DAY OF EMBRYO TRANSFER
The Scoop On Acupuncture
This post was updated to reflect the most recent clinic policies at various Twin Cities fertility clinics as of September 30, 2018. Because each of the clinics in the Twin Cities does it slightly different you'll see that certain parts of this post are now divided up by location and cycle type to make it less overwhelming/confusing!
Since the start of my practice in 2006, supporting women who are undergoing IVF (In Vitro Fertilization) on the day of their embryo transfers has been one of the most special and rewarding parts of my work. It is the day you have worked so hard for and been through so much to get to. I am touched you would consider inviting me in and thrilled when you do!
If you are considering acupuncture on the day of your embryo transfer, here are the basics you need to know and consider, as well as some extra layers if you want to dig in deeper.
What, when, why.
In an IVF, acupuncture is often done the day that the embryo(s) are put into the woman's uterus. In most studies - I'll cover more on the research in a bit - acupuncture is done twice. Once before the embryo transfer, then again after (within 24 hours on either side). So two acupuncture sessions done relatively close to one another are the norm in studies.
" It's okay to feel good about doing what is right for you. "
Based on the studies (read on for links and actual stats), it'd be nice to do some sort of acupuncture relatively soon before and after the embryo transfer. In the real world this boils down to having as many options to choose from as possible and then picking the ones that actually sound like they would make you feel more supported, balanced, and sane. And in turn, skipping the ones that make you feel like a desperate crazy person who is running around doing what a study tells them to do while losing your mind! I have done day of transfer care for MANY years and MANY women. I don't see one magic version that trumps the rest. It's okay to feel good about doing what is right for you.
Should acupuncture be appealing, I plan my normal patient schedule under the assumption that I'll be doing a fair amount of on-call acupuncture for day of embryo transfers as I've averaged about 1 - 2 per week for most of my career.
Mondays 9 - noon
Tuesdays 9 - 3p
Wednesdays 9 - noon
Thursdays 9 -3pm
*NOTE from Oct. 1 2018 - Jan 15 2019 I will be more limited in my Tuesday and Thursday availability. I am working on a project that will be scheduled during these days.
I do prioritize patients that I have been working with and have seen at my clinic, and only add a set number of additional 'stand-alone' IVF patients per month. If you are only looking for day of transfer care, feel free to reach out, but know that I may need to refer you if these spaces are already filled. I'll provide you with a list of acupuncture providers that go to your clinic if I cannot make your date work!
If I can make your date work or you are an established patient, but my schedule and your exact timing doesn't work for any reason (some clinics don't assign times until the day before transfer and sometimes the date moves around based on lining concerns), we will chat about blocks of coverage and alternative options including:
Seeing me at my office before or after you go to your IVF clinic
A house call
My backup (Gina Fabiano of HealOM) or another acupuncturist filling in
*Stick on needles that you take with you
*I use stick-on needles for POST sessions fairly often (see more under your individual clinic's name to read why these might be the best route for you). These needles are very short (1.2mm) 36 gauge needles (the same gauge I use for my full acupuncture needles - but a much more shallow insertion). They are attached to a band-aid like piece of tape to hold them in place which sounds odd, but is actually quite comfortable! You can see a video of them here. You trade slightly larger needles (depth, not width) with shorter retention time for shorter needles but longer retention time (these sticker needles can stay on your body for anywhere from 4 hours to a week depending on where they are and how well you're liking them).
If you do utilize stick on needles YOU remove these needles at home (we'll discuss details and I'll email you all the info you'll need to know).
Why might acupuncture be right for you.
