As if there isn’t enough to worry about after an embryo transfer, worrying that you are ruining any chance of a BFP as you have to get up and go straight after an embryo transfer is up there. This is especially so for women who need to go straight back to work after taking all that time off for blood tests and monitoring, the egg collection and the transfer itself.
Everyone has an opinion on how much bed rest you need and it ranges from none at all, to 10 minutes straight after the transfer to up to three days (who has time for that?). Saying that though, who amongst us wouldn’t lie flat on our backs for three weeks if it was proven to increase the probability of a successful embryo transfer?
When I searched ‘bed rest embryo transfer’ in a medical search engine I found less than 10 articles directly related to this topic in the last 10 years. Needless to say more research would be useful. Or would it? I only say this for I couldn’t find one piece of evidence that indicates that bed rest is beneficial – has this conclusion already been drawn?
The JURY IS IN
If it were to be summed all up in one sentence, Abou-Setta et al in their 2014 Cochrane Review (1) report
there is insufficient evidence to support any specific length of time for women to remain recumbent, if at all, following embryo transfer
So it seems as if there is no evidence to support the need to rest after a transfer. To reach this conclusion they did a thorough search for all trials that had been conducted and found two studies that they thought were appropriate, consisting of 594 patients. When we think of how many embryo transfers get done every day and the amount of money that changes hands, I think that this indicates a disproportionately small number of research articles being produced. Abou-Setta et al (1) also highlight that the research done is of low quality and recognises that more research is definitely needed in this area which may help to change future thinking.
Well at least it doesn’t do any harm…?
Gaikwad et al (2) report that even 10 minutes of bed rest following embryo transfer can be detrimental. They report on one study where there were two groups of women – one who had been told to rest following transfer and one who didnt rest. Ultimately this study had to be abandoned for eithical reasons because it became evident early on that the women who rested following a transfer had a lower chance of a successful outcome then those who did not. Gaikwad speculates on other investigators thoughts as to whether or not the seemingly detrimental effect of bed rest is due to the position of the uterus when lying down as well as speculating that continuing on with every day living helps manage our coping strategies and anxiety levels which has previously been researched to have an impact on success rates.
The amount of time women are recommeneded to rest in bed also varies. This has also been researched and regardless of whether the bed rest is for 10 minutes (2), 30 minutes (3), one hour (4) or one day (5) it seems that the less time that is spent in bed post embryo transfer the better the chances of pregnancy and ultimately a take home baby. It should be noted that there is some conflicting evidence and not all researchers say that bed rest is detrimental (though they do all seem to concur that it is at the very least not beneficial).
Why is bed rest recommended?
Whilst I am sure that they exist (surely?!) I have been unable to find any articles, proper research articles or internet articles that support the need for bed rest, despite the chat rooms and forums being full of women who report that their specialist advised them to do so. Whilst these articles are also not saying to go run a marathon (who would with ovaries the sizes of oranges) why are a lot of women undergoing embryo transfers still be advised to do so? Remember though if your specialist has recommended a period of rest for you, query it with them, there could be something in your particular medical history that makes it a worthwhile pursuit… maybe…
Other reasons why bed rest is not required
Placement of embryo
Personally, despite the fact that whilst I try and linger horizontally in the ‘transfer room’ as long as possible after a transfer, the rational side of me believes that rest is not required and the embryo isn’t going to ‘fall out’ as soon as you stand up. When you look at the thousands of years of natural conceptions that happened prior to IVF, I am pretty sure that not one of those fertile women even thought to have a lie down on day 3 or 5. Especially for those ladies who do the day 5 transfers the location in your uterus where your Specialist places the embryo during the transfer is pretty much exactly where it would be by day 5 in nature, ie typically towards the top of uterine cavity after travelling through the fallopian tube. And for those ladies who don’t do day 5 transfers, embryos can move and fertilise at any point in the fallopian tube or uterus so again, no stress required! Those ladies who really do think about things a lot, yes transferred embryos can move around, but they are pretty well supported once they are in they are in there (its not as if there is just a totally empty space) and the incidence of ectopic pregnancy in IVF gestations is around 1.3% (Australian Doctor, 27th March 2015) which when you think about the overall success rates is relatively low and putting yourself on bed rest because you think the embryo is going to move around doesn’t really outweigh the reasons for NOT going on bed rest.
Circulation and blood flow
Additionally, when we are moving around the circulation through out body is improved, this includes circulation to the uterus. The longer that we are immobile or resting in bed, our circulation system slows meaning that less blood is being pumped around the body and to the uterus. One of the reasons some of us take low dose aspirin or visit the acupuncturist is to try and increase blood flow to the uterus so why would we want to do anything that inhibits this. By increasing blood flow some believe that this can increase the quality of the lining which ultimately supports implantation. When you look at it from this point of view, we really should be making sure that we are doing light exercise and improving circulation throughout the cycle.
Over thinking time
When we are on bed rest it gives us too much time to think. Whilst for a short time we may be secretly quite happy to finish off the Orange is the New Black boxset our mind will pretty soon start turning back to the little ball of cells that has been placed inside of you. One thing that fertility patients tend to do very well is think, which inevitably leads into a dangerous cycle of self blaming, stress and anxiety. No thank you. And this theory is also supported by Küçük (7) and by Gaikwad (2) as briefly mentioned above. More on the impact of stress and anxiety in future posts.
I am sure there are many other reasons why bed rest could be detrimental to embryo transfer success, but these are just to name a few.
But please tell me if have you been instructed to rest after embryo transfer and for what reasons?
And as always, the above is just for information purposes, please discuss with your treating specialist to decide what is best for your individual situation.
1. Abou-Setta, AM, Peters LR, D’Angelo A, Sallam HN, Hart RJ, Al-Inany HG. Post-embryo transfer interventions for assisted reproduction technology cycles (Review). Cochrane Database of Systematic Reviews 2014. Issue 8 2. Gaikwad, S., Garrido, N., Cobo, A., Pellicer, A. & Remohi, J. (2013) Bed rest after embryo transfer negatively affects in vitro fertilization: a randomized controlled clinical trial. Fertility and Sterility Vol 100 (3) 730- 735 3. Purcell, K., Schembri, M., Telles, T., Fujimoto, V. & Cedars, M. (2007) Bed rest after embryo transfer: a randomized controlled trial. Fertility and Sterility Vol 87 (6) 1322 – 1326 4. Bar-Hava I, Kerner R, Yoeli R, Ashkenazi J, Shalev Y, Orvieto R. (2005) Immediate ambulation after embryo transfer: a prospective study. Fertility and Sterility 83 (3) 594–597. 5. Amarin, Z. & Obeidat, B. (2004) Bed rest versus free mobilisation following embryo transfer: a prospective randomised study. BJOG: An International Journal of Obstetrics and Gynaecology Vol 111(11) 1273-6. 6. Australian Doctor 7. Küçük, M. (2013) Review Bed rest after embryo transfer: is it harmful? European Journal of Obstetrics & Gynecology andReproductive Biology Vo (167) 123–126