Embryos Don’t Fall Out After IVF Transfer

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Many patients worry about what they can and cannot do after an embryo transfer. The fear is if they do something wrong, the embryo won’t attach or fall out.

This is simply not true. Yes, you should relax and take it easy after an IVF embryo transfer. But no, bed rest is not necessary.

The Embryo Transfer

One of the most commonly used phrases in IVF is: “The reproductive endocrinologist implants the embryos in the patient’s uterus.” This is not how it works — the embryo or embryos have to implant on their own.

Here’s how it works:

During in vitro fertilization, the embryo(s) develop in a Petri dish for three to five days, and the healthiest embryo(s) are chosen for the transfer. The embryologist removes the embryos from the incubator and shows them to the patient, magnified up to 1,000 times on the video screen.

The next step is to use a vaginal speculum  to wash off the cervix with some sterile fluid. The patient feels pressure, but typically there is no pain. For women who have undergone intrauterine inseminations (IUIs), the sensation should be very similar.

The transfer itself is a fairly simple procedure with very little discomfort. A thin, soft catheter is threaded through the cervix under ultrasound guidance, to be very exact in the embryo placement location, generally 1 to 2 cm from the top of the uterine cavity. After cleansing the cervix with solution, the doctor will place an empty transfer catheter through the cervix into position inside the uterine cavity. Then the embryologist will bring the catheter containing the embryo(s) from the lab a few feet away, so we can minimize the time that the embryos are exposed.

Once we have the embryo(s), we feed the catheter with the embryo(s) through the empty catheter that is in place. On the ultrasound screen the patient will be able to watch the bubble of air and fluid the embryo is contained in get placed gently into the uterine cavity. After placement of the embryo(s), the embryologist checks the catheter under the microscope to make sure that the embryo(s) transferred properly. Then the patient can get up and go straight to the bathroom, if needed.

After that, the embryos have to implant into the uterine lining on their own over the next few days, with the goal of developing into a successful pregnancy.

But Shouldn’t I Go on Bed Rest?

Several recent studies have confirmed that immediate bed rest after the embryo transfer is completely unnecessary. It may seem counter-intuitive, but, in fact, a study published in a well-respected peer-review journal, Fertility and Sterility (Fertil Steril 2013; 100: 729-35), demonstrated better pregnancy rates with immediate resumption of normal activities (including bathroom) compared to bed rest right after the embryo transfer.

Back in the 1980s, after an embryo transfer, we prescribed that patients stay on complete bed rest for three hours and even rely on bedpans instead of going to the bathroom. This is not what we prescribe today.

We know that any fluid you may see coming out is from the sterile cleaning solution.You may even see some spotting, and that is nothing to worry about. Why? It’s because embryos do not fall out.

When you do go home, you absolutely have a prescription to be a “couch potato.” You can sit up and watch TV, or work on your laptop or your iPad. Your position does not matter.

The first 24 hours after an embryo is transferred are most likely the most critical. It is within this time frame that an embryo has to “attach” to the uterine wall before it can fully implant, which may take several days. Therefore, for the first one to two days, stay home and chill out.

Avoid vigorous activities such as heavy lifting, bending or exercise. Why? You want embryos to remain in the uterine cavity and not get pushed into a Fallopian tube, which would result in an ectopic or tubal pregnancy.

Common sense goes a long way. You can go to the bathroom as needed, and you can use stairs but don’t run up and down them. If you feel you don’t have to do something, don’t do it.

Avoid excessive heat. No hot baths or hot tubs, and no whirlpools. Showers are OK because they will not elevate your body temperature. We don’t want you running around or doing vigorous exercise because it may elevate your body temperature. Embryos do not like heat.

Try to relax and stay positive during the “two-week wait”–the 10 to 12 days waiting for the pregnancy test. You don’t want to second-guess yourself regarding doing certain activities.

It’s not your fault if an embryo does not implant, but you don’t want to give yourself any possible reasons for feeling guilty or second-guessing your activity level if the IVF procedure does not work this time.

Dr. Jacobs is a Mayo Clinic-trained Reproductive Endocrinologist and board certified in Obstetrics and Gynecology. He has been practicing medicine since 1975. He completed medical school and an Obstetrics and Gynecology residency at Northwestern University, and then went on to complete a fellowship in Reproductive Endocrinology and Infertility at the Mayo Clinic in 1988. Dr. Jacobs is the Medical Director of the Center of Excellence for Polycystic Ovarian Syndrome (PCOS) at Fertility Centers of Illinois.

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