The embryo transfer can bring a ton of intense emotions during an IVF journey. You’ve worked hard to get here: all the appointments, the blood draws, ultrasounds, medication and injections. Now, there’s only about a two-week wait (and sometimes even less) before your pregnancy test. It can feel like an exciting time, but also a super vulnerable stage. Most doctors will tell you to take it easy after your transfer, but what does that mean? How secure is your embryo in there?
What happens after embryo transfer?
Once your embryo(s) have been placed inside the uterus, they’re sandwiched between the front and back inner walls. Your uterine lining, called the endometrium, starts to interact with the embryo as they send messages back and forth. Immune factors adjust so that the embryo is facing the right direction while adhesion molecules anchor the embryo, tethering it into place. Upon successful implantation, the embryo continues growing and incorporates itself into the endometrium, where it can soon start to get its own blood supply.
What can I do on transfer day?
After the procedure, it’s a good idea to avoid major stressors and not push yourself too hard physically. After all, you just had a catheter inserted up you cervix and something “new” has been introduced to your reproductive tract. You want your uterus to get acquainted with this new embryo, and make sure this process has enough energy and immune support.
That doesn’t mean you need bedrest. In fact, some movement like a nice walk can support your circulation and help decrease the risk of clotting from skyrocketing estrogen levels. What it does mean is you should avoid super strenuous activities (like running up hills in 100-percent humidity) and avoid major stressors (like work emails… or certain people).
And don’t worry, your tiny embryo isn’t going to fall out! Your uterus is made of muscle, and your embryo is tucked away between layers without much space to move around. Picture putting a pea in the middle of a peanut butter sandwich and holding that sandwich vertically with two hands. You can jiggle your sandwich, but it’s very unlikely that the pea will fall out since it’s snuggled and sticky in there.
Take the rest of the day off if you can and/or delegate major tasks if you think they’ll cause you anxiety or stress. If you’re feeling anxious, find an activity that helps relieve this. Binge-watch your favourite show or curl up with your book. Stay well hydrated, eat something warm and comforting (avoid fried foods which are inflammatory) and get a good night of sleep. Self-care is the name of the game on transfer day.
What can I eat after embryo transfer?
Your healthiest choice after transfer is a Mediterranean-like diet (sans wine), rich in fruits and vegetables, whole grains, plant-based protein, and olive oil. This provides lots of vitamins, nutrients, healthy fats (which are used to make hormones), and proteins that are broken down into the building blocks for your new little life form. Avoid or limit red meat and fried foods, which can be inflammatory, and keep your intake of processed sugar and simple carbs (like white breads and rice, cookies and pastries) low. You need healthy blood sugar and insulin regulation to make sure embryonic and fetal development stays on track. Remember, you’re sharing your blood system and everything in it with your implanted embryo!
You can also follow the principles of Traditional Chinese Medicine and stick to warm, cooked foods to benefit the uterus. Foods that are cold and raw (like salads and frozen smoothies) are harder to break down which can limit the amount of energy or qi that can be derived from that food. Cold is also associated with poorer blood flow and could impede implantation. Having a “cold uterus” is associated with irregular cycles, painful periods and infertility, so keep that womb warm:
- Avoid frozen drinks and ice-cold water
- Avoid skin exposure to blasts of air conditioning and cold-weather winds
- Choose cooked foods over raw foods
- Consume “warming” foods like ginger, soups, broths, stews, but not spicy foods which are not warming in the same way
Now is also the time to adopt a pregnancy diet, limiting caffeine intake and avoiding alcohol and undercooked meat.
What can I drink after embryo transfer?
Your metabolism of substances like caffeine and alcohol depends on your individual genetics and the function of key liver enzymes and pathways. The enzymes that do this are the same ones that affect estrogen metabolism and the ability to detoxify harmful chemicals. This means that if you’re using these enzymes to break down and eliminate alcohol and caffeine, you’re temporarily taking away their ability to work on estrogen and other compounds.
Caffeine metabolism is slower during pregnancy, meaning that your pregnant body keeps caffeine around longer than your non-pregnant body, to an average half-life of up to eight hours. Coffee drinking can also impair the absorption of key minerals like Calcium and Iron from your gut which you and your fetus will need.
