Monday, September 01, 2014

Bed rest after IVF is harmful

Most gynecologists in India continue to routinely prescribed bedrest after the embryo transfer . They scare them that if they do not rest, their embryo will fall out of their uterus ! Some of them insist that the patient not get out of bed even to go to the bathroom; while others tell the patient to put a pillow under her hips, so that her embryos remains safe and secure within her uterus.

We know this is complete rubbish , and IVF clinics all over the world now allow patients to resume normal activity immediately after the embryo transfer . Once the embryos is inside the uterus, it cannot fall outside, whether the patient coughs, sneezes , strains or goes bungee-jumping ! This is true whether the embryos reaches the uterus through the fallopian tube ( as it does when couples have sex in  their bedroom); or whether we transfer it through he cervix using an embryo transfer catheter

The embryo does not care if it spends three days in the fallopian tube , or three days in the test tube ! This makes absolutely no difference to embryo implantation , and there is no way physical activity can dislodge the embryo from the uterus.

So why do doctors continue giving such bad advice to their patients .

I think some of these are old-fashioned doctors , and often when they really don’t have anything else to offer patients , they advise them to rest in bed !  This is a historical hangover , and is the standard advise obstetricians have given when ever the pregnancy was complicated.

It’s easy for doctors to advise bed rest – it  doesn't cost them anything to do so. However, the adverse consequences for the poor patient are enormous ! It must be dais in their defense that many doctors don’t even realize the unwitting harm they cause by giving such poor advise. Not only does bed rest disrupt the household; it causes lots of physical problems for the poor patient ( back pain ; an increased risk of DVT; and muscle weakness and atrophy). The emotional price bed rest exacts is huge. It adds to her stress levels, because when she is stuck in bed, all she thinks about all day along is what is happening to her embryos and whether the cycle will work or not. The 2ww lasts for much longer when you have to spend it in bed. At least, when a patient is working, her mind is distracted, and she has other things to worry about.

Even worse, if the patient doesn’t get pregnant , she blames herself by feeling that it’s because I did not rest properly that my embryos fell out. Even if she is mature enough not to beat up on herself, her mother in law will often “blame” her for the failure by saying she did not follow medical advise and did not rest properly.

Bedrest after IVF intuitively makes a lot of sense .This is why many women ( and their mothers and mother-in-laws) will impose this on themselves, even if the doctor doesn’t advise this.

•  It seems logical: after all, won’t standing up allow gravity cause the embryo to drop out of the uterus ?
•It feels better to “ prescribe “ bed rest than to tell a patient, “we really don’t have anything to offer you to improve your chances of embryo implantation”
•Women on bed rest are doing something, which for them feels a whole lot better than doing nothing.
•If bed rest isn’t recommended, and the patient fails to get pregnant, they will always blame the doctor because they may believe that bed rest would have changed the outcome.

Some doctors advise bed rest because they have a vested interest. In case the cycle fails, they can always blame the patient for the failure.  Another reason doctors advise bed rest is because they do not want their patients to go to another center for their IVF treatment.  The leading clinics in India are in the large cities, and because doctors in small towns who do IVF want to hang on to their patients, they scare them by saying that it you travel to Mumbai for your IVF, your embryo will fall out when you travel back, and you will never get pregnant.  This is rubbish , but it's very easy to take ignorant patients for a ride, especially when there are already so many myths and misconceptions about bedrest during pregnancy .

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