Tuesday, January 29, 2013

Will my embryo fall out after the embryo transfer ?



A fear which is wide-spread among IVF patients is – will my embryo fall out if I stand up or walk around after the embryo transfer ? This is quite a reasonable worry – after all, if the embryos are transferred through the uterus through the cervix, then why can’t they come out through the same route?  However, if you understand the anatomy of the uterus , these doubts will vanish and you will fell much more confident and comfortable during your 2ww.

Women imagine that when the doctor puts the embryos inside the uterus, they are deposited inside a space within the uterus in which the microscopic embryos can roll freely!  They believe that if they rest, the embryos will settle down and stick to the wall of the cavity. After all, when you stick two pages together with glue, don’t you leave them undisturbed for some time to allow the glue to set ? They are worried that if they walk about, the embryos will be disturbed from their resting place , and may fall out of the cavity.
In reality, the uterus is a muscular organ , about the size of your fist. When people hear the word ‘uterine cavity’, they imagine that there is a real cavity within the uterus ( like a cave, perhaps) , but this is not true. The cavity we talk about is not a true cavity , but just a potential cavity . The walls of the uterus are in contact with each other – after all, there cannot be any empty areas inside the body ! For example, press your palms together. There is no real space between them , since your palms are touching each other. What happens when you insert a small ball in between your palms ? The ball has created a space for itself ! In the same way , a uterus which doesn’t have an embryo inside it carries only a potential space. Only when the embryo grows in size will this space enlarge. Do you know that at 5 weeks of gestation your embryo is just the size of a sesame seed ? Imagine what will happen if you keep a seed between your pressed palms and move your hands in whatever way you might wish to ? There is no way the seed will be dislodged  - it is safe , snug and secure in its resting place. This is exactly what happens to your embryos inside your uterus !  Nothing you do can dislodge an embryo – NOTHING (even jumping or running) ! If the embryo is healthy and if your endometrial layer is receptive , the embryo will stick to the wall and bury itself inside the lining (just like a seed does , when planted in fertile soil). External physical activity cannot influence this natural biological process which occurs in utero.

A lot women refuse to go to the bathroom for a few hours after the embryo transfer, because they are scared that if they pee, their embryo will fall out of the uterus. They just end up making themselves completely miserable – and I worry that an overdistended bladder can actually cause uterine contractions needlessly ! Others are scared that if they cough or sneeze after the transfer, they will ruin their chances of success. Please do not obsess – remember that nature has designed the body with enough intelligence, that you don’t need to worry at all !

After the transfer, the uterus can contract (for example , during an orgasm, which often occurs while sleeping during  the 2ww ), but the progesterone produced during the luteal phase will prevent these uterine contractions from dislodging the embryo. Intercourse and orgasm cannot cause any harm after the transfer – after all, fertile couples do have sexual intercourse during the 2ww, and they get pregnant all the time.

After an embryo transfer , bed rest is absolutely unnecessary. I have heard from women who have been forced to spend 2 weeks in bed after the embryo transfer – and many of them have done so because of their doctor’s orders ! ( I think the reason some doctors continue to give this outdated advise is a clever way of subtly blaming the patient if the cycle fails ! “ You didn’t get pregnant even though I did such a good job with your IVF treatment , because you did not rest properly “ is their subliminal message) . Even a couple of days in bed can do you harm , physically and emotionally. Bed rest may increase body aches and back pain , and makes your physically uncomfortable.  Resting may actually reduce uterine blood flow by reducing pelvic circulation. Bed rest creates havoc  with your mental well-being as well ! When you lie down in bed all the time and have nothing to do, your mind will start to play all sorts of games with you. The end result is an unhealthy obsession with your body’s symptoms and signs – and this often causes panic , which does not help after a stressful IVF cycle.  The bed rest, rather than resting your mind, often causes more stress !

Please do not restrict your normal day-to-day activities after an embryo transfer.  Use your common sense, and do not do any strenuous activity which might cause you to blame yourself if your cycle fails ! And what happens if your mother in law enforces house arrest ? Remember that she has been brainwashed , and is following well-meaning but misguided advise, based on centuries of myths and misconceptions about bed rest and pregnancy. She is not trying to harass you – she is just trying to help you to have a baby , based on her personal ( but flawed) world view ! Please don’t rock the boat by flatly refusing to listen to her – just give her this article to read , so she understands why bed rest does not help!  And if she is still unconvinced, please share this with her - Bed rest has not been scientifically proven to improve pregnancy rate after embryo transfer(PMID: 19590224).

This is an excerpt from our forthcoming, book, The Expert Patient's Guide to IVF. This being authored by our expert patient, Manju and me.

