Infertility is the inability to become pregnant after one year of intercourse without contraception involving a male and female partner. There are many causes of infertility, including some that medically assisted conception can treat. Estimates from 1997 suggest that worldwide about five per cent of all heterosexual couples have an unresolved problem with infertility. However, many more couples experience involuntary childlessness for at least one year: estimates range from 12 per cent to 28 per cent. The male infertility is responsible for 20 to 30 per cent of infertility cases, while 20 to 35 per cent are due to the female infertility, and 25 to 40 per cent are due to combined problems in both parts.
In 10 to 20 per cent of cases, no cause is found. The most common cause of female infertility is ovulatory problems, which generally manifest themselves by sparse or absent menstrual periods. Male infertility is most commonly due to deficiencies in the sperm, and sperm quality is used as a surrogate measure of male fecundity. In summary, 50 per cent of infertility cases are male, and 50 per cent are female.
Over forty years ago, the study of in vitro fertilisation began. For the first time in the history of medical science, a woman named Lesley Brown was considered sterile at that time, due to her diagnosis of primary infertility secondary to tubal occlusion for about nine years.
The process in IVF has become a global technology accepted for infertility treatment. In Nigeria, over 90 IVF centers are performing about 8,000 cycles of IVF per year.
In vitro fertilisation itself is a very complicated process. It can be a long, challenging process with unexpected twists and turns. It usually begins with a screening and testing stage, then moves to the stage of diagnosis and planning, and then actually treatment stage ensues. Throughout this course, the couples go through physical, financial, and especially emotional challenges. The most challenging difficult time in the entire process is the two weeks waiting period after an embryo transfer.The final stage of a very long process. Some patients may not get to this stage for reasons such as no eggs were retrieved, or there was no fertilisation of the eggs, or the embryos did not develop to astage suitable for transfer.After embryo transfer, Patients experience a lot of anxiety, fear and in some cases, depression. They worry about the outcome of their journey and what they should or shouldn’t do to have a positive result. Today we will discuss some of the common concerns and questions these couples have and proffer answers.
Most couple wants to know if and when they can have sexual intercourse after an embryo transfer. Implantation failure is the most crucial cause of IVF failure. Some reports suggest that intercourse due to deposition of sperm in the reproductive tract during the process after embryo transfer period might improve pregnancy rates, but this has not been the case.
Intercourse increase uterine contractions, which could interrupt or disrupt embryo implantation. Therefore, intercourse during the window of implantation could negatively impact pregnancy outcomes, and patients advised to abstain from sex until pregnancy has been confirmed.
Spotting or light bleeding
Light spotting is relatively common. According to available research, it occurs in seven to 42 per cent of IVF cycles. Women may experience light spotting after egg retrieval, embryo transfer, or later in the luteal phase.
While you should report any unusual bleeding to your doctor, spotting alone is not necessarily bad. Spotting that occurs halfway through the two-week wait may be due to what’s known as implantation spotting. Another possible cause for spotting is progesterone support given via vaginal suppositories. It can cause the cervix to be extra sensitive and manifests as brownish-reddish vaginal discharge. Always call your doctor when you experience heavy uncontrolled bleeds, as medical assistance is quite necessary.
When cramping occur following embryo transfer, many women may feel worried. It is because these cramps are similar to the ones most women have during their menstrual cycle. It can cause a great deal of anxiety and fear that the treatment has failed. But today we tell women that this not the case because cramping can be a sign of successful implantation. Some women experience it while some do not. One should only be worried if cramping is intense and associated with heavy bleeding. In this case, it is advised to seek then the attention of the fertility specialist as soon as possible.
There have been conflicting notion on whether to be on bed rest or to be mobile after an embryo transfer. Traditionally, bed rest is recommended for women after any medical procedure. Still, in this situation, once a woman gets home post embryo transfer, there is no need for full best rest. Staying in bed does not increase the chance of implantation.
We advise that you take it easy for a day or so, and by this, we mean no strenuous activity or vigorous exercising. You can carry on your daily life as you usually would, which includes going to work and subtle house chores. Carrying on your usual routine as much as you can also help keep your mind off the ‘two-week wait’ before your pregnancy test. A recent study showed that there was more conception in patients who continue their daily activities after embryo transfer compared to those who when on bed rest.
The entire process of IVF itself is very stressful, and one can appreciate why. There is no need to stress over an already stressful situation, and the good news is that research has shown that you cannot stress yourself into a negative pregnancy test. It merely means that anxiety or stress is not associated with IVF outcomes.
That being said, women still go through some anxiety and feeling of being alone during these two weeks’ wait. Such women are advised to reduce fertility treatment stress by joining support groups, reaching out to understanding family and friends, and teaching their family and friends how to support them. Some who go through depression can seek counseling.
Some women may experience pregnancy-like symptoms just before the end of the two weeks wait. These symptoms include tender/swollen breasts, tiredness, bloating, nausea, fatigue, and constipation. The truth is that having these symptoms doesn’t mean a woman is pregnant. Some women do not experience these symptoms, and yet they are pregnant. Pregnancy symptoms can be attributed to side effects of progesterone supplementation, the fertility drugs patients are given after transfer, and even sometimes even stress can induce these symptoms.