Many guidelines recommend capping your preconception and pregnancy caffeine intake at two to three servings per day (200 to 300 mg total) due to increased miscarriage rates, but again, it all depends on your genetics. You might only be able to tolerate one serving (one eight-ounce coffee equals 100 mg) or less of caffeine per day without it significantly affecting embryonic and fetal growth. If you’re unsure of your genetic status, consider sticking to a maximum of one serving per day, or switch up your coffee ritual with a decaf grind or half-caf cup.
When it comes to drinking, the CDC in the U.S. supports the line that the safest option is to consume no alcohol at any point in pregnancy. That’s because these next few weeks, including before you can even find out if you’re pregnant, involve the first developmental stages of a primitive brain, spinal cord and heart, and alcohol is a teratogen, which means it can cause issues with embryonic development.
What do the studies show on alcohol? Human studies on alcohol consumption in early pregnancy are tricky and really can only rely on self-reported alcohol use. So, we often look to animal studies to help give us more information. One mouse study found that alcohol exposure in early pregnancy (equivalent to around the time of a human positive pregnancy test, or four weeks) did in fact change fetal brain structure.
In these earliest weeks in humans, it is very possible for alcohol to affect DNA methylation (the process of turning genes on and off). Some sources say that in the earliest days of human embryo development, the embryo itself is likely sheltered from maternal alcohol consumption, but alcohol could interfere with implantation. Also, by the time the embryo is three weeks old and the earliest nervous system and spinal cord are being formed, these cells do become vulnerable to maternal alcohol exposure. That’s also because this is around the time that cells become more specialized so alcohol can interfere with the ability of these cells to change, migrate and grow.
We know that consuming alcohol during pregnancy can cause pre-eclampsia, pre-term birth, and low birth weight babies, in addition to fetal alcohol syndrome disorders, though many of these effects come with heavy and/or regular drinking. That said, there is no “safe” amount that has been discovered. It’s a gamble, and after having gone through so much to get to this point, for many, it’s not a risk worth taking.
Outside caffeine and booze, you’ll want to make sure to drink up. Hydration helps you process all those hormones coursing through your body. Water is also an essential component for embryo growth, development and survival, so you’ll want to aim for two litres per day.
What exercise can I do after embryo transfer?
After your transfer day and during your two-week-wait, you can start doing exercise (unless your doctor has specifically told you not to). Aim for about 150 minutes of physical activity per week including walking, yoga and low-impact aerobics. Avoid the “extremes” including heavy lifting, bootcamps, CrossFit, contact sports, and activities in extreme hot or cold environments like hot yoga. Similar to preconception, limit activities to 60 minutes at a time to avoid overstressing the body.
You might’ve heard that swimming is an excellent form of exercise during pregnancy, and it’s good for the two-week wait too. But if you’re using vaginal progesterone gel or suppositories, make sure to wait at least two to three hours before swimming to avoid washing out some of the hormones you’ve been inserting. You’ll also want to hold off on swimming (and taking baths) for these few weeks if you’re prone to vaginal infections like yeast infections and bacterial vaginosis.
What supplements should I take after embryo transfer?
This is the stage that your prenatal vitamin and especially Folic Acid is most important. Folic Acid is necessary for an embryo to implant. It encourages new blood vessels to form that will supply the placenta. It’s also for necessary for cells to be able to divide and replicate properly, which an embryo relies on.
It’s most important to take Folic Acid in the weeks or even months before conception and in the earliest stage of pregnancy. That’s because between the first four to six weeks of pregnancy (two to four weeks after embryo transfer)—around the time many women find out they are pregnant—the fetus’ spinal cord is already starting to form. Folic Acid helps prevent disruptions and errors at this critical time, allowing proper formation and closure of the brain and spinal cord.
Can I have sex after embryo transfer?
One of the goals after embryo transfer is to keep the uterus calm and avoid uterine contractions in an effort to improve IVF success rates.