 You can email Manju at manjupadmasekar@yahoo.com

Her blog is at www.myselfishgenes.blogspot.com

  



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69 comments:

  1. Anonymous12:33 AM

    Because I had a tiny cyst the fresh embryos 8/4aa then had to be frozen and put off. I did not know to after the FET was done that the 4aa was now a 2cc because of thawing 3 was transferred. I do have pictures of the embryos now. I have 6 remaining. We sold everything we owned to do this. We paid for a donor egg from a young woman to have better chance the doctor said. Our life has been hard. I lost everything before this when my adopted baby was diagnosed with ALL cancer. Going for 2nd try. Is there anything that can be done different?
    Will the glue help?



    ReplyDelete
  2. Anonymous6:01 PM

    Really nice article ... I want to conform after et ll happen can v drive the car plz reply me .

    ReplyDelete
    Replies
    1. Yes, it's safe to drive your car

      Delete
  3. Very nive and informative article

    ReplyDelete
  4. Really v good article.It really put me into confidence and free from stress.Thk u so... much .

    ReplyDelete
  5. I have thin lining problem It dosn't grow thicker more then 7mm. In my case 7mm would be the highest, do u know something that can helps the lining grow thicker thankx

    ReplyDelete
    Replies
    1. You can read more about how we improve a thin uterine lining at http://www.drmalpani.com/articles/thin-endometrial-lining

      Delete
  6. What is the recommended treatment for natural killer cells?

    ReplyDelete
  7. NK cells ( Natural Killer) cells don't need any treatment - they are found in fertile women as well

    Dr Malpani

    ReplyDelete
  8. Anonymous1:42 PM

    Hello sir, on 5th Oct frozen embryo was transferred blastocyst stage and during this 2 ww doc gave me 3 hcg injection 5000 iu at around 9 dpo my hpt was positive but from last two days they are coming up negative. My beta is on 16 th still one day to go.I am getting tensed whether m pregnant or not. I am taking aquagest injection and lonopin injection daily beacause I had a missed abortion in June but karyotype reports were normal

    ReplyDelete
    Replies
    1. Your HPT was positive because the doctor gave you a HCG injection. This is just a way of fooling you into thinking you got pregnant. Good doctors do not give a HCG injection after a frozen embryo transfer

      Can you send me more details about your IVF cycles ? What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ? DO YOU HAVE PHOTOS OF YOUR EMBRYOS ? You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos
      Can you please send me the printed treatment summary from your IVF clinic ?

      The fact you have conceived in the past ( even though you did miscarry) means your chances
      of having a healthy baby are excellent, so please don't get disheartened !

      We look forward to helping you to have a baby !

      Delete
  9. Anonymous11:32 PM

    Can a woman get pregnant after embryo transfer,without any pregnancy sign

    ReplyDelete
    Replies
    1. There are no symptoms or signs during the 2ww after the ET which will tell you whether you are pregnant or not.
      Do a blood test for HCG to find out if you are pregnant.

      Read more at www.drmalpani.com/knowledge-center/articles/hcg



      Delete
  10. Sir..after et is bedrest is compulsary.?

    ReplyDelete
    Replies
    1. No, bed rest after ET is harmful !

      Delete
  11. Anonymous8:05 AM

    Hi Doctor. I had my frozen embryo transfer on 6/11.
    Here is my history:
    34yo - PCOS
    IVF CYCLE 1 - Cancelled because of OHSS
    Waited 3 months for CYCLE 2
    IVF Cycle 2 - Lower dose and only 3 eggs retrieved and fertilized
    FET 1 - No med but cancelled because took too long to ovulate
    FET 2 - Did transfer on 6/11 DAY 5. ONLY ONE MADE IT TO BLASTOCYST, THE REST DID NOT PROGRESS ALTHOUGH ONE LOOK PROMISING but they said in day 6, they will discard them.
    I was only given to take pessaries progesterone on 7/11 one dosage of 200mg
    I had just done my BT on 11/11. My HCG is very low only 4.9, and my doc has increased my dosage to 2 per day. Will be doing another BT on 13/11.
    Questions:
    Q1
    Is the HCG level very low at this stage and what is the latest/max duration to confirm if pregnant. My doc said if the HCg doesnt double on 13/11, it means negative.
    Q2
    Given what has been observed is it really worth giving ivf another shot, this is my first cycle or it if yes, should i change clinic?
    Q3
    My doc has increased my dosage of pessaries quite late yesterday so I put two of them one after another with one hour apart. Is this ok?

    Thanks a lot.

