includes supporting our embryologists with the latest information and technology to further improve the performance of of laboratory.

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Dr Tiki Osianlis (middle) with our embryologists

(4) Research

Monash IVF had been and is still actively involved with Research in Human Reproduction. Many current technologies involved in IVF today was the result of research of yesterday by a group of researchers from Monash IVF. Some of the key research areas we are involved in can be found under this link: http://monashivf.com/category/research-and-education-foundation/research-interests/ Some of the recently completed research by Monash IVF can be found under this link: http://monashivf.com/category/research-and-education-foundation/completed-projects/

(5) Sharing of information and scientific data

Our direct link with Monash IVF provides us with an excellent opportunity to be involved with research. As a centre located in the heart of South East Asia with heterogeneous group of patients from various ethnicity, KL Fertility Centre serves as an excellent partner in providing scientific data to further strengthen the power and significance of the study.