Public Service Information

This will be a long one. Sonja asked in the comments to my post on Tuesday why I was doing some of the things I'm doing, so I thought I'd do a post on the advice that my clinic gives post-transfer with some additional information that I've dredged up from the net.

Bed rest

My clinic doesn't recommend bed rest after transfer, and in fact they didn't make me lie down for more than a couple of minutes immediately afterwards. Apparently studies have been done where the position of the little bubble of fluid in which the embryos are transferred has been checked by ultrasound after women have either lain down for half an hour or so or got up straight away, and no discernable difference has been detected.

In other words, getting up straight away doesn't displace the embryos and will not cause them to fall out. There is also no statistical difference in outcome between people who have been on bed rest for a day or two after transfer and those who haven't.

My clinic advises that there is no need to rest after transfer and that you can return to your daily routine but avoid strenuous exercise.

In fact, I felt pretty battered and bruised after egg collection and embryo transfer, and apart from my trip to the acupuncturist I rested with my feet up for more than 24 hours after transfer - just because I didn't feel like doing anything else. We went to the theatre on Saturday night, but that turned out to be a mistake, as I felt absolutely dreadful by the time we were going home.

I am still taking it easy (or easier than usual) - apart from the four loads of laundry I had to do yesterday (because although I normally do 4-6 loads a week, DH seems to think that doing a single load over the weekend will keep us on top of things).

Progesterone

Progesterone supplementation is apparently given for two reasons. The first, and more important, is that it can help the uterus to stop contracting after transfer and thus help implantation.

The second is that after all the messing about that your hormones have had during the process so far, your body may not get the usual message to produce progesterone after ovulation and so a top-up may be necessary to support a pregnancy until HCG takes over.

My clinic prescribes enough Cyclogest to last two weeks, then renews the prescription to take you up to 12 weeks if you are pregnant.

For me, the main side effects of Cyclogest have been extreme exhaustion, sore boobs from the day after transfer and a bit of nausea. I've also been getting night sweats, to the extent that since yesterday I have a very attractive heat rash on my stomach, and when I woke up this morning the neck of my t-shirt was damp.

Taking the suppositories rectally, there is no discharge and no mess, although (TMI) my poo is a funny colour!

Aspirin

The clinic recommends taking 75 mg of aspirin daily from the day of transfer onwards - not earlier, as it can increase bleeding during egg collection and transfer. The reason for taking this is to prevent clotting, which can cause miscarriage.

Fluid intake

My clinic advises that you increase your fluid intake to two litres of water and half a pint of milk a day. I'm struggling with this one, as I don't usually drink that much, though as the weather gets a bit chillier I am enjoying my mug of hot milk before bedtime.

The reason for the water is partly to avoid OHSS (with only six follicles, I'm not at much risk for that, although it has been known in the unlikeliest of candidates). It also helps to flush the drugs out of the system. And finally, being well hydrated helps with blood flow, and good hydration remains important throughout pregnancy, so it's good to get into the habit.

As for milk, it can help throughout the IVF cycle - the protein it contains can help to produce better quality eggs. The calcium is useful when downregging - the induction of a mini-menopause can lead to depletion of calcium levels in your bones, increasing the risk of osteoporosis in later life.

Calcium is also very important in pregnancy for the development of the baby's teeth, bones, etc, and if you're not taking enough in, the foetus will take what it needs from your body, again increasing the risk of osteoporosis in the future.

Many people in the West these days have a diet which is deficient in calcium, particularly if they're trying to be careful of their weight (avoiding cheese, full-fat milk, etc) so getting those levels of consumption up is a good thing. Also, because during pregnancy you have to avoid soft cheeses, many women's calcium consumption may actually be going down and increasing consumption of milk/yogurt/hard cheese can counteract that effect.

Finally, I have read a comment from an IVF doctor who said that after he started recommending that his patients drink more milk after transfer, several who had had previous unsuccessful cycles became pregnant. This is anecdotal, but good enough for me.

Other stuff

I'm also doing the following (I've put an asterisk against the ones specifically recommended by my clinic):

• Taking folic acid 400mg daily - OK, I've been doing this for a couple of years now, so there must be some build-up in my system by now, but I'll carry on... *
• Eating five brazil nuts a day for the selenium
• Listening to this hypnotherapy CD every day - there are two separate parts for pre- and post-transfer, and I do find it helpful in keeping me calm. Research (I'm not sure how scientific, as I've only read about it on hypnotherapy websites, which clearly have a vested interest) has shown that using hypnotherapy can increase the chances of success in IVF
• Acupuncture on all the days recommended - proper scientific research has been done on this and concluded that acupuncture at the right times can significantly increase the chances of success in IVF. It's important to have a good acupuncturist, as the research has shown no increase in success (ie, no placebo effect) if pins are stuck in but the relevant points are missed.
• Avoiding foods that you're not supposed to eat while pregnant - raw egg, pate, soft cheese, offal (who knew? Looks like DH will be eating my yummy steak and kidney casserole on his own) *
• Healthy eating, lots of rest and generally trying to listen to my body. *

Phew, so - well done for reading this far. I'd be interested to hear any additional advice that you've been given, or anything that you have found helpful.