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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25 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

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