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 !

30 comments:

  1. Jim Dougherty2:06 AM

    Dr. Malpani,

    Thank you for the informative post. Can you point me to the "medical studies ... done by many IVF clinics which prove that embryo implantation and pregnancy rates are not affected by rest"? Also, thoughts on "bouncing" activity -- such as car rides, exercise, etc. -- during the 2ww? Thanks!

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  2. Anonymous7:14 AM

    Doctor,

    You CANNOT speak for every women and her body when it comes to bedrest!!!!! I know many women who after trying to concieve several times decided to go on bedrest and they have said that the rest and not having to stress helped them. BE CAREFUL WITH YOUR DIAGNOSIS!!!!!

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  3. Anonymous1:24 AM

    If activity does not have any impact, then why do you recommend patients take it easy for 48 hours?

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  4. What's your success rate doctor? Why are major clinics such as SDFC, ORM, and CCRM who all rx bed rest (1-2 days) all have the highest success rates in the US and abroad?

    I think each clinic is indivual as is each woman and her body. I did bed rest and had my son. So go figure.

    ReplyDelete
  5. Anonymous8:17 AM

    It's been 2 days after my 3 day transfer, my dog jumped onto the couch and plopped his leg right on top of by stomach, could he of caused the embryo's to fall out?

    ReplyDelete
  6. Anonymous3:14 AM

    I've done 3 fresh cycles of IVF, and each cycle, I stayed in bed for 4 days straight, listened to music and radio programs, and only got up to use the bathroom. I even had food brought to me in bed. I would not shower for 4 days straight. After each failed cycle, I asked myself if perhaps I should've just used a diaper in bed and not gotten up to use the bathroom, or maybe I used too much force went I peed. I'm on to cycle number 4.

    It's great that bed rest has worked for some of you, and I can see why you would swear by it. I wished it brought us all good results. But please don't make it sound like the reason people fail to get pregnant is because they refuse to do bed rest, or because their doctors don't have the wisdom to mandate it.

    ReplyDelete
  7. Anonymous8:30 PM

    It makes a lot of sense. Take it slow but bed rest not required.
    What about swimming? Can you please give your opinion on swiming. My doctor told me I should not swim for 2 weeks. Is there such a thing as not swim until the cervical plug is formed (at the 7th week)?

    ReplyDelete
  8. Anonymous8:32 AM

    Doctor,

    From my view, it appears the underlining objective of 1. bed rest or 2. limited activity is to minimize further physical and mental stress. For some woman, perhaps bed rest is the best way to minimize further stress (it certainly was for me) whereas with other women, perhaps retaining a schedule (at a limited form) is the best stress reducer.

    I agree that clinic could use the bed rest angle as a possible safeguard to protect themselves from guilt of failure but given there are so many other elements to the process of IVF, I believe Clinics could find more convincing arguments for failed rounds.

    ReplyDelete
  9. Anonymous12:23 PM

    Dear Doctor,

    I read your comments ,its very informative.I just like to say regarding the "Bed rest".This can be varied from woman to woman depending on their natute of daily work.As I am a working lady,I know the amount of load i have to take every day at home and at office.I am basically an Engineer & hold a responsible position in my organisation.I have a huge Work load in office.Due to my natural self i take a lot of workload to myself at home also.I have to travel a long distance everyday for going to office.In my case i feel that after an Embryo Transfer minimum 2 days bed rest is very much necessary.Hence,you can not compare my requirement of bed rest with any house wife who need not to take so much of trouble everyday.So,nothing can be generalised.

    My E trasfer has been carried out on 26/11/09.Hope with blessings from all of you it gets successful.
    regards

    Soma -kolkata
    s_rkar@hotmail.com

    ReplyDelete
  10. I am an american woman who has underwent 8 IVF cycles, 6 of them with donor eggs. I've had reattachment of my fallopian tubes by the giant in north carolina, I've been to the top clinics in Los Angeles, travelled to Hadassah, Israel, Bangkok and Brno, in the Czech Republic. It is in the latter country that I finally got pregnant and delivered twins. It's over kill, in the US, besides being so expensive. It's over kill in Bangkok without the expense and the embryology lab is suspect. Israel is quite smug, but very academic, however by law they do not do donor cycles. Then there's the Czech way... No bedrest after transfer, I can go shopping, eat out and "enjoy life", as I was told. Take the pregnancy test in two weeks. I'm back again for my next IVF. THe cycles are simplified. I could use my left over expensive progesterone from previous cycles.
    Supplementary oral progesterone was not deemed necessary. Any estrogen, ok. IVF with PGD less than EU6000 includes donor compensation. I get to go to Vienna and Paris while waiting for embryos to get to blasts. Out of 10 eggs 7 are fertilized. WIth PGD, the yield is 4 normal cell embryos and at day 5 three of them are high quality hatching blasts. The lab is superb! I transfer only 1 embryo and freeze the remainder. Bedrest is silly. In Bangkok I had to be wheeled like an invalid all theway to the airplane. WIth the US clinics. I was reduced to bed pans and meals in bed while contemplating how to kill myself if I didn't get pregnant again :)
    Will blog some more after pregnancy test. Me: 47. Twice pregnant with 2 children aged 22 and 25. IVF children: twin girls aged 1 year. 30 week gestation. Babies in NICU for 35 days. Both healthy now.

