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A few weeks ago we published the first part of the “false myths about assisted reproduction”: those beliefs or affirmations we all have at one point or another, and which generate doubts and fears in every step of this long process… Those beliefs are, more often than not, unfounded, or at least unproven. In this new post, Dr Dosouto helps us dismantle other great myths such as:
… I have menstrual pain, I’m not pregnant…
… Pregnancies through IVF processes are high-risk pregnancies…
… Don’t stress, stay calm and it will work…
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Carlos Dosouto Capel is a gynaecologist specialized in assisted reproduction at Dexeus Women 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: I’M GETTING FEW EGGS OUT, IT’S NOT GOING TO WORK.
YES and NO – The number of eggs does not define the future quality of the embryos, there are many more factors at stake.
” At the beginning of the treatment, the only way to know whether things are going well or not is the number of eggs. Do not hold on to this information because you are going to go crazy, there are many other factors that influence the fertilisation, and then the implantation of the embryo.
At equal age and situation, statistically it is true that the more eggs, the better: mathematically, it is better to have 15 eggs than 4, because they give more possibilities.
However, regardless of the number of eggs, the most important factor of all is age: it is better to have 4 eggs of a 30-year-old woman, than 10 eggs of a 45-year-old woman.
And then the “quality” is also involved: there are patients who have many eggs, but which give embryos of poor quality. The eggs are fertilised, but the embryos develop badly. It’s much more likely to get pregnant with a good-quality embryo, than with 2 embryos of bad quality. “
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BELIEF: I’M BLEEDING, IT HASN’T WORKED – OR ON THE CONTRARY: MY BREAST IS SWOLLEN, I’M PREGNANT
FALSE – During the waiting period, there is no symptom that can explained by the pregnancy or on the contrary by a non-pregnancy.
” Until the results of the pregnancy test, forget whether you feel tired, have breast pain, blood loss, nausea, etc. All these pregnancy-like symptoms can be mistaken with the effects of progesterone, or of the IVF or insemination process itself. Even in case of pregnancy, before the blood test it is very unlikely to experience pregnancy symptoms. Do not trust the signs, either in one way or another.
For example: it is common to have small bleedings a few days before the blood test. But unless you bleed in a significant way, you should not interpret it: the implantation itself can cause bleeding, and even in a “normal” pregnancy, it is frequent to have small bleedings. “
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BELIEF: PREGNANCIES THROUGH ASSISTED REPRODUCTION ARE HIGH-RISK PREGNANCIES.
TRUE – But due to statistics, not to the process of assisted reproduction itself.
” In general, pregnancies through assisted reproduction have a little more risk. If we compare a group of IVF patients with a group of naturally pregnant patients, the IVF pregnancies present more risks. Not because of the treatment itself, but because it is a group of patients in general (at the statistical level) with a higher age, with several problems making it impossible for them to get pregnant naturally (hormonal problems, etc.) This is the reason why there is a little more risk of prematurity, hypertension during pregnancy, diabetes, etc.
This doesn’t not mean that the risk is high, but only that it is slightly higher than in natural pregnancies, because of the patients’ profile. In the case of a young couple, with a male problem that we managed to fix with an IVF, the pregnancy can be considered completely normal. “
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BELIEF: THE PSYCHOLOGICAL FACTOR IS KEY: DON’T STRESS, STAY CALM AND IT WILL WORK.
YES and NO – It is not demonstrated, and what’s more it is not the most important factor. But it is true that very high levels of stress may have an impact on reproductive functions.
” There are no studies to prove it, and if a patient can get pregnant, she will end up getting pregnant, whether or not she is nervous and stressed out. In the same way, if a patient has major physiological problems, the fact of being relaxed will obviously not be decisive. It’s no use saying: “stay calm and it will work.”
However, it is clear that stress is at odds with fertility in general: a high level of stress can produce a rise in cortisol levels and a series of hormonal changes (including menstrual cycle disorders, ovulation problems, etc.) In this case, acupuncture for example can be very effective as it helps reduce stress levels.
In case of assisted reproduction in particular, there are no studies either that show that stress influences negatively the results of a cycle, although it seems plausible: in IVF cycles for example, a woman who is very nervous and stressed out on the day of the transfer may have uterine contractions. This is why we usually give a sedative to very anxious patients before the transfer to calm them down. “
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BELIEF: IF I HAVE A HEALTHY LIFE DURING THE TREATMENTS, IT WILL HELP
FALSE – You have to change your habits at least a couple of months before you start the process.
” Don’t feel guilty: starting eating only biological food during the process will not be decisive, and neither will the contrary. Many patients put a lot of pressure on themselves during this last month to be more fit, stop smoking, lose weight, etc. But it’s something on a much longer term, that should be started months before: changing all your life habits during the transfer can be very stressful and won’t have a great impact. The seminal quality of a man, for example, depends on what he has been doing in the last 3 months, not only during the last month.
However, even though the physical impact is not immediate, there are many things you can do to live the process in a more positive way: sleep well, learn to relax, take care of yourself, etc. It may not be decisive, but the whole process will be much easier and more bearable. “
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BELIEF: THE MORE EMBRYOS ARE TRANSFERRED, THE BETTER (IVF)
FALSE – We tend to transfer fewer embryos than before: what matters most is the quality of the embryo. What’s more, transferring several embryos can lead to multiple pregnancies, which present more risks.
” In Dexeus, it’s been 3 or 4 years since we don’t transfer 3 embryos anymore – unless patients specifically ask for it and insist a lot (by law they can transfer up to 3 embryos). We will almost always recommend transferring a single embryo, especially in case of egg donation: the multiple pregnancy rate in case of egg donation is very high, and with overweight patients aged 45 or 46 for example, the risks are not insignificant.
Furthermore, we have more and more ways of selecting THE embryo that’s going to get you pregnant: that’s why today we easily transfer only one embryo, because we have more ability to know which is the “correct” one. “
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HOW ARE THE EMBRYOS SELECTED?
” Nowadays we’re able to cultivate the embryos for a longer time, and we can wait for the embryo to reach the state of blastocyst (5 days of life). We increase the chances of pregnancy per transfer, because we know that the embryos we are transferring are more likely to lead to a pregnancy: if they have reached this far in the laboratory, they are more “survivors” in a way. We get fewer embryos, but the ones we get have more chance of leading to a pregnancy.
We also have what we call the “embryonic kinetics”. With an “embrioscope” and the cameras we have now, not only can we see the number of cells of an embryo (which determines their ” note ” or quality), but also the speed and pattern to which it is divided. We get mathematical formulas that tell us if they are more or less likely to lead to a pregnancy.
In short, nowadays we have more information than before, and more tools to select the embryo most likely to get to pregnancy. We make fewer and fewer transfers, but we get better results per transfer and we are able to avoid “frustrated transfers” (transfers that we cannot lead to a pregnancy). “
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Dr Dosouto, to conclude, what advice would you give to those who start a process of assisted reproduction?
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