Saturday, April 19, 2008

Putting the myth of bed rest after IVF to rest

One of the old wife's tales which still plagues every IVF patient is the myth that they need "strict" bed rest after the embryo transfer. Many patients are scared that the embryo will fall out if they walk around - after all, if it was inserted artificially, isn't there a risk that it can "fall out" through the " track " through which the doctor inserted it ?

I remind my patients that God designed the body with enough sense that walking, running, coughing and sneezing do not cause an embryo to fall out ! Embryos are safe and secure in the womb , and just because they have spent 48 hours in the incubator in the IVF lab does not change anything ! IVF allows us to mimic nature , and once the embryo has reached the uterus, it's exactly like an embryo "made in the bedroom" ( embryos do not have a memory !) After all, when fertile couples have sex and get pregnant naturally, they continue leading a completely normal life after sex , so why should IVF make any difference ? Enough medical studies have been done by many IVF clinic which prove that embryo implantation and pregnancy rates are not affected by rest; and patients can walk out just 10 minutes after the embryo transfer.

In fact, enforced bed rest can have a very unhealthy effect on the patient. Being forced to lie down in bed when you are well can be demoralising, so say the least. Taking a bed pan ( during "strict bed rest") can be extremely humiliating. Also, if you are forced to lie in bed, then you tend to spend all your time thinking about what the outcome is going to be - a very unhelpful process, because the outcome is no longer in your hands. As it is, during the dreaded 2ww ( two week wait between the embryo transfer and the pregnancy test), each minute seems to last for an hour. Lying in bed makes the time crawl even more slowly !

So why do some doctors still insist their patients take "bed rest" after embryo transfer. I think this is a very clever way of "victim blaming" ! If the patient does not get pregnant, they can always "blame" the patient for the failure, because she did not "rest" properly. The biggest tragedy is when the family members start believing this untruth.

I think patients ( and their loved ones) need to understand that activity does not have any impact on the embryo inside the uterus, because it is protected from external influences in its uterine haven. Implantation is a biological process which is not affect by external activity - or by gravity ! We suggest patients take it easy at home for 48 hours after the embryo transfer , after which we encourage them to resume work, so they can keep themselves gainfully occupied. This is actually more for their peace of mind, rather than because it changes the outcome. I always tell patients that if resting helped to increase pregnancy rates by even 1%, we'd happily keep them in hospital for even 15 days after the transfer !

There is a difference between transfer and implantation ! While embryo transfer is a simple mechanical procedure, implantation is a complex biochemical event which involves a dance of exchanged signals between the endometrium and the embryo - something which cannot be influenced by diet or activity !

Being infertile is bad enough - don't make it worse by forcing yourself to rest in bed when you don't need to !
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