Take a minute to imagine your home. If you invite guests over, what are you going to do? You’re probably going to clean the house. And if it’s the most memorable guest you could invite over, let’s say, Lady Gaga 🙂 You’re going to make sure everything is absolutely perfect. When it comes to preparing for an embryo transfer, you want to take the same approach. Your metaphorical home in the house analogy is your uterus.
The devastation of doing more tests and finding out that something might be wrong that you have to fix is kind of a pain, but the devastation of going through a transfer that doesn’t work is also pretty darn awful. Because I work so hard to help families, if I can do anything to prevent someone from not experiencing the devastation of a negative embryo transfer, I’m going to do everything possible to clean up that house and make sure it’s perfect.
3 Tests Before Embryo Transfer
There are three tests we consider doing to make sure the uterus is absolutely perfect prior to your embryo transfer.
- Saline Infusion Sonogram
Just the exercise of getting into the uterus during any of those procedures takes care of doing something a lot of people have heard of called a mock embryo transfer (practicing placement of a transfer catheter).
Finally, on the day of transfer, or in the house analogy, the day your guest arrives, the last thing you want is to have your doctor not able to get your important house guest through the door. If that door is locked, that’s not the day you want to figure it out. If I’m in the situation where the door is locked and a patient has severe cervical stenosis (blockage of the entrance into the cervix), I’ll take the appropriate steps to dilate the cervix ahead of time so that on the day of the transfer is just smooth sailing and what I call fertility textbook perfect.
Here are some of the ways I recommend you prepare for your embryo transfer.
No one smokes in their houses anymore, so please don’t smoke. Don’t smoke when you’re doing a transfer and please don’t smoke before your transfer. I think you get the point.
If your BMI is over a certain threshold, some studies suggest over 30, it may decrease the receptivity of the lining of your uterus, meaning the chance that an embryo is actually going to get accepted by your uterus might be lower.
I know your fertility is not skin deep and that there’s nothing about IVF that makes you feel sexy, in shape, or on your game. But when it comes to doing IVF, once you have the embryos and they’re frozen, especially if you do genetic testing, you can just take your time. Take the time to reach some weight loss goals before you do the embryo transfer.
If you’re an elite athlete, talk to your doctor about that. Ask them how you should or could modify your exercise routine. This is the time to do it before your embryo transfer so that you know what your activity restrictions will be before, if any, and after. I always want my patients to know what they can do so they never look back and say, ‘I wish I had known that.’
In preparing for the transfer, you want to make sure that you’re on a really good prenatal vitamin. This is actually one of my favorite ones, from Ortho Molecular Products. Disclosure, I do not get paid or own stock in the company, it’s just one of the purest with the most ingredients. If that is not the one you want to take, you at least want it to include folic acid, vitamin D, DHA, EPA. I stock it in my office for patients.
Before your embryo transfer you want to make sure that you’re immune to things like Rubella and Varicella. The last thing you want to do is get chickenpox and expose the pregnancy to this infection.
A lot of patients ask me ‘should I do acupuncture?’ And the answer is yes! I talk to everyone about acupuncture at their first appointment, and patients often ask me about the benefit of acupuncture. And I say, you’ve got to read this book: Planting the Seeds of Pregnancy. This book will not only change how you think about Eastern Medicine if you are skeptical about it, but it will also change how you think about Western Medicine too.
As a personal example, I do ultrasounds all day, and the movements that I use for my work is almost like being a tennis player. I once had a severe pain rating radiating down my arm and rather than doing surgery or anything like that, I did an acupuncture treatment and I’m pain free now. I’m definitely a believer.
Another thing that people ask me is, “My transfer is on Friday and I’m going to a wedding on Saturday. Can I drink alcohol?”
And my answer is no. No, no, no. You can drink in moderation before your transfer, but not after.
Can I drink coffee after my transfer? How much? The answer is it’s actually pretty good for your mood in my opinion. When you’re feeling kind of bummed, or you’re tired, or just feeling the effects of being on hormones, coffee can help with a quick boost. I recommend no more than two cups of coffee per day.
Once you’re pregnant, you’ll notice that your heart rate starts to go up and you might have trouble sleeping, which makes it very easy to cut out coffee. For some, pregnancy causes them to feel extremely tired, so coffee may help. Talk to your doctor about their coffee recommendations for you before you cut it out completely. The last thing you want to do is cut it out the day of the transfer and then end up having bad headaches.
And along those lines, there are things that you can take if you have a headache or a cold. You can still take Tylenol, Advil, even after your transfer in the first trimester. But talk to your doctor first before doing anything like that.
Nail Polish and Hair Dye
I don’t paint my nails cause I’m dealing with little embryos, and they don’t want little chips of nail polish in there. My patients always ask me, “Can I get my nails done?” Or, “Can I get my hair dyed?” And I tell people, yes, go get your hair dyed whatever color you want before your transfer, because once your transfer is done, there is no hair color for you through the first trimester. That’s my rule. A lot of doctors agree with that, but not everyone does. If something is going to give you a headache, you don’t want it around. You have a special house guest, remember? So don’t do it.
I designed some really cool pants specifically for my fertility patients! The pants have a discrete opening so your doctor has access for ultrasounds and procedures throughout your fertility care. You can actually wear your pants to your transfer and not worry about being cold and bottomless in front of your fertility team.
Now let’s talk about your transfer day. This is what happens if you’re a patient of mine.
-You are going to arrive at the IVF lab 15 minutes before your scheduled transfer time.