    ReplyDelete
    Replies
    1. Why did the doctor do a HCG so soon after the ET. We normally wait at least 9 days after a Day 5 transfer

      Read more at www.drmalpani.com/knowledge-center/articles/hcg

      Can you send me more details about your IVF cycle
      DO YOU HAVE PHOTOS OF YOUR EMBRYO ? You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos
      Can you please send me the printed treatment summary from your IVF clinic ?

      We look forward to helping you to have a baby !

      Delete
  12. Anonymous12:15 AM

    Hello Doctor. I have pcos problem & also have polyps in my uterus. My husband have very low sperm count. My AMH is 13.5. From last two &half years I m going through fertility treatment. I have done laparoscopy ovarian drilling on april 2013. Then iui-failed. Then went for icsi. During 1st icsi cycle only 2 eggs retrieved & only one get fertilized. Transfer is made on 3rd day & failed. Next icsi was on march 2015. 4eggs retrieved, 2 get fertilized again transfer is done on 3rd day &failed. 3rd icsi was done on july 2015. 8eggs get fertilized. All of them kept frozen (2 day). Fet was don on 14/12/2015. 3 embryos were transferred. Again failed. My et lining was 7.5. Do I have some major problem?. Can I ever get pregnant? Is my uterus not receptive for embryos?

    ReplyDelete
    Replies
    1. Every woman's uterus is receptive and can accept embryos, so please stop blaming yourself

      I need more information to be able to provide you with intelligent advise.

      Can you send me more details about your IVF cycles ? What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood at the time of the HCG trigger? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ? DO YOU HAVE PHOTOS OF YOUR EMBRYOS ? You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos
      Can you please send me the printed treatment summary from your IVF clinic ?

      We look forward to helping you to have a baby !

      Delete
  13. Had embryo transfer yesterday. Today, I woke up and found pieces of creamy-colored tissue on toilet paper when I peed. Are these cervical tissues or embryo expelled?

    ReplyDelete
  14. No, the embryo cannot get expelled. An embryo is microscopic and cannot be seen with your naked eye

    ReplyDelete
  15. I just fell down 1 step and had some bleeding a little red aND some brown. However I have been having bleeding off and on. Could I have dislodged the embryo? I am 9 days post transfer.

    ReplyDelete
    Replies
    1. No, you cannot dislodge your embryo. However, the bleeding you are having is worrisome !

      Delete
  16. Anonymous10:05 AM

    Dear Dr Malpani,

    your blog has been very helpful. i have been reading a lot since i was deciding between cystecomy for severe endo with low AMH and IVF.

    i eventually have chosen IVF and have 2x day2 embryos for transferred.

    the next day after the transfer i have lower abdominal cramp propagated to vaginal in the late afternoon and increased of discharge like PMS. the symptoms were not severe but they are quite noticeable. the symptoms lasted for 24hours and got better. i was still able to move about.

    i have been on luteal support since ET, Estradiol 4mg om & progesterone 200mg tds vaginally.

    i have been thinking what could went wrong and i guess the most suspicious one would be the lunch which consisted of peppery pork rib soup and a small portion sesame oil chicken(probably with some wine, smell like having some)

    i m really concerning if those are contraction? and would that dislodge my precious embies. appreciate if you could share some light with me.

    Best regards,
    CKL

    ReplyDelete
    Replies
    1. Please don't worry about the cramps - these will not harm your embryos !

      Can you send me more details about your IVF cycle ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      We look forward to helping you to have a baby !

      Delete
  17. Anonymous2:32 AM

    Hello Dr. Malpani, I am sorry to trouble you but have a question regarding the orgasm, I was recommended no vaginal penetration for 48 hours after frozen transfer, but nothing related to having oral sex, can uterine contractions cause any detriments? I am now worried and almost regret, it happened 4days after FET, I would appreciate your reply, Thank you! ES

    ReplyDelete
  18. Dear Dr. Malpani, I have a few questions if I may:

    1. I have been worried after I had a verbal argument with my significant other another day, do you think excessive stress can affect the implantation and embryo development? I had 4 of embryos transferred with my eggs since I am 44yo about 5 days ago,

    2. Also it has been very cold and I was shivering on a few occasions of times walking outside, probably silly questions but still make me concern if these two factors have any effect,

    3. Can I take hot shower? I was told in the clinic no direct heat application to the area,

    I would really appreciate your reply.

    Thank you,

    ReplyDelete
    Replies
    1. Please don't worry

      Your embryos are safe in your uterus, like a pearl in an oyster. Nothing you do can harm them , so please do not worry about this.

      Please do not let your mind play games with you

      Read more at http://www.drmalpani.com/knowledge-center/articles/care-after-embryo-transfer

      We look forward to helping you to have a baby !

