IVF Success Rates are not affected by bedrest

IVF success rates depend on many factors. Some of these we know, some we do not. From the earliest days of IVF, bedrest has been recommended in the hopes that it would increase the likelihood of implantation. It was not unusual for IVF specialists of the time to keep an IVF patient in bed for 24 hours or more. As time progressed, the duration of recommended bedrest after an IVF embryo transfer became shorter and shorter. Then actual data became to emerge that IVF success rates may not depend on bedrest. In 1988, a report was published calling into question the logic of bedrest after IVF. The arguement was that since the uterus is tilted in the body, that in the upright or standing position, the uterus is almost horizontal. It made more sence, then to have an IVF patient stand rather than lie down. when this IVF group then encouraged patients to get up after an embryo transfer, their pregnancy rates actually increased!Another study used ultrasound to study the issue. During an IVF embryo transfer, there are air bubbles present in the transfer cather that are visible on ultrasound. After the embryo transfer is completed, these air bubbles can be seen in the uterus. It was found that when patients are asked to stand immediately after the embryo transfer, the position of the air bubble (and by extension the embryos) do not move. In the modern are, there are two times in which bedrest has been recommended:

• Immediately upon performing the embryo transfer

• After the patient is discharged and goes home. Lasting from some specified amount of time from a few days to a few weeks

Two IVF studies from the United Kingdom have addressed this issue. In both studies, no effect of bedrest could be detected on IVF success rates. This month, another study was published in the journal Fertility and Sterility. In this study, 406 patients were given the option to rest or not after the IVF embryo transfer. Of these women, 167 decided to get up immediately and 239 decided to stay for 1 hour’s bed rest. The results are not surprising. Pregnancy rates did not differ between the groups: 41 out of 167 (24.55%) in the group that got up immediately and 51 out of 239 (21.34%) in the bed-rest group. This should not be surprising to anyone. We have been counseling patients that bedrest after the embryo transfer or later at home is not necessary and maybe counterproductive! However, when we tried to institute apolicy where the patients got up immediately after the transfer... they revolted. I compromised and now allow patients to rest for one half hour after the transfer. I also have been telling patients that they can resume any normal activities once they are released. No bedrest at home is required. Patients can go back to work if they like. This reduces stress levels and that may have some benfit as well.