    ReplyDelete
  11. After IVF Procedure ..how long we need to take a rest n can we walk much here n there after procedure? just like when we working , shopping or anything.?

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  12. Your embryos are safe in your uterus. Nothing you do can harm them , so please do not worry about this.

    Please do not let your mind play games with you !

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  13. Anonymous2:57 PM

    i just Fail my IVF Procedure....i dont know am i walk too much n not enought rest...?

    ReplyDelete
  14. It's very common for patients to beat up on themselves and blame themselves when their IVF cycle fails. Please do not do so. Human reproduction is an inefficient enterprise - whether it's done in the bedroom, or in the clinic ! It takes fertile couples time to make a baby as well - you just need to be patient. It's true that when it takes time in the bedroom, couples do not mind - and when it takes time in the clinic, it hurts - both emotionally, physically and financially !

    ReplyDelete
  15. I didnt see a response to the swimming question. Is it okay to swim after transfer? Specifically, I am day 2 after transfer and am taking some r&r after doing my treatment in Turkey before we fly back to US. Am I supposed to wait for cervical mucus plug or anything? Three more questions, first, is flying and disrupting circadian rhythms bad for embryo in any way during this sensitive time? Second, how long does it take for an embryo to implant for a day 5 blastocyst transfer? Third, please ease my mind, you know how much a mine field our minds are during ivf, I sat up quickly right after transfer to scoot back on table and the drs and nurses all jumped and startled and told me to lie back, do not sit up. Is it at all possible that I could have pushed them out or lost them immediately after transfer?
    Thank you for your info!

    ReplyDelete
  16. Your embryos are safe in your uterus. Nothing you do can harm them , so please do not worry about this.

    Do whatever you are comfortable doing. Don;t do anything you will beat up on yourself afterwards is my only advise.

    Please do not let your mind play games with you !

    Read more at http://drmalpani.com/care-after-embryo-transfer.htm

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at http://twitter.com/#!/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  17. Anonymous6:14 PM

    I was upset that I sneezed right after my implant but my clinic nurse told me "it's like a grain of salt inside a jam sandwich, nothing you do will dislodge the embryo". I just kept thinking about my little jam sandwich and 9 months later had a healthy baby boy!

    ReplyDelete
  18. Prerana3:44 AM

    Agreed that bed rest will be bad for some women mentally, but could you tell us if it would affect implantation? I mean if I chose to do bed rest after ET, would that harm the implantation? Is it a must not to do bed rest after ET?

    ReplyDelete
  19. The point is that there are no do's and don'ts - do what keeps you happy and comfortable, so that you do not beat up on yourself later on !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at http://twitter.com/#!/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  20. Anonymous8:48 PM

    I 100% agree with the DOCTOR with no bedrest. I had to laugh at some of your comments..really? If you got pregnant while on bedrest you honestly think that it was because you layed still for a few hours? How absurd. If this is the case then why is it that people with perfect embryos, with bedrest NOT get pregnant and others with horrible low graded embryos do get pregnant on the sane bedrest? Listen implantation will happen if it was meant to happen regardless of what you do...PEOPLE get pregnant EVERYDAY and not know it, drink, smoke, dance, ski, mountain climb, swim, fall, run, you name it. Why is it different if you lay down in a bed for rest because you know you had an embryo placed there and think it would be better? Dr's say take it easy because they dont want you to stress. I understand your fears as I struggle with InFertility myself but I also know that if that embryo will implant it will implant case closed. Do not think bedrest got you pregnant, you had a strong embryo that implanted is what got you pregnant. The doctors just bypass some of the normal functions that your body has a hard time doing. It is left up to mother nature and your body if you get pregnant and if that embryo implants NOT laying in a bed. So then do this forget any ART procedure no IVF, no IUI in your babymaking process, have sex and bedrest and tell me are you pregnant? I didnt think so.

    ReplyDelete
    Replies
    1. Anonymous6:09 AM

      Well said! This is exactly what every woman and man undergoing ivf treatment needs to hear! Look after yourself and you will look after your embryo(s). Thank you also dr malpani for providing consistent support to keep our ever wondering and worrying brane sane!

      Delete
  21. Anonymous4:32 AM

    Thank you!!!

