After embryo transfer, it is important, that you are reasonable and avoid strenuous activities such as lifting heavy things, vigorous activities such as climbing multiple flights of stairs, running, cycling and adventure sports. This is not an exhaustive list of activities, but only a guidance.
5. Do I need to take time off during treatment? / How much time off do I need to take when going through treatment?
This is a common question from patients starting their first treatment. During an IVF treatment, you have to attend around 5-7 clinic appointments besides the initial consultation.
After the initial consultation and before starting IVF, you would attend an IVF co-ordination or injection training appointment. During stimulation phase, you have at the least three or more follicular tracking or monitoring appointments.
These appointments are either daily or on alternate days until the egg collection. Most patients can manage these without having to take time off. Yet, if your employer is not so considerate, then you may have to explore your options.
You will need to take time off on the day of egg collection and for at least the next 48 hours. Between day 2 – 6 of the egg collection, you will come for the embryo transfer.
Sometimes, it may be best to take a week off from the egg collection. This may give you a few days to recover. Prepare yourself for the embryo transfer and take a day or two off after embryo transfer.
This is a general suggestion for most patients going through an IVF or ICSI or PGS treatment cycle. It also depends on the nature of work, work schedule and how supportive your employer might be.
Patients going through artificial Insemination or IUI also have to come for follicular tracking appointments, just like IVF patients. Most patients do not have to take time off.
Patients going through frozen embryo replacement cycle have fewer monitoring appointments. Hence, less disruption to your other commitments.
6. I am over 40 and have a good ovarian reserve. Can my age still affect my chance of getting pregnant with IVF?
Most women are aware that fertility decreases with age. Thus, it is less likely that they will get pregnant either naturally or the following treatment. Many are under the impression that if their ovarian reserve tests such as FSH or AMH are normal, then there should not be any compromise in them getting pregnant at least after treatment.
Despite having normal FSH and AMH, the chances of successful fertility treatment is lower in women over 38 when compared to someone less than 35. This happens because the quality of the remaining eggs is not as good. This leads to mistakes in the splitting of the genetic material during cell division and fertilisation.
So, some embryos may end up having too much genetic material or too little. Both of these situations may lead to a genetically abnormal embryo. The embryo is unlikely to implant after embryo transfer or even if it implants it is more likely to miscarry. In summary, the chances of getting pregnant are lower in women over forty even with good ovarian reserve.
7. My gynaecologist said I had mild endometriosis. Will it affect my chances of conceiving with IVF?
Many patients are aware of having endometriosis, but they don’t know what is best for them and whether this may affect their treatment. The facts are that 10% of women in the general population may have endometriosis. But, in women experiencing infertility, the incidence of endometriosis can be as high as 24 to 50%.
The chance of women with mild endometriosis conceiving each month is as low as 2.5 to 5% compared to 15 to 20% for women with no fertility problems. This further decreases for women with moderate to severe endometriosis to around 2.5%. Endometriosis is a condition where the lining of the womb is present outside in the pelvis or bowel.
How does endometriosis affect fertility?
Endometriosis changes the pelvic environment in subtle but important ways. We do not understand how it exactly affects fertility, but there are different theories. Some of these propose that it may cause blockage of fallopian tubes from scarring, an inability of the fallopian tube to pick up the egg by changing the structure and function of the tube.
While other potential reasons are that it may cause inflammation and this may lead to changes in an immune environment. This can affect the egg quality, embryo quality and the implantation in a negative way.
Those women who had mild endometriosis and had been surgically treated may have a small period where their natural fertility has been restored. They should try to conceive naturally in the following 6-12 month period. Mild endometriosis does not affect the success rates of most fertility treatments including IVF.
Those women who have moderate to severe endometriosis will need a proper assessment whether the endometriosis should be cleared by surgery before starting IVF treatment. Your fertility specialist or gynaecologist will make a decision. It also may be a joint decision between both.
8. I have a small fibroid. Should I get it removed before starting fertility treatment?
The fibroid is a benign or harmless lump in the muscle of the womb. Almost 5-10% of women with fertility problems may have a fibroid within the uterus or womb. Many women conceive with fibroids.
Fibroids may affect fertility in different ways. For example, by blocking fallopian tube. It is possible that a cervical fibroid may distort the cervical canal and prevent the sperms from entering the womb cavity.
In others, it may distort the womb cavity and make the womb less favourable for embryo implantation. In some, especially with fibroids over 6-8 cm, it may redistribute the blood flow. Thus, it may reduce the chance of implantation and pregnancy.
So, the mere presence of fibroid in the womb does not mean you need to have surgery to remove it before starting any fertility treatment. If the fibroid