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POST EMBRYO TRANSFER CARE: MYTHS VS FACTS - IVF Treatment in Jaipur

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POST EMBRYO TRANSFER CARE: MYTHS VS FACTS - IVF Treatment in Jaipur

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  1. VASUNDHARA H O S P I T A L POST EMBRYO TRANSFER CARE: MYTHS VS FACTS

  2. 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 With the advancement of medical science, these myths have been replaced by facts.

  3. Myth #1 – need for bed rest post embryo transfer • No "bed rest" after embryo transfer:Putting 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 " 

  4. 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., RakefetYoeli, et al Fert Steril 2005

  5. 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

  6. 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.

  7. EVIDENCE: • Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the 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

  8. 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.

  9. 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.

  10. 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 <35 years old (P ≤ 0.01) but not among women ≥35 years. Dimitrios Karayiannis et al Human Reproduction, 2018

  11. 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.

  12. 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: 1.23–3.77). • 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

  13. 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.

  14. 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 Shen C. et alGynecolObstet Invest 2015;79:1-12

  15. 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.

  16. 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.

  17. 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.

  18. EVIDENCE: • Addition of oral micronized E2 to maintain the serum E2 level >200 pg/mL and i.m. or vaginal progesterone, if necessary, to maintain serum P level >20 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 Humaidanet al, journal of fertility and sterility 2015: Issue 4: 879–885

  19. Thank You

  20. Contact Us Hospital Website :- https://www.vasundharafertility.com/jaipurFacebook Page : Facebook.com/vasundharahospitaljaipur Jaipur Address :- B-9 (D), GovindMarg, Adarsh Nagar, Jaipur Contact No :- +911412612540 / 9001421404 / 9116132765

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