      Delete
  19. Thank you Dr. Malpani for your comforting words, I appreciate your reply

    ReplyDelete
  20. Anonymous6:22 AM

    Hi Doctor

    if i quarreled with my hubby after the transfer and was feeling extremely agitated and frightened, will these negative emotions jeopardize my chances? also after my FET i was told to keep my urine in for a least an hour and had a difficult time controlling my full bladder. again, will this jeopardize my chances? thanks for your time.

    ReplyDelete
    Replies
    1. No, please do not worry about this. Don't let your mind play games with you please !

      Delete
  21. Anonymous6:26 AM

    hi dr, what then will cause a failed ivf and cause the embryo to dislodge? will trying to keep a full bladder in dislodge the embryo? thanks

    ReplyDelete
    Replies
    1. No, it will not. Your embryo is safe in your uterus, like a pearl in an oyster !

      Delete
  22. Hi Dr, if i have hard poop and I trying to push out will it affect the embryo to flow out too?

    ReplyDelete
  23. Hi dr , had my fet on Monday 14th of march,can I still cont drinking rasberry leaf tea, cos I drank it before my transfer and it helped my uterus lining thicken from 3 mm to 12.8mm, thou I'm taking progenova and inserting cyloget, but since ve done fibroid operation twice., anytime I'm ovulating I see brownish blood,
    Since after my fet on Monday ve bn seeing brownish blood. Is it safe for my embryo?
    And lastly I went to poo this mg and I saw some brownish after flushing, do u think my embryo is still safe dr?The u so mch

    ReplyDelete
    Replies
    1. I agree the bleeding after the transfer is worrisome.

      Can you send me more details about your IVF cycles ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      Delete
    2. Thank u dr for ur quick response,I was given progynova I started with 4mg but later changed to 6mg,and 800mg for cyclogest (progesterone pheur,only one embryo was transferred cos ve done fibroid operation 2wice,I grew 11folicles,6good eggs were collected,but only one made it tru,was told by d dr and d embryologist that d quality was good,nd it as bn frozen since November ,dont ve the picture of the embryo,I didn't request for it,the endometrial thickness was 12.8mm before transfer,don't kno the e2,thank u so much dr hope to hear from u soon,thank u.

      Delete
    3. Where are the photos of your embryos ?

      This is not correct. You have a legal right to your medical records - every hospital has to provide them by law ! Please make a request for this in writing.

      The only tangible product an IVF clinic can deliver is embryos ! All good clinics provide embryo photos proactively and routinely

      Any clinic which does not provide embry photos is a poor quality clinic.

      Please find a better clinic if you want to maximise your chances of success

      Delete
    4. Tank u so mch dr for ur response,I saw the picture on the screen,but I never requested for it,will request for it and send it to u,tnx so mch for ur time doc.

      Delete
  24. And dr pls what do I need to eat to make my embryo grow before the 2 we. Thnk , can I still drink my rasberry leaf tea and cranberry pomegranate ..juice , heard pineapple and brasil nut is equally good, thank u so mch dr, hop to hear from you soon.

    ReplyDelete
    Replies
    1. There's little you can do to improve the chances of your embryos implanting. This is a natural biological process which we cannot control or influence, sorry

      Delete
  25. Hi Dr.Quick question,
    Yesterday I was 6dpt 5d embryo and I was spotting but just browning color and when I called the nurse she informed me that was probably the progesterone (crinone 8%).Today I did not have any spotting at all and everything went away. Do you think that was the progesterone or there was a possibility that implantation was taking place?
    Also, as you might know when you are on progesterone ando estrogen comes into place. :(. When I went to the bathroom I have to push so hard that I am afraid now that my to embryos fell out. Is that possible ? Also, I don't have any more symptoms.
    Thank you for any information you can offer.

    ReplyDelete
  26. No, your embryos cannot fall outside when you push, so please don't worry needlessly !

    ReplyDelete
  27. my vagina is always tense and every time I notice it, it's as if trying to push. Could my tense vagina push my embryos out??

    ReplyDelete
    Replies
    1. No, it cannot. Your embryos are safe in your uterus

      Delete
  28. Anonymous3:44 PM

    hi dr...i had my fet last sunday ...and i take some days off from work...i need to know can i drive car on my way to work ..

    ReplyDelete
    Replies
    1. Yes, it's safe to drive

      Your embryos are safe in your uterus, like a pearl in an oyster. Nothing you do can harm them , so please do not worry about this.

      Please do not let your mind play games with you

      Read more at http://www.drmalpani.com/knowledge-center/articles/care-after-embryo-transfer

      We look forward to helping you to have a baby !

