False myths about fertility and assisted reproduction – part 1

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Fertility problems are becoming more and more frequent, and advances in medicine over the past 40 years have been spectacular. However, infertility in general, and assisted reproduction in particular, remain delicate subjects, surrounded by taboos and fears and about which people are little or wrongly informed – all this leading to many unfounded statements or beliefs: what we call in this article the “false myths about fertility and assisted reproduction”. Ignorance leads to fear… and false myths!

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Carlos Dosouto Capel is a gynaecologist specialized in assisted reproduction at Dexeus Women’s Health Institute. We met him to clarify some of these “myths”, and to benefit from practical advice from his experience and expertise.

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BELIEF: IT IS BETTER TO REST AFTER EMBRYO TRANSFER (IVF)

FALSE – It’s necessary to rest after the egg collection, but not after the transfer.

“It’s a physiological issue: the embryo simply cannot fall just because the woman moves and doesn’t rest. People often imagine the uterus as an empty cavity, like a pear in which we put the embryo, but it’s not like that: it’s a virtual cavity which walls are united, like hooked to one another – as if it were an empty balloon. The embryo is placed in the upper part of the uterus, in a place from which it is impossible to fall.

And I would say even more: the upright position, standing, is physiologically better because the uterus is in a bending position. On the contrary, when the woman is lying, the uterus stays in a horizontal position, aligned with the cervix.

It is better to be in movement but relaxed, than at rest but nervous and stressed out, because stress produces cortisol and uterine contractions that can expel the embryo. All this, obviously, as long as you don’t do extreme activities or sports!

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BELIEF: THE EMBRYO IMPLANTS RIGHT AWAY

FALSE – The implantation of the embryo takes place on the 7^th day of life (that is to say, 7 days after the fertilization)

“In an IVF procedure, the embryo doesn’t implant exactly where we leave it: during a couple of days, it moves of a few millimetres into the uterus, going to one Fallopian tube and then to the other: it is looking for the best place to implant, where molecularly speaking the dialogue between the mother and the embryo is conclusive.

In the end, implantation takes place approximately on the 7^th day of life (7 days after the egg collection and fertilization). IVF patients have their embryo transfer on the 3^rd or 5^th day after fertilization, and many of them think: “today is the implantation, I should stay calm”. But it’s not like that, as the embryo will implant 2 or 4 days after the transfer (for a transfer respectively on day 5 and 3 after fertilization).

The same applies to patients who do artificial insemination: it’s useless to rest and to remain calm on the day of insemination, as well as the following days.

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BELIEF: SINCE THE EMBRYO IS INTRODUCED EXACTLY IN THE RIGHT PLACE, ECTOPIC PREGNANCIES ARE IMPOSSIBLE IN CASE OF AN IVF

FALSE – Unfortunately yes, it is possible to have an ectopic pregnancy after IVF.

“As previously said, during the first few days the embryo is moving little by little, it is not static where we leave it. An ectopic pregnancy may occur if the embryo goes to a Fallopian tube which is damaged, stays there and cannot return. It’s not that the transfer has gone wrong or that the embryo has been introduced in the wrong place, but the embryo is moving and gets trapped in a damaged Fallopian tube.

The rate of ectopic pregnancies in case of IVF is actually slightly higher than in natural pregnancies, but only because statistically patients undergoing IVF treatments are patients with more alterations than the rest of the population – it has nothing to do with the IVF process itself.”

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BELIEF: IT IS BETTER NOT TO GO TO THE BATHROOM IMMEDIATELY AFTER THE TRANSFER (IVF)

FALSE – It’s totally impossible for the embryo to fall just because the woman is peeing.

“Many patients tell me after the transfer: “I don’t want to go to the toilets because I am afraid the embryo might fall”. It is a totally natural fear, but fortunately also totally unfounded.

As we said earlier, the movement will not make the embryo fall – nor will the simple fact of going to the bathroom to pee. I would even say that it’s worse to hold back as the urge to urinate can cause uterus contractions. You need to a full bladder for the transfer (to facilitate the ultrasound), but it’s better to pee right after.”

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BELIEF: BATHS CAN BE HARMFUL TO THE IMPLANTATION OF THE EMBRYO

YES and NO – Water immersions are not recommended during the days following the transfer or insemination, but only to avoid infections.

“It is not that bathing decreases the probability of implantation of the embryo. We recommend not to bathe during one week after transfer or insemination only to avoid any risk of infection: during the embryo transfer, we go through the cervix with a catheter, which opens a little bit the cervix. There is therefore a small risk of infection when bathing. But this the only reason why baths are not recommended – not because they’re bad for the implantation.”

WHAT ABOUT SEXUAL INTERCOURSE?

“Sexual intercourse are not recommended during the first week after transfer as the effect of semen on implantation is unknown.”

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You found this article interesting?

Stay tuned: part 2 will be published shortly, with more false myths and practical advice!

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