Friday, September 03, 2010

What precautions should I take after the embryo transfer ?


One of the commonest questions patients ask me is - " Doctor, what are the dos and don'ts after the embryo transfer ? " They are very worried about the risk of failure, and are petrified that they may end up doing something which will cause their embryos to "fall out" of the uterus. Many will often spend the entire 2 week wait obsessing about their diet and physical activity.

Some will even put themselves on voluntary house arrest. Even worse, their relatives will often force them to sleep in bed for 14 days after the transfer. And to add insult to injury, many IVF doctors will also "advise" this !

Why do we still continue to perpetuate this myth ? I think it's partly doctors who are responsible For one thing, many doctors do not bother to educate their patients that physical activity will not affect embryo implantation. Others have a hidden agenda. Some want to hold on to their patients and by claiming that bed rest is essential after the IVF treatment, they can dissuade their patients from going to Bombay for their treatment ! Other doctors use this as a subtle way of " blaming the victim " if the cycle fails. ( " Your IVF cycle failed because you did not rest" is the hidden subtext !)

The reality is that bed rest does not help to improve pregnancy rates after IVF. Many studies have proven this conclusively. As I remind patients, the human body has been designed with enough sense, that embryos do not fall out if your cough or sneeze ! The truth is that human reproduction is inefficient and we cannot control the outcome. Whether the embryo implants or not is a biological process which the patient cannot influence in any way !

Am I taking an excessively casual approach ? No, I am just taking a realistic approach ! The problem is that when patients do not get pregnant, they often end up blaming themselves - and a common regret is - I did not rest enough. And even if they are smart enough not to do so, there are enough "friends and well-wishers" who will do this for them ! " What , you did not rest ? Your doctor must be crazy giving you such bad advise ! When my sister did her IVF in Delhi, her doctor made her rest for 9 months and now she has a beautiful 2 year old daughter" !

Once the embryos have been transferred into the uterus, they are safe and cannot "fall out " . This is simple commonsense ! IVF embryos , once they have reached the uterus, do not "remember" that they have spent 3 days in an IVF incubator - they are just like all other "in vivo" embryos which are formed after intercourse in the bedroom. Whether the embryo spends 3 days in your fallopian tube or in a test tube makes no difference to the outcome !

You need to have enough maturity to understand that the final outcome is not in your hands. It's important that you not blame yourself in case you do not get pregnant - doing this just makes a bad situation worse ! Trust your gut instinct and your commonsense - your body has enough wisdom to guide you as to what is fine and what is not. My advise is simple - Don't do anything which you may regret later !

Curtailing physical activity during the 2ww is a huge challenge for women who already have a baby and are doing IVF to complete their family. They feel torn between their desire to pick up their toddler and their fear that this "strain" may expel the embryo !

A word of advise to spouses. You are very likely to be overprotective during this time. You will want her to "rest" and "take things easy". You will tell her not to go to work, or to be very careful as to what she drinks or eats. While I am sure your wife will enjoy this pampering, please do not go over the top. She is smart enough to figure out what to do - after all, she is the one who has the most at stake, and is unlikely to do anything which will jeopardise her chances of getting pregnant ! Try to protect her from the well-meaning advise of busy-bodies, who are often very poorly informed !

Actually, this bed rest can be harmful; and we do our best to encourage our patients to go back to work after the embryo transfer ! Keeping yourself gainfully occupied is your best bet. Sitting at home when you are well can be very demoralising.

It can be very hard to deal with the uncertainty and anxiety of the 2 week wait ! The emotional stress is enormous - and lying in bed all day just exacerbates this a thousand fold ! Patients on bed rest tend to brood all day long about the outcome. Every minor twinge and ache is magnified, and your mind plays games with you during the 2 week wait - and commonsense suggests this stress cannot be good for you ! Moreover, when you are on bed rest, you are a burden to the rest of the family, and this adds to your guilt ! And if the cycle fails, then you end up blaming yourself ( I got up to pee after the embryo transfer, and this caused my embryos to get dislodged !)

You cannot influence the outcome - all you can do is gracefully let nature take its own course !

Please remember the Serenity Prayer
God grant me the serenity to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.


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