      Delete
  29. Anonymous4:36 AM

    I'm 25 years old, my doctor informed me everything looks great. They were able to capture 10 eggs, 9 fertilized, 1 transferred, 6 froze. we transferred 1 blast on 7/1. When can I expect to see results on a pregnancy test? I have previously have had 1 child.

    ReplyDelete
    Replies
    1. You need to do a blood test for HCG 12 days after the transfer

      Read more at www.drmalpani.com/knowledge-center/articles/hcg

      Delete
  30. Really informative.. Thanks for sharing your experience.. I am 32 years old working woman.. and I have gone through several ART embryo implanting treatment..Is there any triplet probability during birth..??
    please reply same.. I am so scared about this.. don't know what to do??

    ReplyDelete
    Replies
    1. If you transfer only 2 blastocysts, then you will not have triplets !

      Delete
  31. Anonymous8:08 AM

    Hi doctor,
    Can i use indian style toilet aftet my embryo transfer?

    ReplyDelete
    Replies
    1. Yes

      Your embryos are safe in your uterus, like a pearl in an oyster. Nothing you do can harm them , so please do not worry about this.

      Please do not let your mind play games with you

      Read more at http://www.drmalpani.com/knowledge-center/articles/care-after-embryo-transfer

      We look forward to helping you to have a baby !

      Delete
  32. Everytime i cough my abdoman hurts i had egg transfer yesterday do you think this is from egg retrieval

    ReplyDelete
    Replies
    1. Yes, the ovaries can be tender after egg retrieval because they are enlarged and the needle puncture can cause soreness

      Delete
  33. Anonymous3:06 AM

    After my embryo transfer yesterday, I had difficulty emptying my bladder, and when I finally did, there was (sorry for TMI) wind comong out of the virginal. Could this be due uterine contraction? Have I lost the embryo?

    ReplyDelete
    Replies
    1. No.

      Your embryos are safe in your uterus, like a pearl in an oyster. Nothing you do can harm them , so please do not worry about this.

      Please do not let your mind play games with you

      Read more at http://www.drmalpani.com/knowledge-center/articles/care-after-embryo-transfer

      We look forward to helping you to have a baby !

      Delete
  34. Hello Dr just gone thru ur blog. Thanks so much really very informative.I just had done my FET on Oct 1 my doc advised me about HCG injections on 5th 9th and 12th Oct but in one of ur blog u told HCG doesn't require after FET.

    ReplyDelete
    Replies
    1. That's true - you don't need HCG after a frozen ET as there is no corpus lutem in a FET cycle

      They sometimes do this to fool you because HCG injections will cause your beta HCG blood test to come back as positive

      Delete
  35. Anonymous9:56 AM

    On the 11 the did transfer the gave me pleyris injection and the following day I used the athor 1 without reading the paper I supposed to inject after 3 days I'm worried now

    ReplyDelete
  36. Hello, your site is really helpful. I am having my egg collection day after tomorrow. So far I got only two matured follicles. My AMH is very low( .47) and now I am on 33.Is there any connection between egg quality and AMH and egg quantity and AMH

    ReplyDelete
    Replies
    1. Patients with low AMH have few eggs and these are usually of poor quality as well

      Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at http://www.drmalpani.com/knowledge-center/articles/afc

      Delete
  37. Hello doctor.i had my last set of FET done today.last two times it was negative. This time couldnt hold so urinated after 5 mintues of transfer.as per ur blog if it wont affect the embryos then why doctors here insist to lie atleast for 10 to 15 mins? It is unnecessary creating concern for the patients like me..plz do help me.

    ReplyDelete
    Replies
    1. Good doctors will never tell you to lie down as this does not affect the chances of your embryos implanting

      Delete
    2. Thank you sir for your reply.i am into my 2ww waiting period after my fet.i have been prescribed with endogest sr300mg thrice a day and crionone gel 8% twice a day.due to some problem with the crinone applicator, it's been replaced with progesterone 200mg two capsules 3 times a day.my question is sir is it ok to replace pills with gel in the mid of waiting period?is the amount of progesterone I am taking is more than enough of or is adequate?

      Delete
  38. Hi Dr.
    Had FET 3day transfer 3 grade B embryos.
    7dpt observed tiny black substance while wipping off progestrone tablet white discharge on tissue. Can it be embryos? Can embryos stick to progestrone tabs and come out along with it?

    ReplyDelete
    Replies
    1. No. Your embryos are in your uterus and cannot fall out. They are microscopic and cannot be seen with the naked eye

      Delete
  39. I am 45 yrs of age can i have my own baby

    ReplyDelete

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