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Embryo Glue: The 5 Secrets Everyone Should Know Post-Embryo Transfer

There may be no more anxiety-ridden interval than the time between the embryo transfer and the first pregnancy test. Simply stated, it is sort of terrible. Those nine days can feel like nine years. Every symptom you feel (or don’t feel) can take your mind to places you didn’t think it was possible to go. However, while the rollercoaster of emotions is real, the good news is that you are not alone. Nearly every woman who has come before you and every woman who will come after you find the time between the transfer and the pregnancy test to be incredibly stressful. Here are five tips on how to best deal with your emotions during the transfer-to-test interval.

  1. Movement: Standing up after the embryo transfer is finished ranks up there on many women’s top 10 list of scariest activities while going through fertility treatment. The “if I move these embryos are going to fall out sensation” is super common, but it isn’t super credible. In fact, there is absolutely NO medical evidence to show that movement, be it in the form of a trip to the ladies room or a bumpy car ride home, will negatively impact your chances of pregnancy. Don’t sideline yourself just because you had an embryo transfer.  Movement won’t be the factor that makes or brakes the pregnancy.
  2. Diet: Food gets a lot of credit and a lot of flak when it comes to fertility. Pineapples will make your embryo stick, and hot dogs will make your embryos not stick. And although who doesn’t love a sweet pineapple in the middle of July, there is no evidence that food will improve or harm your chances of pregnancy. Bottom line, don’t lose sleep over what you have and have not taken in—your “intake” will not impact if your embryo takes up a permanent spot in your uterus.
  3. Exercise: There may be no more controversial words than exercise and fertility. These two engender A LOT of emotions. And while it may seem like it from what you hear and what you read, in reality exercise and fertility are by no means oil and water. Exercise—be it walking, running, cycling, or swimming—is not a no no post-transfer. While you may have to curtail your specific activity based on if you had a fresh or frozen embryo transfer, breaking a sweat won’t break your chances of pregnancy.  We do usually recommend a 48-hour period of relaxation after the transfer—but after that, most forms of exercise are okay. Just touch base with your doctor.   We will say, for those of you who will look back and blame yourself if the transfer does not work, we recommend you don’t engage in any activity that will make you think twice.  We can tell you there is no sound data to suggest moderate exercise after an embryo transfer will lower implantation rates, but we want you to have zero regrets!
  4. Coffee: Don’t say sayonara to Starbucks just because you had an embryo transfer. Coffee is not the culprit for your infertility and is cool (or hot!) post-transfer. While you should taper the amount of caffeine you ingest (<200mg/day), you can continue to indulge your caffeine kick.
  5. Stress: It’s nearly impossible not to count down the days from the transfer to the pregnancy test. The anxiety, anticipation, and stress mount as the time between these two events is minimized. These emotions are totally normal. Everyone has them. Engaging in activities that can help alleviate your stress is recommended but not mandatory  (although de-stressing will do your mind good, it won’t make a difference on the outcome of the transfer). On the flip side, if you can’t take your stress level below a 10 no matter what you do, don’t freak out. Stress post-transfer has not been demonstrated to decrease the chances of pregnancy.  

It’s important to always remember that whether you DO or DO NOT get pregnant, post-embryo transfer has to do with the quality of the embryo, the genetics of the embryo, and your uterine lining—not what you DID or DID NOT do. Unfortunately, you can live your best you and still not get pregnant. And while we don’t have all the answers for what makes some transfers work and others not, we promise to keep searching for that evasive “embryo glue”—and if we find it, we won’t keep it a secret!

Double Duty…Why Two Is Not Always Better Than One

It would be nearly impossible to count the number of times patients tell us the following regarding how many embryos to put back into the uterus: “I want two…it’s like two for the price of one!” “I want to be one and done!” “It’s like getting a twofer!”

And while we understand the desire for two (trust us, the thought of minimizing the number of times one is pregnant does sound appealing), twins are not just double strollers, matching onesies, and names that start with the same first letter. Twins and triplets-plus can be complicated, not only for the babies but also for the mother. Therefore, serious thought needs to be put into how many embryos are put back into the uterus.

Old-school fertility doctors routinely transferred several embryos into the uterus at one time; twins, triplets, and even quadruplets were sort of the “cost of doing business.” Back in the day, our IVF techniques weren’t so great. The procedures were new, and there were a lot of unknowns. To increase a patient’s chance of getting pregnant, multiple embryos were put in. Although even then, “the more the merrier” wasn’t our motto, (women are not meant to carry litters!), we were limited in our ability to identify which embryos had the best chance of making a healthy baby.

Fast-forward 20-plus years, and we are actually really, really good at this stuff. Not only do we know exactly what a three-day-old embryo needs to grow in versus a five-day-old embryo (can you believe it they are already picky eaters at this age!) but we also actually have the ability to check them and make sure they have the right number of chromosomes!

Now, while we can’t tell if they will look like you or your partner or go to Harvard or Yale, we can take a few cells and check to make sure they have the correct number of chromosomes. (The magic number is 46!) When this technique is done and a healthy embryo is found, we almost routinely only put one back in because even this guy or gal more than half the time makes a baby.

If you are considering an IVF cycle or are maybe even in the midst of one, make sure to have a long and serious discussion with your doctor about the number of embryos to transfer back in. Nowadays, not every IVF center is the same; many have the ability to grow embryos in the laboratory to day 5, rather than the traditional day 3. Although two days may seem inconsequential when it comes to most things in life, for an embryo, it’s a big deal. Just these 48 hours gives the embryo time to develop and the embryologist who is watching the embryo develop more information to pick the one that has the best chance of making a baby!

