What’s the Data Behind Pelvic Rest After IVF?

I had my first IVF transfer a few days ago, and the fertility clinic, along with several other online sources, says to refrain from intercourse or orgasm for anywhere from five days to “at least two weeks.” I have no history of miscarriage, bleeding, or other complications, and I successfully carried my first child to term two years ago. How solid is the research behind this recommendation?

—Anonymous

“Pelvic rest,” i.e. no sex or orgasm after embryo transfer, is a long-held practice that dates back to the beginning of IVF, and there haven’t been many updates to these recommendations in decades.

In some of the original protocols circa 1980, patients were not only recommended pelvic rest but also bed rest for up to two weeks. The concept makes sense in theory. Movement, intercourse, or orgasm can cause uterine contractions, which could cause premature expulsion of the embryo. Since then, though, abundant evidence in the form of multiple randomized controlled trials, as well as several systematic reviews, cohort studies, and patient series, all show that bed rest of varying durations had no impact on pregnancy rates.

One group even went so far as to do a study in which they placed an air bubble in the uterus where one would typically put the embryo, then had the patients get up and immediately walk around, then performed the ultrasound again to see if the air bubble moved. They found that the air bubble was in the exact same place after walking. Basically, whatever way we study it, there is no evidence to show any benefit of bed rest. However, there aren’t any studies looking specifically at pelvic rest and embryo transfer, IUI, or natural cycle success rates. So the pelvic rest recommendations are made purely in the absence of good data and are admittedly conservative.

Because there is no good data, common sense is the best we have. We know that people in the general population are doing strenuous workouts and having sex during the implantation window and are still having healthy pregnancies. While I would not advise doing two-a-day Barry’s Bootcamp or having hours of tantric sex immediately after embryo transfer, if you do have an orgasm or run up a flight of stairs, you are not hurting your transfer success rates.