POST EMBRYO TRANSFER CARE: MYTHS VS FACTS - Fertility Hospital in Jaipur

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POST EMBRYO TRANSFER CARE MYTHS VS FACTS
VASUNDHARA H O S P I T A L
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• There are many myths about infertility that
  exists in the minds of people. With the
  advancement of medical science, these myths have
  been replaced by facts.

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Myth 1 need for bed rest post embryo transfer

• No "bed rest" after embryo transferPutting the
  myth of bed rest after IVF to rest, once the
  embryos have been transferred into the uterus,
  they are safe and cannot "fall out " 

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EVIDENCE

• Immediate ambulation after embryo transfer A
  prospective study
• Study population 406 patients 
• Pregnancy rates did not differ between the
  groups 41 out of 167 (24.55) in the
  immediate-ambulation group and 51 out of 239
  (21.34) in the bed-rest group.
• Conclusion Immediate ambulation following the ET
  procedure has no adverse influence on the ability
  to conceive.
• Itai Bar-Hava, M.D., Ram Kerner,
  M.D., Rakefet Yoeli, et al Fert Steril 2005

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EVIDENCE

• Bed rest after embryo transfer negatively affects
  in vitro fertilization a randomized controlled
  clinical trial
• Conclusion The statistically significant higher
  LBI rate shown in our NR group confirms that 10
  minutes of bed rest immediately after ET has no
  positive effect and in fact can be negative for
  the outcome of IVF with OD. The
  anatomical/physiological or psychological reasons
  for this should be explored in future research
• Sharayu Gaikwad, et al, journal of fertility
  and sterility, 2013

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Myth 2 Stress lowers IVF success rates.

• Although there no direct way of measuring the
  level of stress but studies have still found an
  association between stress and less success
  rates.
• A more thorough study of stress and its role on
  IVF success is still needed.

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EVIDENCE

• Preconception stress increases the risk of
  infertility results from a couple-based
  prospective cohort studythe LIFE study
• STUDY QUESTION Are women's stress levels
  prospectively associated with fecundity and
  infertility?
• CONCLUSION Higher levels of stress as measured
  by salivary alpha-amylase are associated with a
  longer time-to-pregnancy (TTP) and an increased
  risk of infertility.
• C.D. Lynch et al , journal of Human
  Reproduction 2014

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• Stress reduction modalities, such as yoga,
  meditation and mindfulness, that have been shown
  to be helpful in reducing stress in studies of
  other health outcomes, might be relevant for
  further consideration.

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Myth 3 Diet and IVF success

• There is no strong evidence that any specific
  diet will increase chances of success but a few
  studies advocate probable positive effects of
  diet , if followed on a long term basis.
• Maintaining BMI within normal range is also
  important. Women with body mass indices of over
  35 or under 20 do experience lower pregnancy
  rates.

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EVIDENCE 1

• Adherence to the Mediterranean diet and IVF
  success rate among non-obese women attempting
  fertility
• Diet impacts fertility and certain nutrients and
  food groups appear to have a greater effect on
  reproductive health, but there are relatively few
  published data on the role of dietary patterns,
  and the Mediterranean diet (MedDiet) in
  particular, on assisted reproductive performance.
• Conclusions MedDietScore was positively related
  to clinical pregnancy and live birth among women
  lt35 years old (P  0.01) but not among women 35
  years.
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  Dimitrios Karayiannis et al Human Reproduction,
  2018

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• NOTE Mediterranean diet (MedDiet) is high in
  vegetables, fruits, legumes, nuts, beans,
  cereals, grains, fish, and unsaturated fats such
  as olive oil. It usually includes a low intake of
  meat and dairy foods.

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EVIDENCE 2

• Vitamin D Deficiency and Infertility Insights
  From in vitro Fertilization Cycles
• Results The adjusted odds ratio for clinical
  pregnancy in women with vitamin D 20 ng/mL was
  2.15 (95 CI 1.233.77).
• Conclusions Vitamin D is an emerging factor
  influencing female fertility and IVF outcome.
  Additional studies are pressingly needed to
  confirm a causal relationship and to investigate
  the potential therapeutic benefits of vitamin D
  supplementation.
• Alessio Paffoni et al, Journal of Clinical
  Endocrinology Metabolism 2014 99(11)E2372

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Myth 4 Acupuncture helps you get pregnant.

• The theory behind undergoing acupuncture during
  IVF is that it increases blood flow, which may
  help with embryo implantation. Studies are split
  Half show no benefit and half show a significant
  benefit.

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EVIDENCE

• The Role of Acupuncture in in vitro
  Fertilization A Systematic Review and
  Meta-Analysis
• Conclusion The study showed that acupuncture did
  not significantly improve the IVF clinical
  pregnancy rate when performed only at the time of
  ET, while there was a pooled benefit of
  acupuncture for IVF when performed at follicular
  phase and 25 min before and after ET, as well as
  30 min after ET and implantation phase.
• The modality needs further research before
  advising it universally to all the patients
  undergoing IVF-ET
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  Shen C. et al Gynecol Obstet
  Invest 2015791-12

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Myth 5 intercourse and IVF success

• Although there are conflicting results of most of
  the studies, it is always better to advise
  couples to maintain abstinence post ET.
• Intercourse directly and because of prostaglandin
  content of seminal fluid can induce uterine
  contractions, can lead to infections and also
  straining of abdominal muscles which are already
  strained after oocyte retrieval in cases of fresh
  embryo transfer.

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EVIDENCE

• Intercourse after Embryo Transfer and Pregnancy
  Outcomes A prospective case control comparative
  study.
• RESULTS women who had intercourse on one day
  during the implantation window had 1.59 times the
  odds of miscarriage (95 CI 0.26-9.78) compared
  to women that did not have intercourse. The odds
  of miscarriage were greater in women that had
  intercourse on two or more days.
• CONCLUSIONS Couples should consider abstinence
  following embryo transfer.
• 
  Natalie M.
  Crawford, et al Fert Steril 2014.

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Myth 6 Spotting in post ET phase

• A little spotting and bleeding is also nothing to
  worry about but patients should always consult
  their doctor in such a case.
• It could be
• A sign of pregnancy in the form of implantation
  bleed
• Sign of failing pregnancy/ early miscarriage
• Inadequate luteal support
• How to interpret Immediate blood samples to be
  sent for S. Estradiol and S. progesterone. USG
  and clinical examination to rule out local
  causes.

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EVIDENCE

• Addition of oral micronized E2 to maintain the
  serum E2 level gt200 pg/mL and i.m. or vaginal
  progesterone, if necessary, to maintain serum P
  level gt20 ng/mL should be the target.
• Reference Luteal phase supplementation
  after gonadotropin-releasing hormone agonist
  trigger in fresh embryo transfer the American
  versus European approaches
• Peter Humaidan et al, journal of fertility and
  sterility 2015 Issue 4 879885

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