-If you’ve decided to do acupuncture, you’re going to do an acupuncture session 30 minutes before and 30 minutes after.
-I ask my patients to drink three eight-ounce glasses of water about two hours prior to the transfer. Your bladder should be full at check in, but not too full.
-Don’t forget your ID! At check in, the ultrasonographer will ask for your ID. I know who you are, but it’s always good to confirm it.
-When it’s time for the transfer, you’ll enter the transfer room. It will look very similar to every ultrasound room that you’ve been in, but the difference is that the embryology lab is on the other side of one of the walls.
-Once you are lying down, the ultrasonographer will check your bladder and make sure it’s absolutely perfect. Again- you need a full bladder in order to see the uterus.
-I have patients take Valium because it prevents the uterus from having strong contractions when the catheter goes in.
-Now it’s time for the embryo transfer. In the lab that I use, you will get a photo of your embryo taken at the time it was thawed. We’ll also show you a video of your embryo on a screen before the embryo comes in. Once the catheter is inside your uterus, we’ll load the embryo up in a separate catheter and then feed it through the inner sheath and get the tip in the perfect spot before we transfer.
-Then hopefully we’ll see something that I call the spark of life. An embryo is microscopic. You cannot see it with a naked eye unless it’s magnified several hundred times. When you see that spark of life on ultrasound it’s just a reflection of where the embryo is going. It’s really fun and nice to see.
The Other Stuff
Now for all the other stuff that people ask me!
Eating the core of a pineapple.
I have had fertility patients tell me that they’ve heard they should eat the core of a pineapple after their transfer. The core of the pineapple is the grossest thing if you ask me, but it’s probably more of a fertility myth than truth. The core of the pineapple contains a substance that’s considered anti-inflammatory called bromelain.
So do you really have to chew on the core of a pineapple to get it?
No. You can actually get bromelain supplements, believe it or not. But the last thing I want patients to be doing is trying something totally new that they’ve never done on the day of their transfer. So if the core of a pineapple is something that you like to eat and munch on, go for it. Otherwise, know that if this actually helped, I would have a pineapple stand in my office.
Is my partner in the room for the transfer?
Yes, absolutely. Your partner is in the room for the transfer. Sometimes patients have other family members as well in the room. It’s nice for me to know who everyone is and what the relationship is before the transfer, but certainly if you have someone else that you want to be in the room, your best friend, your mom, they’re certainly welcome.
Can I pee out my embryo after the transfer?
Once your transfer is done, you’re going to lie down for five minutes and then you’re going to go pee. Research shows that you can’t pee out your embryo. You also can’t poop, cough or burp out your embryo, while we’re on the topic! There’s really no way that embryo is going to come out- hopefully for nine months.
There’s no need to fear the embryo falling out when you get up after your transfer.
This is called a cabana boy. The idea is that when you get home from your transfer, or once you’re done with your acupuncture session, you call your ‘cabana boy’: your partner, or family member that was in the room during the transfer, it doesn’t matter who, but you call on them for two days.
And what are you going to do over those next two days? Simply put, it’s butt-to-bed, butt-to-chair, butt-to-couch and then repeat.
Or I tell patients, go to a beach, but a beach that I would go to because when I’m at the beach, I’m not doing anything. The point is, you’re just relaxing. You’re binge-watching whatever you want to watch. And try to make it fun.
I’m always super hopeful after every transfer that I do, but the next two days I think are important. A lot of doctors say you don’t need the bedrest, you don’t need to rest from work, so I do a lot of my transfers on Fridays. That way patients have Saturday and Sunday to rest, and then they can go back to work on Monday.
The truth is that I’ve had patients who’ve done everything perfectly and the transfers don’t work. And no matter what I say I don’t want there to be any issue with patients for one second blaming themselves. Taking a two-day break and just enjoying life and being totally mindful never hurt anybody. So remember: butt- to-bed, butt-to-chair, butt-to-couch, and rotate.
Prepared meals can be so helpful for those days after your transfer, when you want to take it easy but still eat nutritious, good food.
I use a company in the San Francisco Bay area called Methodology and I reached out to them. I said, ‘Hey, I love your food. I eat it all the time. It’s how I keep healthy with my busy schedule. It’s really easy to get the meals delivered, breakfast, lunch, and dinner. It’s already done for me and it’s super cost effective.’
And they’ve agreed to give my patients 20% off their first order! Pretty cool. Just use code “eggwhisperer” on your order.
And remember, I recommend trying anything new before your actual transfer date.
Now this is a great blog: IVF Is Very Fun! It takes you step by step through, what to expect at the transfer, what to expect after the transfer, and the two week wait. I can tell you that the two week wait will mess with you. Are you pregnant? Are you not? You have a headache, your breasts are tender, what does that mean? This blog will help show you that you’re totally normal to think that everything might be a sign for pregnancy.
Some patients actually test early, but I really try to encourage my patients to wait to test. I will test HCG levels in the blood eight days post-five-day transfer. You’ll see this online a lot: 8dp5dt and that refers to how many days after transfer a patient is testing. Try to wait and test with your blood tests if you can. I like to test at eight days because it gives me a true, accurate result. If it’s negative at eight days, it’s not going to turn positive. If it’s positive at eight days, it is a true positive. Then we’d like to check it two days later. If it’s doubling nicely, then I don’t need to check it again unless the patient has a history of a miscarriage, then I like to keep checking it.
If a patient’s levels look great, then I schedule their first ultrasound two and a half weeks later, and that’s when we see the heartbeat and that’s one of the best ultrasounds and appointments that I have with my patients.