If you are lucky enough to have several A-plus embryos and your doctor only recommends putting one back in, the others can be frozen. Yup, we said frozen. Don’t worry; frozen embryos are not like frozen chicken! Embryo freezing has come a long way, and now in many centers, frozen embryo transfers have a better chance at making a baby than a fresh one. Simply stated, you won’t lose anything from freezing the extra embryos and putting only one embryo back in at a time. Sticking with the “one and done concept,” many couples get all the embryos they will ever need in one fresh cycle, thanks to good freezing techniques!

It’s sometimes hard to imagine that anything can go wrong in twin pregnancies. Nowadays, our schools and parks are teeming with twins; it really has become all the rage! But take it from us, not every twin pregnancy ends in a cute Anne Geddes photo. Twins have a higher chance of almost all risky pregnancy complications. On the fetal side, these include stillbirth, preterm delivery, and the serious problems that can come along with having a preterm baby: neurologic, cardiac, pulmonary, gastrointestinal, and serious developmental issues. Additionally, a high percentage of twins will experience some delay (motor and verbal skills) in the first two years of their life that requires treatment.

On the maternal side, women carrying twins or more have a much higher chance of serious medical complications. These include diabetes, high blood pressure (preeclampsia), heavy bleeding, hyperemesis (significant nausea and vomiting), Cesarean Section, and post-partum depression. Although most twins and most moms of twins will be running (actually, probably sprinting) and laughing in no time, there are a number of twins that will suffer permanent consequences from prematurity. The risks are real and should not be ignored.

And partners of those who have twins don’t get off easily, either. Sure, they don’t have to endure the insane stretch marks, the prominent varicose veins, and crazy swelling that multiple babies in one uterus at one time can bring, but let’s face it, double the work comes with added stress on the relationship. Studies have shown that divorce/separation rates are higher in families of multiples. Having a baby is not easy, sleepless nights and long days can be beyond difficult; imagine multiplying that by two!

We live in America too, and trust us, we get it. Other than pounds, for most of us, more or bigger always seems to be better. Why have one of something when you can have two? While we are not going all one-child-policy on you, we are advocating having one child at a time. It will be healthier for you and healthier for your unborn children. While twins are adorable and the bond they share is unlike any other sibling relationship, we are big fans of taking it one step at a time if possible.

When building a family, slow and steady is the best and safest way to get to the finish line.

5 + 5 = 2? The Difference between Follicle Count and Embryo Number

Numbers are no strangers to fertility medicine; success rates, dosages, and egg/embryo counts are all things we count. And despite our tenuous personal relationship with math, over time, we have become quite comfortable with statistics, percentages, and probabilities (disclaimer—as they relate to IVF only)!

However, the number that often eludes us, and the question on so many patients’ minds, is the following: What is the follicle to egg to embryo to viable (able to make a baby) embryo conversion rate? Simply stated, if I have 10 follicles will I have 10 eggs, and if I have 10 eggs will I have 10 good embryos? The short answer, without any derivatives, formulas, or equations is no…You will very likely not. And here’s why.

Human reproduction is an incredibly inefficient process; think the DMV on a bad day! While we start with over a million eggs, a very small percentage of them actually have the potential of making a baby. So while a woman may ovulate every month, many of these months the egg that is released won’t put you on the path to pregnancy. Now, while in most natural un-medicated cycles only one egg is released per month, there are actually a group of eggs that are vying for the ovulation “trophy.”

Think of egg /ovulation selection as a horse race. At the beginning of the month, several horses (a.k.a. eggs) are racing to become the egg that will be ovulated. Ultimately, one breaks free, garners enough receptors to capitalize on the available hormones, and wins the ovulation race. When we are young, there may be 30 or 40 “horses” that enter this race. Although there will still only be one winner at the finish line, the race is more robust. As a result, there is a much higher chance that your winner will be fast, strong, and able to get the job done.

As we age, the number of “horses” lining up at the gate declines until we are left with only a few weaker, slower, scrawnier participants. There will still be a winner, but you may not get very many calls from interested breeders!

Let’s stay with the horse-racing metaphor for a moment. One of the primary goals of an IVF cycle is to ensure that all of the horses that start the race finish it; in this race, we don’t want a winner. As fertility doctors, we give hormones to ensure that there is enough juice to get every follicle/egg to go the distance and cross the finish line. We want all of the eggs in that month’s cohort to grow and develop at the same rate and ultimately achieve maturity.

However, even with the strongest of cocktails we are limited by the number of entrants. If five horses enter the race, we can have no more than five horses finish it. Think of the first ultrasound in an IVF cycle as the race check-in. If the doctor sees five follicles (remember, eggs are microscopic so we count follicles that hold the eggs) there are likely to be no more than five eggs extracted at the time of the retrieval.

Unfortunately, IVF is not as simple as horse racing, and the follicle number seen at the start does not always translate into the egg number you have at the end. There is a very large attrition rate as you move throughout an IVF cycle. The race is longer than a couple of laps around the track, and therefore, the numbers drop off quickly.

And the situation only becomes more complex as women age. As the years rise, the baseline follicle count falls, and you lose your cushion. With a diminished starting follicle count at the outset comes a decline in egg number at the conclusion. Fewer eggs equal fewer embryos. Fewer embryos mean fewer viable embryos.

No matter how young or old you are, there will always be a noticeable decline in the follicle to embryo equation. It is a function of human reproduction. However, if you are going to fall, you hope that there is a cushion below you to break that fall.