As I mentioned, there is some great research showing that it can be helpful. In general, the average of the studies seems to show about a 10% increase in success of those doing acupuncture vs not. Acupuncture can help improve outcomes by normalizing hormones, improving uterine blood circulation, and relaxing the cervix so the transfer is smoother. Those who seem to benefit the most from acupuncture during their cycles are those who are "poor responders" and those who do even more customized acupuncture (whole systems acupuncture) leading up to their IVF. So if you are reading this enough in advance to start a month or two prior to your IVF, even better. If not, there's no time like the present! At Life Healing Life my day of embryo transfer success rates are over 80 - 90% for patients we have worked with me in advance (fresh and frozen cycles vary), and between 60 - 75% for those I only see on the day of transfer (again with frozen having better results than fresh). This is a really big deal which I attribute not only to the acupuncture - as the research shows that's just a 10% boost over the clinic success rate - but to everything else I add into the typical protocol. Acupuncture is the base, but there are so many ways additional to make it even better!
" Doing acupuncture should make you feel more supported, more relaxed, more empowered, more sane. "
One thing I really stress with prospective patients is there are a few studies where acupuncture seemed to acutally decrease the odds of success. In every case, the conclusion of the study says that the stress of the extra running around, fear of needles, having acupuncture done by a stranger, etc canceled out the good of the acupuncture and then some. So if this applies to you, don't feel bad about saying no to acupuncture. I've even talked some women out of doing acupuncture when I realized they were very stressed about it. I wouldn't feel comfortable seeing them, because my Hippocratic oath is to "do no harm."
So really consider this - doing acupuncture should make you feel more supported, more relaxed, more empowered and more sane.
What makes Life Healing Life the BEST day of transfer care around.
Most other clinics do little to none of these extra layers that I consider a MUST:
Pre-Transfer Education - You'll get both in-advance and on-site education - from what to expect on the big day, to bladder prep basics, implantation and embryology 101, and how to cope with the pressures of the two week wait and beyond. If we haven't worked together we will be sure to do a phone consult in advance.
Consistent Communication - I spend 2 hours per day communicating with patients between visits. I check in the day before transfer with prep info, the morning of to confirm I'm on my way, after the transfer with an email follow-up filled with resources and reminders for self-care, and in the 2 week wait to see how you are holding up. If you let me know you have had success I've even got an early pregnancy after IVF packet I'll send your way!
The Little Things - From candles and dim lights, to music and massage. Undeniably, an IVF transfer is a scientific wonder, but it is also about a couple's love and welcoming a baby into a woman or couple's life. I like it to feel like both!
Customization - My success rates are higher than most acupuncturists because I never stop with a protocol or one-size-fits-all approach. I start with the foundation of IVF transfer support, but always add layers that serve the individual. Every transfer is uique and personal.
If you can't work with me, there are some ideas I want every woman and couple to have.
Locations and Schedule Overviews
CRM - Chicago Ave, Minneapolis
Logistical Important Notes:
CRM does not assign their transfer TIMES until the day prior to transfer. This means once we know your DATE we line up BLOCK coverage... For example: We know your transfer is going to be on a monday but we won’t know the time until Sunday afternoon. So, we figure out the blocks of coverage options. Let’s say perhaps on this particular monday, from 9-noon I can be on deck to go to CRM (Block 1), from noon to 4 my backup Gina can go to CRM OR you could come into the office and get a treatment from me there. in the morning and use take home sticker needles (Block 2) and from 4-6 neither one of us can be at CRM so you could come to the office earlier or arrange for a house call the next day, etc (Block 3)... On the day before your transfer when you get the phone call with your actual time we confirm the exact arrangements.
CRM is the busiest clinic in the Twin Cities. Their transfer times can be anywhere from early morning to late afternoon and even occasionally the evenings.
CRM does not allow POST transfer acupuncture on site. This means stick on needles will work best for POST sessions if CRM is your clinic. If you prefer a POST session at my office this can occasionally work depending on the day of the week, but I actually think for most people the extra running around adds to the stress and generally encourage stick on needles and going directly home to rest and watch some funny movies!
The REs at CRM rotate doing retrievals/transfers from week to week. Your assigned doctor may not be the one to do your transfer. If you want to know who will be there for your big day be sure to ask when they call you with your times.
