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Embryos Don’t Fall Out

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A blog by Dr. Laurence Jacobs, Fertility Centers of Illinois, February 9, 2015

During the IVF embryo transfer procedure, Robert, my long-time ultrasonographer, has been telling patients for years:

"Laughing, coughing, sneezing, peeing, pooping and walking do not knock the embryos out. Embryos don't fall out. You can't knock them out, but you also can't make them stick."

Many of my patients worry the most about what they can and cannot do after an embryo transfer. The fear is if they do something wrong, the embryo won’t attach or fall out.

This is simply not true. Yes, you should relax and take it easy after an IVF embryo transfer. But no, bed rest is not necessary.

The Embryo Transfer

One of the most commonly used phrases in IVF is: “The reproductive endocrinologist implants the embryos in the patient’s uterus.” This is not how it works — the embryo or embryos have to implant on their own. Here’s how it works …

During in vitro fertilization, the embryo(s) develop in a Petri dish for three to five days, and the healthiest embryo(s) are chosen for the transfer. The embryologist removes the embryos from the incubator and shows them to patient magnified up to 1,000 times on the video screen.

The next step is to use the vaginal speculum in order to wash off the cervix with some sterile fluid. The patient feels pressure, but typically there is no pain. For women who have undergone intrauterine inseminations (IUIs), the sensation should be very similar.

The transfer itself is a fairly simple procedure with very little discomfort in which a thin, soft catheter is threaded through the woman's cervix under ultrasound guidance, so that we can be very exact in the embryo placement location - generally 1 to 2 cm from the top of the uterine cavity. After cleansing the cervix with solution, an empty transfer catheter will be placed through the cervix into position inside the uterine cavity. Then we wait a few moments for the embryologist to bring the catheter containing the embryo(s) from the lab a few feet away, so we can minimize the time that the embryos are exposed.

Once we have the embryo(s), we feed the catheter with the embryo(s) through the empty catheter that is already in place. On the ultrasound screen you will be able to watch the bubble of air and fluid the embryo is contained in get placed gently into the uterine cavity. After placement of the embryo(s), we wait until the embryologist checks the catheter under the microscope to make sure that the embryo(s) transferred properly. Then you can get up and go straight to the bathroom if you desire.

At that point, it’s not under our control anymore. The embryos have to implant into the uterine lining on their own over the next few days, with the goal of developing into a successful pregnancy.

But Shouldn’t I Go on Bed Rest?

Several recent studies have confirmed that immediate bed rest after the embryo transfer is completely unnecessary. It may seem counter-intuitive, but, in fact, a study published in a well-respected peer-review journal, Fertility and Sterility (Fertil Steril 2013; 100: 729-35), demonstrated better pregnancy rates with immediate resumption of normal activities (including bathroom) compared to bed rest right after the embryo transfer.

Here's an interesting historical note. Back in the 80s, after an embryo transfer we prescribed that patients stay on complete bed rest for three hours and even rely on bedpans instead of going to the bathroom! This is not what we prescribe today, and we know that any fluid you may see coming out is from the sterile cleaning solution.

You may even see some spotting, and that is nothing to worry about. Why? It's because embryos do not fall out.

However! When you do go home, you absolutely have a prescription to be a "couch potato." You can sit up and watch TV, or work on your laptop or your iPad. Your position does not matter.

The first 24 hours after an embryo is transferred are most likely the most critical. It is within this time frame that an embryo has to "attach" to the uterine wall before it can fully implant, which may take several days. Therefore, for the first one to two days, stay home and chill out. So …

  • Avoid vigorous activities such as heavy lifting, bending or exercise. Why? You want embryos to remain in the uterine cavity and not get pushed into a Fallopian tube, which would result in an ectopic or tubal pregnancy. Common sense goes a long way. You can go to the bathroom as needed, and you can use stairs but don't run up and down them. If you feel you don't have to do something, then don't do it.
  • Avoid excessive heat. No hot baths or hot tubs, and no whirlpools. Showers are OK because they will not elevate your body temperature. We don't want you running around or doing vigorous exercise because it may elevate your body temperature. Embryos do not like heat.
  • Try to relax and stay positive during the "two-week wait," the 10 to 12 days waiting for the pregnancy test. You don't want to second-guess yourself regarding doing certain activities. It's not your fault if an embryo does not implant, but you don't want to give yourself any possible reasons for feeling guilty or second-guessing your activity level if the IVF procedure does not work this time.
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Comments (7)

This is a very good article. I just had my first embryo transfer & my embryo did not stick (blood test was negative after two weeks). I am preparing for my second transfer and I was “blaming” myself a bit that maybe the reason my embryo did not stick because I had been coughing, was doing normal activity (but in a slower phase but no lifting nor working out) instead of just lying and being a couch potato. This article made me understand that it’s not my fault and it’s just not meant to be.

Hello Sir, so far I had 2 IVF cycles which were failed. 1st was day 3 transfer which got failed. 2nd was failed as there were less number of eggs and the cycle got converted to IUI. im My 3rd cycle,I had 2 embryos freezed which were day 6 blastocysts.I had both embryo's transferred yesterday evening. As I had my bladder full, the pain was uncontrollable and I had to go to washroom within 8 minutes after my FET. as per my clinic minimum 15 minutes I had to lie down. Post that, the progesterone gel got withdrawn (may be due to bloated bladder). I am afraid that my embryos might have passed out during urination. after my transfer in my 1st IVF cycle, I had some feeling that yes, something has been transferred. But this time I do not have any feeling as such. May be this is due to the urination which occurred after the FET. Also, my doctor had said that the embryo;s were Grade B, coz it was not expanding as per his expectations after unfreezing. The expansion of the embryos were a bit slow. I am very much tensed and I have no hopes this time as well. Please suggest if this urination after ET and no feeling post transfer is normal?

Dear Dr Jacobs This is a truly wonderful article. A real Godsend to my wife and I who have just undergone embryo transfer 6 hours ago. I am going to get her out of bed and take her for dinner across the road. Keep up the good work. Samuel

I would like to say that your article seemed helpful. I'm anxious myself. I've never had a live pregnancy and hopefully this one is my dream come true. Good luck to everyone :)

This article scared me. I was reasonably careful after my egg retrieval but I might have lifted things here and tgere by mistake, nwithout thinking. Everything I read seems to say eptopical pregnacy is ususlly not from anything tge women did.

You mention that doing rigorous activity of lifting could cause ectopic pregnacy? I find that scary cause thats any easy mistake to mske. All the litiature I read says ectopic pregnacy is not a result of anything the nother did, short of perhaps smoking or drugs. But I just had a transfer over a week ago. I have been reasonably careful but a few times I might have bent or stretched to get stuff or opened windows without thinking. I dont think inruptied anything but yourcarticle scared me. Like I said I think I was reasonably careful, Also for hiw many days after does bending and lifting cause ectopic pregnacy? I have been snxous about my test results, now your article brought another concern.

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