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I am about to have my egg retrieval as part of an IVF cycle. The clinic has sent me a long list of post-op restrictions similar to the ones I’ve been living under pre-egg retrieval, e.g., don’t exercise, don’t put anything in your vagina, and, for the post-op specifically, no water submersion. All of this feels completely arbitrary and based on no real data. Can you tell us what guidelines have real data backing them up and which ones are without justification?
—Anonymous
There are lots of challenges when undergoing an IVF cycle, including the disruption to your normal routines, like exercise or going in a hot tub.
Postoperative guidelines are meant to reduce your risk of potential complications. While some of the recommendations may seem arbitrary, there is a rationale behind them.
During the IVF cycle, your ovaries get a lot larger than they normally would be. After a retrieval, the ovaries are still quite large as the follicles we drained fill back up with fluid and blood. We know that ovarian torsion, meaning when the ovary twists over the ligament that also contains its blood supply, can happen when the ovary’s weight or size allows for it to flip. Ovarian torsion is most commonly seen when someone has an ovarian cyst, especially one over 5 centimeters. However, with the IVF process, your ovary itself might get to 5 centimeters (it’s typically about 2 centimeters). Not only is this incredibly painful, but it is also a surgical emergency requiring surgery to untwist the ovary and prevent it from being very damaged or, at worst, needing to be removed entirely.
The reported rates of ovarian torsion during IVF are quite low, ranging from 0.02% to 0.2% of cycles. However, I still caution my patients on vigorous exercise, like running, jumping, or heavy lifting, which provides a way for the ovary to bounce and twist right over that ligament. Sex is also off limits, as it could also cause the ovary to twist. Exercise that doesn’t involve running, jumping, or twisting is something you can do, like a walk or light stretching. These limitations are only temporary, and once you get your next period, you can go back to your usual routines.
The recommendations regarding water submersion or having anything in the vagina are related to the risk of infection. Reported rates of infection after an egg retrieval are extremely low. One retrospective analysis of over 26,000 egg retrievals found a very low rate of infectious complications, around 0.04%. The way we think infections occur is through contamination from bacteria in the vagina. While the needle used in an egg retrieval does not create a large place for bacteria to seep through, there is still a potential risk, albeit very low.
Risks of certain complications also change based on other potential conditions a patient may have. Those who have PCOS typically have a lot of eggs retrieved, meaning they would have very large ovaries and a higher risk of ovarian torsion (this is possible even if a patient doesn’t have PCOS and just has a large ovarian reserve). Some patients may have a history of pelvic inflammatory disease or endometriosis that may increase the risk of bleeding or infection.
Complication rates of egg retrievals are overall low, and the timeline of these restrictions is limited. To avoid any delay in getting to the next step, usually an embryo transfer, I’d try to adhere to these precautions, knowing there is some wiggle room — while running or a high-intensity workout class may be off the table for another week or so, a long walk is not.
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