Some background science: In preparation for an embryo transfer, doctors usually prescribe progesterone to support implantation. Even in a non-medicated cycle, the body produces natural progesterone after ovulation. One function of the progesterone is to calm the smooth muscles (the muscular layer of the uterus that contracts for menstrual cramping and labor). So avoiding uterine contractions is key after transfer.
Risks of sex after an embryo transfer
- Contractions: Vaginal intercourse can increase uterine contractions through mechanical stimulation (movement of the uterus) and/or orgasm. Ideally, you want to keep your uterus nice and calm (and contraction-free!) post-transfer.
- Bleeding: It’s common for vaginal intercourse to result in mild bleeding, generally as a result of micro-tears of the vaginal wall or some force against the outside of the cervix (it's the same reason for bleeding after a Pap smear test). This bleeding is not medically concerning and resolves quickly, but any form of vaginal bleeding after an embryo transfer will create a high-anxiety situation, and may lead to your fertility doctor investigating further with a physical exam, bloodwork or ultrasound when it's not actually needed.
- Infection: Both intercourse and lubricants can introduce irritation and pathogens (bacteria, viruses, etc. that might lead to an infection) into the vagina. A hot topic in the reproductive space is the optimal uterine microbiome to improve implantation, which is directly connected to the vaginal microbiome. If you’re prone to yeast infections or bacterial vaginosis, especially if they flare up after you have sex, hold off until your doctor tells you it’s safe.
- Reduced efficacy of medication: If you’re on progesterone gel or suppositories, avoid vaginal sex for at least two hours after use, because it may reduce the amount in your vagina available to be absorbed, and even some amounts of the medications can be absorbed by your partner.
Benefits of sex after an embryo transfer
There's no proof to support the medical benefits of sex after an embryo transfer in IVF. Semen might have other “pro-implantation” factors that benefit implantation based on one study, but it’s not a consistent finding that’s been reported.
Overall, there's limited evidence to guide us either way about sex after an embryo transfer. Since there's a lack of consistent evidence to show that sex improves pregnancy rates, and there are multiple concerns (contractions, infection, bleeding and medication absorption), the majority of fertility doctors advise against sex after an embryo transfer. Our doctors suggest that their patients wait until the first ultrasound after a positive pregnancy test to get back to it, simply because if miscarriage occurs, they don’t want patients to feel unnecessary guilt or blame on top of already very intense and complicated emotions. However, if you do choose to go for it, you should be equally reassured that you're unlikely to have affected your outcome. After all, there are non-medical benefits to having sex, too.
What else can I do after embryo transfer to increase chances of success?
Managing stress and anxiety and focusing on self-care should be a priority during this time. A little bit of stress or feeling anxious is expected, but being in a constant state of panic or long-term “fight or flight” can have affect your hormones and blood flow. It can also hurt your sleep which is critical for the function of your body and your brain. Instead of worrying about feeling anxious during this time (which can leave you feeling even more anxious!), try to accept it and work on managing it. Do a guided meditation, take a walk in nature, watch or read a comedy and laugh at something you find funny. This helps your body focus on the task at hand (implanting and growing your embryo!) instead of devoting hormones and resources to chronic stress responses.
Have you heard of acupuncture to support an embryo transfer? Acupuncture points are located along meridians or paths of the body. These meridians are an actual map of the body’s peripheral nervous system, following tracks of nerves. Inserting acupuncture needles at specific locations has been shown to activate beta-endorphins and the opioid system, and can slow down the cortisol-releasing hormone, allowing acupuncture treatments to reduce pain, stress and anxiety. Acupuncture not only tackles fight-or-flight mode, but locally can help improve circulation. Studies have even shown that acupuncture can reduce anxiety after an embryo transfer, and reduce stress before and after an embryo transfer which could positively affect pregnancy rates.
When consumed as either a food or juice, beets are a source nitric oxide which helps dilate blood vessels and improves uterine blood flow (fun fact for people with sperm: it can similarly improve penile blood flow in those with erectile dysfunction). One study found that those who drank a beetroot, watermelon and ginger juice daily from embryo-transfer day until their pregnancy test had a significantly higher implantation rate (24 versus 18 percent) and clinical pregnancy rate (41 versus 22 percent) compared to those who didn’t juice daily.