Day of transfer Flow for On Site Acupuncture
Arrive 1 hour and 40 minutes prior to transfer - get signed in, use the bathroom one last time and sit tight. I'll come get you from the waiting room.
We'll have a private exam room, time for education, Q&A and needles. You take valium during this time and drink water - I'll prompt you and coach you if you have questions or concerns.
I'll remove needles 1/2 hour prior to transfer when the nurse will come to admit you.
If you are doing stick on needles for the POST points I will place those stickers on your body after I remove the first set.
1/2 hour prior to your transfer time a nurse brings you back to the IVF side of the clinic and gets you ready for transfer.
10-15 minutes of laying down in the transfer room, then get up and use the bathroom.
Either go home for more R&R (with or without the stick-on needles for your post points), or drive just 3 blocks to the Life Healing Life clinic for the post session.
CRM can be a slightly challenging clinic to schedule day of transfer care for because a) they don't assign their transfer times until the day before by 2pm, b) they do transfers from early mornings to later afternoons and sometimes even early evenings so the range can be, and c) they dont' have a room for acupuncturists to do post sessions on site. Many acupuncturists have discontinued offering day of transfer care at CRM because of the logistical challenge. I still think transfers here can be amazing and worthwhile and promise to do my best to offer as many options as I can, but please know that they may be limited, especially if your transfer time is later in the afternoon or evening. I encourage CRM patients to share their feedback and desire to make acupuncture a part of ther transfer care with CRM. If they get enough feedback they may consider making their process more holistic-friendly in the future. For now, we make it work just fine!
CCRM - France Ave, Edina
Logistical Important Notes
CCRM is by far the most supportive of holistic care and day of embryo transfer acupuncture. They've done a great job of incorporating acupuncture and making it a part of their day of transfer care. That said, because the acupuncture is a part of their flow there are several moving parts that overlap with the PRE acupuncture session (a blood draw at check in, vitals taken, nurses instructions, meeting with embryology staff, several rounds of consent forms, bladder check etc. all overlap with the acupuncture window. Because this cuts into our time to do education and Q&A on site, I do require all CCRM patients to do an educational phone consult (for no additional charge) prior to transfer. If possible partners are encouraged to listen in on this call too.
CCRM has very high standards for final lining checks. Although we have the DATE in advance, it is helpful to know that about 25% of CCRM's transfers actually get moved further out due to lining concerns. Once a final lining check results in an official green light for transfer you will get your transfer TIME (usually this is about a week ahead of time). This makes the DATE harder to pin down in advance, but the TIME and exact coverage super easy once the lining check is good to go.
CCRM generally does their transfers in a fairly small window from midmorning to early afternoon. There are occasional exceptions (more likely on weekends). This may change as the clinic brings on more doctors and gets busier, but as of summer 2018 this is the window for transfers.
Unless you have been told otherwise due to travel/vacation plans your doctor will be the one to do your transfer at CCRM.
Day of transfer Flow for On Site Acupuncture
Arrive 1.25 hours prior to transfer and have blood work drawn.
You are brought to the one room you'll be in the rest of the time for the pre session.
The nurse will go over instructions and take your vitals, you will be given your valium, you will change your clothes to a gown, an embryologist will give you an update and you will sign several consent forms - the order of this varies depending on the clinic flow sometimes acupuncture starts AFTER al of these, sometimes they are woven together.
When I'm given a window to do so based on the above, I'll put needles in and we do the pre session while you sip water and your valium kicks in - I'm happy to guide you if you are concerned with pacing drinking water/bladder prep.
I'll remove needles about 5 minutes prior to tranfer.
If I cannot stay for the POST I will place the second set of stick on needles in here.
Your bladder will be checked.
Empty your bladder if you’d like (they will offer you a bedpan, you are not allowed to get up for 1/2 hour)
If you are doing the regular needles for the POST session, we'll get started after you empty your bladder. The post session acupuncture will be timed to be done right at your discharge time, which is 1/2 hour after your transfer. If you use the bedpan our POST session will likely be closer to 15-20 minutes with needles in. We can discuss this further and weigh the pros and cons of doing the stick on take home needles instead.
