How to prepare for embryo transfer? What to do before and after?

Patients going for IVF would do as much they can to increase their chances of getting pregnant. However, is it at all possible to improve assisted reproductive techniques results? In this webinar, dr Magdalena Golańska-Wróblewska and dr Bogna Sobkiewicz from Polish IVF clinic Salve Medica prove that it is!

According to dr Magdalena Golańska-Wróblewska, leading a healthy lifestyle and avoiding extremes, both in a physical and chemical sense, may significantly increase IVF success rates. Moreover, there are additional aids available that have a positive effect on embryo implantation success. These are e.g. all sorts of drugs modulating the immune response or preventing uterine contractions. Last but not least, the way a patient behaves and is taken care of after the transfer is also very important.

Lifestyle does matter

In fact, a patient’s chances for pregnancy may be affected by a number of factors, both internal or external. These include age, diet, lack of exercise, drinking alcohol, smoking or taking drugs. There are also the so-called occupational factors, such as excessive physical exertion, shift work (where night shifts may affect one’s cardiovascular system and cause hormone secretion disorders) and exposure to chemical or biological agents. Operations that a patient has undergone can also have an impact – especially when we talk about oncological treatment and the removal of ovaries or the fallopian tube.

When it comes to the most important factors influencing a woman’s infertility, age surely plays the most significant role. Dr Golańska-Wróblewska admits that in women, the age effect on fertility is more marked than in the case of men. However, the truth is that ovarian reserve decreases with age – it is manifested in a reduced pool of ovarian follicles. Moreover, when a woman ages, the number of mature oocytes decreases while the number of errors in cell divisions increases. The latter may influence the risk of genetic diseases (such as Down syndrome). The risk of other diseases (e,g, achondroplasia or Aper syndrome) increases, on the other hand, with the father’s age.

Dr Golańska-Wróblewska says that it is crucial to follow a balanced diet if you want to be successful in your IVF treatment. Whilst an elimination diet is not necessary, it is important to maintain proper body weight. High BMI not only reduces the chances of pregnancy but it also is a risk factor for adverse events during pregnancy. Besides, the higher the body weight, the greater the potential for vitamin D deficiency. And according to dr Golańska-Wróblewska, proper levels of vitamin D positively affect fertility – both in women and men. Another factor helpful in maintaining proper BMI (and thus, increasing the chances for successful IVF treatment) is frequent physical activity. Regular daily exercise (at least 30 minutes a day) reduces the risk of metabolic diseases and also helps in relieving stress which can be very beneficial in the process of infertility treatment.

While it is easy to change our diet and introduce more physical activity into our lives, it is not always possible to avoid occupational factors that have a lot of impact on our reproductive health. Although we all seem to know that exposure to ionising radiation can cause infertility (or even sterility), not all of us realise that contact with pesticides, high temperature or chemical factors may cause a decrease in the number, motility and percentage of normal sperm and as a result, negatively influence its fertilising capacity. Similarly harmful are drugs – it refers both to those used in treating oncological diseases or peptic ulcers and the antipsychotics and antidepressants prescribed by psychiatrists. In all of these cases, it is advisable to wait a few weeks after the drug therapy to undergo an IVF procedure.

Embryo transfer – a major determinant of IVF success

Leading a healthy lifestyle is one way to increase patients’ chances of getting pregnant. Fortunately, there are also some additional medical procedures that may turn out to be helpful in one’s fertility journey. One of them is scratching which has a proven positive effect on subsequent embryo implantation. And the latter is surely one of the most critical steps in determining the success of an IVF cycle.

Embryo transfer is a complex process, depending on many variables. Dr Bogna Sobkiewicz reminds us to always differentiate fresh embryo transfer from frozen embryo transfer. Both of them have their pros and cons. The frozen one is used when there is the risk of developing ovarian hyperstimulation syndrome, when doctors conduct pre-implantation genetic diagnosis and when late-follicular progesterone is elevated. What’s the most important, It can boast higher pregnancy rates. The fresh embryo transfer, on the other hand, is less extended in time but one always has to consider the so-called ‘embryo-endometrial asynchrony’ due to supraphysiological hormone levels after the necessary hormone stimulation.

When conducting IVF treatment, doctors always have to decide whether to use a patient’s natural cycle or hormone replacement treatment. Oestrogen supplementation surely helps to achieve endometrial proliferation and follicular growth suppression whilst by taking progesterone, it is easier to promote the final phase of endometrial preparation. In case of natural cycle, endometrial preparation is conducted by using only endogenous steroids (what excludes the risks of exogenous hormones) and the whole procedure requires no medical or pharmacological intervention, except for endocrine and ultrasound monitoring to schedule the transfer. And what’s interesting, when it comes to results, a recent multi-center study did not show any significant difference between the natural cycle and hormone replacement treatment in regards to live birth and clinical or ongoing pregnancy rates.

Improving implantation rates

One of the factors deciding of the success of the embryo transfer is the day it is conducted. Dr Sobkiewicz says that in Salva Medica clinic they suggest to perform it on day 5. Such a solution allows selecting more viable and stronger embryos that have demonstrated the potential to develop and differentiate. In fact, embryo selection is probably of the highest importance when it comes to improving the cycle implantation rates.
Another question to answer while preparing to embryo transfer is how many embryos to transfer. Data from various countries indicate a general tendency to transfer individual embryos to the uterine cavity – and in case of failure, repeat the whole procedure in the next cycle. This successfully excludes the risk of multiple pregnancy which may entail various complications.

There are of course other ways doctors can use to improve patient’s implantation rates. They can, for instance, introduce additional drugs (e.g. Intralipid, Atosiban, Accofil). As these are not routine procedures, there are always extra consultations needed to indicate the real benefit of their use. Other medications that doctors can make use of for patients’ benefit are folic acid, Heparin, Encorton and acetylsalicylic acid.

Assuming the embryo transfer was successful, there are various indications of how to behave afterwards in order to increase one’ own chances of pregnancy. Dr Sobkiewicz mentions the necessity to continue the use of medications (in some cases almost until the end of pregnancy), bed rest straight after the procedure and refrain from sexual intercourse until the first pregnancy test. A patient should always take exceptional care of their own emotional state, too. It is advisable to use stress relieving techniques, maintain one’s own social life at its current level and focus on other aspects of life (such as job, friends, hobbies, etc.) to avoid constant uncertainty and depressive thoughts. Differentiating between anxiety and depression is also highly important as each requires different psychosocial interventions, including consultations with specialists.

The presentation and answers to all the questions from attendees were given by experts:

• Dr Magdalena Golańska-Wróblewska – MD, graduated from the medical department at Medical University of Lodz, in 2010. Finishing PhD studies in Endocrinology Clinic in Medical University in Łódź. Her attention is focused on diagnosis and treatment of infertility, endocrinology, gynaecological procedures, ultrasonography.

• Dr Bogna Sobkiewicz – MD, graduated from the medical department at Medical University of Lodz, in 2013. Finishing the specialisation of gynaecology and obstetrics. Her attention is focused on endoscopy, small procedures and counselling.