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A very common question being asked after an IVF failure, in spite of transferring good quality embryos. In fact a very frustrating moment for the infertility specialist also.
The couple and the treating specialist usually develop high expectations after seeing beautiful embryos on the monitor. But reality is an implantation rate of 25-40%.
Another tendency is to blame the uterus as the cause of failure as embryos seemed very good at the time of transfer. But this is not true.
In 2/3 of the implantation failures the uterine receptivity is the major causes and in approximately 1/3 the embryo quality, as all good looking embryos are not genetically normal.
Implantation failure doesn’t always mean an uterus with some inherent defect or permanent inability to implant and grow a baby. As many of these patients may conceive with donor oocytes. The major cause of implantation failure in self cycle is hormonal effect on the endometrim due to stimulation process used on the ovaries. They alter the intrauterine environment with which the embryos interact.
Now few solutions to these problems which can work to some extent. Certain modifications in the stimultation protocols and freezing all resulting embryos and transfer after some time have promising results.
Whenever a sudden shift is made from fresh embryo transfer to frozen embryo transfer the couple usually have many queries in mind. So, let’s evaluate both and see pros and cons.
Fresh embryos transfer is undergoing ovarian hyper stimulation making of embryos and transferring resultant embryos to uterine cavity in same cycle. In frozen embryo transfer first two steps of controlled ovarian hyper stimulation and process of IVF/ICSI are same but the resultant embryos are frozen using vitrification techniques and not transferred in same cycle. They are thawed and then kept uterine cavity after preparing the uterine cavity.
In patients who are normal or hyper responders the frozen embryo transfers are known to have better results than the fresh embryo transfer . The reason can be that due to ovarian hyper stimulation and high levels of estrogen may have negative impacts on the endometrial receptivity. In some cycles another hormone called progesterone may also be raised, which again decreases embryo implantation rate. Whereas in frozen embryo transfer the body and uterus have already recovered from the impact of hormonal disturbance and hence more receptive.
Because of their reason in patient with PCOS the frozen embryo transfer is associated with higher live birth rate. It also reduces complications like ovarian hypertimulation in these patients.
Another reason where we make a sudden shift from fresh to frozen embryo transfer are when the ovarian stimulation part is good but the endometrial thickness fails to reach an optimal level.
So because of the above reasons we are moving towards more frozen transfer than fresh transfers in self cycle.
Adenomyosis is a condition in which the cells of endometrium (the uterine lining) are present inside the muscular wall of uterus. There is also associated hypertrophy uterine muscles.
Adenomyosis can affect fertility in two ways. Firstly it effects the uterine contractions which helps sperms to reach the tubes. Secondly it also increases the number of toxic cells in the uterine lining which may effect the implantation of embryos.
Adenomyosis may also be associated with endometriosis, a condition in which the uterine lining cells are present in the ovaries or other sites in pelvic. This may further effect the oocyte quality and number, further contributing to difficulty in conception.
The most common question asked in IVF counsellings is “Doctor, as we have heard, we need to do complete bed rest after embryo transfer or I can move around. Do you think 15 days leave is sufficient.”
So it’s time to give away this myth forever now. The implantation of embryos placed inside your uterus after embryo transfer depends upon three most important factors –
Moreover uterus is a collapsed cavity with opposins walls and a closed cervix. If the embryos are placed inside the uterus at their proper position then few minutes after embryo transfer they remain at their same stable position and in no ways they will fall down even if you stand after the embryo transfer.
Going by literature, various studies have been conducted in which pregnancy rates were compared between the groups who were made to get up 20 minutes after the embryo transfer and those made to rest for varying periods from 3 minutes to even 24 hours in some centers. But no difference was found in the pregnancy rate and the live birth rate. In certain systemic reviews and meta analysis it has been shown that complete bed rest might negatively affect the outcome of IVF/ICSI cycle and the cause may be stress and anxiety mechanism.
So a lot of evidence is against the bed rest factor. Even at Reviva we have seen pregnancy rate comparable between the bed rest and no bed rest groups. I can recall many positive results even in those patients who jump out of bed even half an hour after transfer and those joining their offices the very next day. But inspite of clinical evidence we daily come across patients who had undergone failed cycles at other centers or one of their relatives had undergone treatment elsewhere and were advised complete bed rest after transfer and to the extent that they were kept hospitalized for 24 hours. All this increases the anxiety factor in the patient. Very obvious that lying on bed the whole day is not easy and the thought process is totally focused on one thing and more of stress and negative feelings. How do you think it’s going to help the success rate. And if unluckily the results negative than the female takes the whole burden on her. She thinks it didn’t work because she didn’t have sufficient rest.
So our advice to all our patients, don’t go on house arrest of 2 weeks. Take it easy and carry out with your normal activities. Rest is not going to influence your outcome. So relax, be normal and wait for nature to do its best.