One very sweet new patient came to me with a tearful story of her two-year struggle with infertility. After she had failed to conceive in her first year of marriage, her well-intentioned mother-in-law stepped in to offer some "advice". The mother-in-law was convinced that this patient was failing to get pregnant because she was not resting enough. So, in a radical move, the patient reluctantly quit her job and spent the better part of the past year at bedrest. She described how each cycle, after her ovulation test turned positive, she had gotten together with her husband and then obediently stayed confined in her bed, getting up only to use the bathroom, and even then, not without feeling a bit guilty for leaving the bed. Despite her faithful adherence to this rigorous bedrest regimen, and despite compliantly consuming the wide array of Chinese herbal concoctions that the mother-in-law thrust at her, her period would eventually come, bringing with it mixed feelings of sadness for not conceiving, yet some relief at being temporarily free from her confinement. After a year of this suffering with no results, she came for medical help. Ironically, it was her mother-in-law who had asked around, found my office, and had made the appointment for her.
While this woman’s story is one extreme example, it’s by no means the only example. Several women I’ve encountered have had it in their minds that the reason they are not conceiving is because they are not resting enough. So the question comes up of what exactly is the role of bedrest is in helping fertility. And my answer is NONE. Well, almost none. Bedrest is not necessary in order to get pregnant, either for patients trying to conceive on their own, nor for patients undergoing treatment with IUI, nor even for those doing IVF. In exploring this issue, let’s remind ourselves that there are two ways to get to the truth scientifically - LOGIC and EVIDENCE.
Logic dictates that being immobilized is not a normal human state. When women have sex while they are immobilized either due to spinal cord injury or leg fractures, there is no increased fertility observed. Also, understanding the mechanism of how the Fallopian tubes pick up the ovulated eggs would suggest that adopting a variety of different body positions could actually ENHANCE egg pickup by allowing the end of the tubes to fall into different locations at different times, exposing them to more possibility of picking up an egg.
Evidence from studies comparing bedrest after IUI and after IVF embryo transfers show no advantage of bedrest. There is one exception and that pertains to a short 10 minutes of bedrest after IUI. During IUI, the sperm is delivered as a volume of liquid into the uterus. By staying flat for 10 minutes afterwards, the sperm can disperse better. In my practice, we take it one step further by using our electric beds to tilt the patient upside down for those 10 minutes. Note that this principle does not apply to regular sexual intercourse. The difference is that with IUI, the sperm in inside the uterus already. Being upside down will help it flow into the tubes which is where we want it. With sex, the sperm is not deposited directly into the uterus, but rather just into the vagina. So going upside-down after sex merely results in the sperm pooling in the upper corners of the vaginal vault and not into the uterus. Even with IUI, after those 10 minutes of resting slightly upside-down, we encourage patients to resume normal activity for the rest of the day on.
What about bedrest after embryo transfer and IVF? Historically, when IVF first came out back in the 1970’s and 1980’s, patients were instructed to be at bedrest for days or even weeks afterwards. This was not based on any evidence, but just on playing it safe because we didn’t know better. Over the years, research studies have confirmed that prolonged bedrest after IVF is not helpful and might even be harmful, presumedly due to increased stress brought on by the confinement.
In my own practice, the approach is to have the patient stay home in a happy peaceful safe environment for the day of and the day after embryo transfer. The focus is on being at peace. By staying home, no unexpected things such as minor car accidents can happen. This probably is not necessary, but any attempts we’ve made to tell our patients to have no bedrest at all are met with violent protests, so we have just fallen into this routine and have great success rates to show for it. Bear in mind that for some patients, bedrest is very stressful and is comparable to being a prisoner isolated from ones favored usual daily activities.
I have a memorable example of a patient who underwent IVF four times (two fresh and two frozen cycles). Out of those four transfers, the patient, who is herself a doctor and in her residency, went on overnight call immediately after her transfers three times. Those were the three instances that she became pregnant and went on to delivery a single healthy baby each time. The one time where she was on vacation and decided to take advantage of bedrest was the one time she didn’t conceive. At the risk of offending any statisticians out there, I do not advocate drawing any scientific conclusions from this one isolated case. However, it’s fun to mention it.
One final exception is as follows. If you have a horribly hectic schedule and you want to experiment taking off one month or two, either vacationing in Tahiti or just being at bedrest, watching DVD’s and doing Sudoku puzzles, then by all means, give it a shot. Who knows? You might end up pregnant and make for a very good story. (Please share with me if this works). If not, don’t let your mother-in-law keep you at it for a whole year, because this would violate the first rule of getting pregnant, which is "If the way you are trying is not working, try something different".
Also, bear in mind, all this discussion pertains to getting pregnant, not what happens AFTER you are pregnant. Once you are pregnant, there are several situations in which bedrest is good, but that’s for the 2nd and 3rd trimesters - a whole different story.
Conclusion: Ten minutes of bedrest after insemination can be helpful in conception. All other situations (conceiving naturally, IVF cycles) do not benefit from bedrest.
By the way, the first couple with the strict bedrest was surprised when further investigation revealed that their problem was a sperm problem. They went on to have two IVF cycles, each time delivering a healthy baby. Everyone is happy now, especially the mother-in-law.