    ReplyDelete
  22. Anonymous11:00 PM

    I carefully read all the comments and the only thing I have to say is to do whatever will relax you and give you peace of mind. Opinions are like belly buttons, everybody has one. If bed rest will keep you calm, do it. If being up and running is your thing, power to you. If you want to be with your legs up for two weeks, cool. Not me or the others that have posted comments is anybody to criticize a practice or method or even worst to laugh at what somebody believes can help them to make this difficult process better true or not. I applaud all of you going through it to become mothers and have a family. I have done a couple and have tried everything (bed rest, no bed rest, working, not working, etc.) with the same result. It is just what is going to make me feel I did my best at the end. Take care!

    ReplyDelete
  23. Anonymous11:02 PM

    I carefully read all the comments and the only thing I have to say is to do whatever will relax you and give you peace of mind. Opinions are like belly buttons, everybody has one. If bed rest will keep you calm, do it. If being up and running is your thing, power to you. If you want to be with your legs up for two weeks, cool. Not me or the others that have posted comments is anybody to criticize a practice or method or even worst to laugh at what somebody believes can help them to make this difficult process better true or not. I applaud all of you going through it to become mothers and have a family. I have done a couple and have tried everything (bed rest, no bed rest, working, not working, etc.) with the same result. It is just what is going to make me feel I did my best at the end. Take care!

    ReplyDelete
  24. Anonymous9:38 PM

    Dr Malpani,

    I am 30 yrs old and husbad 31.Perfectly healthy couple with undiagnosed undeterminable infertility. Thus after trying naturally for 2 years we recently underwent IVF. I had 2 9 cell embryos and rest 8 cell embryos on Day 3 thus my Dr decided to go for Day 5 transfer and did transfer a 4AA blastocyst embryo. Given my age and health (no issues) they decided to go for only 1 ET. Now my question is here on if it fails (since everything else was textbook perfect as per my clininc and DR)what are some factors to consider and know.

    ReplyDelete
  25. Anonymous7:11 AM

    i have had 3 transfers so far. i am in the 10 day waiting period right noe during my 3rd ivf. i am a surrogate and had complete bedrest for 2 1/2 days in a hotel because its a 5 hour drive from my house to my clinic. that ivf failed. my 2nd ivf i stayed in hotel for about 3 hours and then went walking on the beach and shopping at the mall. that ivf was a success. now i am on my 3rd ivf and did the same as the 2nd....3 hours bedrest and then the beach and shopping. i am on my 5th day of waiting and already have a positive on a home preg test!!!!

    ReplyDelete
  26. Anonymous4:15 AM

    Thank you soooooo much Dr.

    My own RE is extremely conservative- no exercise for 2 weeks after implantation, not even 15 minutes strolls with the dog. I have gone through two fresh cycles and two FETs, one of whic resulted in in a miscarriage. Every time I was the perfect IVF patient, putting myself on bedrest for 2 weeks and laying around, obsessing. And after each time, it takes me months to put the pieces back together emotionally, to start getting into a good exercise routine, etc etc and when I do.... the next cycle starts.

    Running is something I do for myself- not to look a certain way or please other people. In fact I am not even that good at it! But not being able to run stresses me out, and on top of IVF, it makes me feel like an invalid. Running helps me shut down obsessive/anxious feelings.

    Thank you so much for posting this and validating my gut instinct that I am not lessening my chances of implanting if I do run. It has given me a HUGE amount of comfort.

    ReplyDelete
  27. Anonymous4:16 AM

    Thank you soooooo much Dr.

    My own RE is extremely conservative- no exercise for 2 weeks after implantation, not even 15 minutes strolls with the dog. I have gone through two fresh cycles and two FETs, one of whic resulted in in a miscarriage. Every time I was the perfect IVF patient, putting myself on bedrest for 2 weeks and laying around, obsessing. And after each time, it takes me months to put the pieces back together emotionally, to start getting into a good exercise routine, etc etc and when I do.... the next cycle starts.

    Running is something I do for myself- not to look a certain way or please other people. In fact I am not even that good at it! But not being able to run stresses me out, and on top of IVF, it makes me feel like an invalid. Running helps me shut down obsessive/anxious feelings.

    Thank you so much for posting this and validating my gut instinct that I am not lessening my chances of implanting if I do run. It has given me a HUGE amount of comfort.

    ReplyDelete
  28. Sometimes patients sign away a lot of their autonomy to their doctor. This is not a good idea. Often the doctor's advise is not evidence based - after all, we are human and have our own biases as well.

    It's best to :

    do your homework
    discuss options with your doctor. Let him know your preferences - he cannot read your mind
    use your commonsense
    and then -
    take the path of least regret !


    ReplyDelete
  29. I am going to have embryo transfer this Thursday or Saturday. I need to visit a dying auntie. Can I fly after ET or should I wait after 2ww? How does the stress impact on that?

    ReplyDelete

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