If you have the stick on take home needles you will still rest for 1/2 hour total post transfer and then be allowed to go home.
Home for R&R.
CCRM is a big advocate for acupuncture and will even prescribe it for some patients with uterine blood flow concerns, so they're completely down with both the pre and post and make it easy! I encourage you to tell them that you appreciate this if it makes your day feel less stressful and more personal so they can know their choices make a positive impact on your experience and big day!
RMIA - Woodbury or Edina
Logistical Important Notes
RMIA is very supportive of the idea of doing acupuncture but hasn't incorporated it into the flow into their transfer process so it is tacked on WAY before and then again after in a bit of a more cumbersome way. They want acupuncture to be completed a full HOUR prior to transfer. RMIA is also the furthest from my office/home, so travel time is a factor... these two things translate to a full PRE and POST session at RMIA taking 4.5-5 hours and so it is rare for me to be able to make a full PRE and POST work with my schedule unless they are on a Tuesday or Thursday and I do not have any other IVFs at other clinics. Doing either a PRE with stick on needles or a PRE at my office the day before and a POST at RMIA more likely.
RMIA also does more FRESH transfers than the other clinics and so often the way we find out the DATE of the transfer is by knowing when the trigger shot is scheduled (then transfer will be either 3 days or 5 days later).
For FETs RMIA will give their DATES for transfers in advance and they don't tend to move them that often.
The TIMES are assigned anywhere from a week to a few days prior to transfer.
Unless there is a vacation/travel conflict, your doctor will usually do your transfer at RMIA.
RMIA will tell you that there is a chance they will not have a bed for you to receive acupuncture and that they do not know if they will or not until you arrive. THEY ALMOST ALWAYS DO have a bed (either in an ultrasound room or in the recovery room). If they do NOT, they will offer a reclining chair in a curtained off area where they used to do blood draws. We can still make this very cozy. I have had to use the recliner option a few times over the years. It can be just fine if need be.
Day of transfer Flow for On Site Acupuncture
Arrive 2.25 hours prior to transfer, get checked in, use the bathroom one more time. I'll be set up and the nurse will bring you back to me.
We have ample time for some education and Q&A, then you'll get needles in for the pre session. You will sip water while your needles are in - I'll guide you.
Needles are removed 1 hour prior to your transfer. You will then go with the nurse to prep for transfer.
You will take your Valium AFTER you are with the nurse and have chatted with the embryologist - 1/2 hour prior to transfer.
You will rest 10 minutes, then empty your bladder and come back to me, or go home for more R&R (with or without stick-on needles for the post-transfer session.)
If we are doing the post session on site you will be done about 40 minutes after we start, which is about 1 hour after your transfer.
RMIA is in the middle as far as ease of scheduling goes. While we get dates in advance sometimes, they do more fresh transfers and we have to fly by the seat of our pants as to whether it will be day 3 or day 5 transfers. They also require acupuncture to start earlier and be done a full hour in advance of the transfer, so doing a full on site pre and post takes quite a large window of time. We will talk more details once you get your exact date / time and I'll do my best to give you what you want!
Important Stuff For All Locations
If you are communicating anything relating to your IVF, please always email me the info. My voicemail and texts occasionally do not get to me right away. They seem to get hung up in the ether and I occasionally do not receive a text for a day or two after it was left. This will not do for IVF!
If this info is helpful and you want to chat more, please send me an email at firstname.lastname@example.org and include your phone number and we can touch base and talk more. I'd love to be a part of your big day!
Disclaimer: These recommendations and ideas are based on my own practice and the fertility clinics I work most often with. Some variables exist and can be addressed once I know more about you, your cycle and which clinic you are working with. If you are looking at this information and are not in the Twin Cities or planning to work with me, I recommend you confirm or get more info from your actual provider and do not rely solely on this article.