Supporting clients through IVF

These days it's so common to have a client walk through your door who's either about to go through or has been through IVF treatment. It’s a path that many women have to take when planning a family or wanting to grow it further. It’s a time that must be treated with the utmost care and consideration.

Senior Educator for Polestar Pilates Australia and Senior Physiotherapist Jeni Guest provides an overview of the current research when it comes to IVF and how we should be working with these clients.

First, let’s look at the numbers to understand the impact. Last year 55,000 women in Australia underwent IVF treatment. Success rates have increased by around 18% in the past decade. With the number of women receiving IVF expected to continue to increase, it’s a good reason for us to be across how we support these clients through their journey.

IVF or Invitro Fertilisation is the medical science of joining an egg and a sperm outside of the body, and the viable embryo being surgically implanted into the female. The first IVF baby was born in the UK in July 1978, but it was through the 1980s, in Australia, that the developments of IVF expanded exponentially both scientifically and with more supportive regulations.

In a successful IVF fertilisation, it is after 12-weeks pregnancy, remembering there is an average of 40 weeks in total, that a pregnant mum is transferred to her own Obstetrician and cared for under the normal obstetric services.  

While there are key considerations for working with all pregnant women, and we’ll cover those first, there are also some really important things we need to know when working with women undergoing IVF, which we’ll take a look at as well.

Key Considerations for all pregnant women:

·       Get ultimate clearance from the treating reproductive doctor /obstetrician 

·       In most cases, ongoing exercise is recommended to ensure that the body is maintaining its equilibrium 

·       Keep this exercise impact gentle and monitored throughout the class and through the entire pregnancy.

For women undergoing IVF treatment, there are specific considerations:

·       It is recommended that a pregnant mum exercise four hours per week for optimal fitness without causing undue harm to her or the unborn baby. In 2006, The Obstetrics and Gynaecological Council of Australia recommended four hours of exercise each week, in the form of low-impact walking, swimming, Yoga or Pilates.  

·       During the two weeks from egg transfer and before confirmation of pregnancy, we must keep exercise low-impact, consistent and uneventful (nothing new) 

·       We must avoid torsion around the pelvic region, maintain skeletal alignment and limit any impactful shearing through the pelvic girdle. So to avoid a torsion force through the pelvis we must avoid any rotational load that causes a force opening through the sacroiliac joints or pubic symphysis (that’s the front centre joint of the pelvis (where the two pubic bones join with a small cartilage in between). This can occur when we overwork one of the oblique pelvic slings or work in a unilateral stance. For example, doing the standing leg pump with rotation on a duradisc, side lunge on the wunda chair or advanced side splits on the reformer with a light spring. 

We also need to remember:

·       The effects of the hormone Relaxin (which peaks at 12 weeks and 39 weeks of pregnancy) and the ligament laxity produced. Respect the ligaments throughout the process and the pregnancy.

·       Avoid overheating, so keep the room temperature controlled, consider adjusting the repertoire in the summer months, and keep cardiovascular impact and changes to a minimum 

·       At the point of egg retrieval in the IVF process, and two weeks after egg transfer avoid any high impact exercise through the clients’ pelvis

·       Ensure you tell your client not to do any running exercise (even if they are a runner). 

·       At the 12-week gestation, we will consider all our pregnancy precautions and contraindications thereafter.  

Other considerations that will be weighed up by women undergoing IVF, which are helpful for you to be aware of:   

·       The number of attempts the woman has had at conception thus far 

·       Ongoing options related to the mother’s age and remaining viable eggs / embryos 

·       The potential for multiple births (we all remember the story of Octomum who carried 8 viable embryos to term)  

Our approach to Pilates

With the above in mind, it’s important that we:

·       Avoid flat supine lying exercise after 20 weeks 

·       Avoid supine abdominal loading after 24 weeks 

·       Avoid torsion forces through the pelvis during egg harvest and embryo transfer phases 

·       Respect the hormonal ligament laxity  

·       Take a good history of your client 

·       Explain to your client, your own understanding of the IVF journey and why we may control some movements  

Exercise program

This means that like with pregnant clients we are avoiding any advanced work, no inversion or supine abdominals and no exercise which could potentially cause a Valsalva breath hold (when you breathe out of your mouth and block your nose).

At the time of IVF injections, ligament laxity increases, so it’s important that you ensure stability and work through smaller ranges of movement. Some women may also choose to take a break from exercise during this time.

Working with new clients versus existing clients

Always remember to take a good history of your new clients.  

If it is an existing client, who then starts IVF, be aware of the phases of their cycle and support them through those. The advantage you have here is that you have already taught them the fundamentals of the Pilates Method. 

If someone arrives to class and they are a first-timer and they are undertaking IVF, they must have a Specialist’s approval to begin. It would be best to ask them to have an initial appointment with you first, for the safety of themselves and the foetus. 

Feel comfortable knowing that quality Pilates is a viable option for women undertaking IVF and pregnancies. As an instructor, stay faithful to your knowledge, your understanding of precautions and contraindications and your awareness of the fundamental principles.  

Supporting those taking multiple rounds

Whether they are undergoing multiple rounds of IVF or perhaps they are trying for a second child, we want to maintain the same approach for any pregnancy, however, we may look to reduce the load generally speaking if a woman is having twins, triplets or more, as they can potentially overheat more easily.

Supporting clients going through a miscarriage

This will be a delicate time for a client and so if they share this with us, it's important that we show them support and encouragement at this time. In my own view, I’d look to be really careful with them. I wouldn’t recommend that they stop exercising because you want the body and movement as regular as possible.

Our role as practitioners is to help guide, encourage and support these clients. If nurtured they can become long-term clients. Remember it’s o.k. if you don’t have all the answers; you aren’t their obstetrician. We need to encourage them to get advice from their obstetrician and keep us up to date on any developments so we can best support them over this crucial time.

Jennifer Guest is a Senior Educator Polestar Pilates Australasia and Senior Physiotherapist Smart Health, South Australia.