Interesting study about bed rest after ET

I found this on another board and thought it was interesting
***************************

I've never, ever seen a study that finds bed rest to be a good thing. There certainly are REs that recommend it, but both the randomized and non-randomized (self-selected) studies come out with an edge for moving around after the first 20 minutes or so. (A surgical nurse pointed out, some time back, that she wants her patients up and moving around to get good blood flow -- and we certainly want good blood flow to the uterus during this time.) My RE tells us to take it easy, but not strict bed rest.

And, for anecdotal evidence, I was fixing T'giving dinner the day after my successful transfer in 2001. BOTH embryos implanted, but only one became dd. So, 100% of all embryos I've ever transferred implanted with no bed rest after transfer.

I've collected some literature that follows.

One study pooled ("meta-analysis") all the acceptable studies-to-date on bed rest and concluded there was no good reason for bed rest. Based on nearly 600 women in the three studies, all studies found somewhat better implantation per embryo with limited/less bed rest, and no significant difference on twin pregnancies or miscarriages.

http://www.gfmer.ch/Medical_education_En/PGC_RH_2005/pdf/Mobilization_ET_R.pdf

I found the abstract for one of the studies cited in the meta-analysis, which found reduced implantation per embryo in the 24 hours bed rest (compared to 1 hour), and we don't usually have spare embryos, but pg rate differences were insignificant. That said, taking it easy makes sense.

BJOG. 2004 Nov;111(11):1273-6
Bed rest versus free mobilisation following embryo transfer: a prospective randomised study.

Amarin ZO, Obeidat BR.

Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Irbid, Jordan Fakeeh Hospital, Jeddah, Saudi Arabia.

OBJECTIVE: To evaluate the efficacy of two clinical methods of post-embryo transfer protocols in patients undergoing in vitro fertilisation. DESIGN: Prospective, randomised clinical trial. SETTING: Hospital-based clinic for reproductive medicine. SAMPLE: Women under 40 years of age who were undergoing in vitro fertilisation with GnRH pituitary down-regulation and controlled ovarian hyperstimulation. METHODS: Patients were randomised to rest for either 1 or 24 hours after embryo transfer. MAIN OUTCOME MEASURE: Clinical pregnancy per cycle rate (the percentage of cycles started that demonstrated a live fetus on ultrasound examination performed at six or seven weeks of gestation). RESULTS: The clinical pregnancy rates were 21.5% for the 1-hour and 18.2% for the 24-hour post-embryo transfer groups. The implantation rate per embryo was significantly higher in the 1-hour group (14.4%) than in the 24-hour group (9%). CONCLUSION: One-hour and 24-hour rest post-embryo transfer result in comparable rates of clinical pregnancy. However, 24-hour rest results in reduced implantation rate per embryo.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 15521874 [PubMed - indexed for MEDLINE]

And here's an article (regular press, not peer-review) reporting the results from the BJOG study:

"The clinical pregnancy rates were 21.5% for the 1-hour and 18.2% for the 24-hour post-embryo transfer groups," the two researchers wrote. That wasn't much of a difference.

"However, they found significant differences when they looked at embryo implantation. "The implantation rate per embryo was significantly higher in the 1-hour group (14.4%) than in the 24-hour group (9%)," Amarin and Obeidat noted."

http://www.fertilityneighborhood.com/content/in_the_news/archive_1109.aspx

And here’s one more study concluding even getting up right away after transfer made no difference (vs. one hour rest). If anything, there were more pregnancies in the group that got up right away (but not statistically significant more):

Fertil Steril. 2005 Mar;83(3):594-7.

Immediate ambulation after embryo transfer: a prospective study.

Bar-Hava I, Kerner R, Yoeli R, Ashkenazi J, Shalev Y, Orvieto R.

Department of Obstetrics and Gynecology, Rabin Medical Center, Golda Campus, Petah Tiqva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. [email protected]

OBJECTIVE: To assess whether bed rest following the embryo transfer (ET) procedure contributes to the implantation process and pregnancy rate. DESIGN: A prospective (patient-influenced) study. SETTING: An in vitro fertilization (IVF) unit of an academic medical center. PATIENT(S): Four hundred six patients undergoing controlled ovarian hyperstimulation and IVF. INTERVENTION(S): All women undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles in our unit were given a special individual counseling session before the ET procedure in which they were informed that our previous experience showed no advantage for bed rest over immediate ambulation after ET. The women were allowed to select the practice of their choice, and they were assured that their decision would have no influence on their further treatment. MAIN OUTCOME MEASURE(S): The stimulation pattern and cycle outcome were compared between the two groups (bed rest and immediate ambulation). RESULT(S): Of the 406 patients counseled during the study period, 167 preferred immediate ambulation and 239 opted to stay in the unit for 1 hour's bed rest. There were no significant differences between the groups in mean patient age, number of embryos transferred, and other variables of the assisted reproductive technique cycles. 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(S): Immediate ambulation following the ET procedure has no adverse influence on the ability to conceive.

Re: Interesting study about bed rest after ET

Hmm interesting Donna. My RE told me to get up about 20 minutes after my procedure (I had had anasthesia), take it easy for the rest of the day, and then to carry on as usual, travelling being absolutely fine.

Although it didn't work for me, I think this go-around I will not go on any trips right after the ET. I was pretty wiped-out, but I think mostly because of the heat and humidity of New Orleans, moreso than the ET.

PS - makes tons of sense about getting the circulation going. That's why so many people do acupuncture immediately after too, go circulate blood to the uterus...

Message edited 8/8/2006 10:50:32 AM.

Re: Interesting study about bed rest after ET

My doctor told me the same thing. Women fly in to Columbia and Cornelll from around the world and are back on a plane the next day.

But, I have a friend that went through several rounds of IVF and it wasn't until she decided to stay in bed for five days did it stick. It stuck almost too well... she has triplets.

Who knows

Re: Interesting study about bed rest after ET

Its making me think about BR after my next cycle - anyone consider showing this to the Dr?