Eating pineapple, specifically the core of the pineapple, before and after an embryo transfer has become a very popular procedure amongst those women going through an IVF cycle. The pineapple has become an IVF symbol – from estrogen patches to socks and T-shirts, with images of pineapple making it to the homes of those trying to conceive via IVF. So how does pineapple improve the success rate of an embryo transfer procedure?, or does it?
Introduction
It is believed that pineapples are an implantation aid and that in order to increase the success rate of an embryo transfer during an IVF cycle, the patient should eat an entire pineapple. One of the recommendations is to cut the pineapple into 5 pieces and eat a piece of pineapple, including the core, for five days after the embryo transfer. Others recommend to eat a small piece of the core of the pineapple every day for 5 days leading to the embryo transfer and then again for 5 days after the transfer.
Background
Pineapples are rich in a group of digestive enzymes, or proteases, known as bromelain. Apparently, these enzymes have anti-inflammatory and anticoagulant properties that can increase the rate of implantation. Although the anti-inflammatory and anticoagulant properties of bromelain in living humans have not been scientifically confirmed, there is a lot of research showing how inflammation can negatively impact fertility.
Inflammation and Pregnancy
Inflammation, either caused by an autoimmune condition, infection, allergies, or another source, has been associated with infertility. Some of the most well researched immune response cells dealing with inflammation are T helper cells (also known as CD4+ T cells). There are two main types of these cells, T helper 1 (Th1) and T helper 2 (Th2). Th1 creates a pro-inflammatory response, while Th2 creates an anti-inflammatory response. They are both crucial during pregnancy. The inflammatory response is beneficial to the invading trophoblast (cells forming the outer layer of a blastocyst), and the anti-inflammatory response protects the fetus by balancing Th1 immunity and accommodating fetal and placental development. While the amount of Th1 and Th2 in a non-pregnant woman is relatively the same – a 1 to 1 ratio, the ratio between Th1 to Th2 changes during pregnancy. During a healthy pregnancy, the body must be able to shift to a relatively anti-inflammatory state to maintain the pregnancy. Studies show that for pregnancy to take place the female body needs to produce less Th1 and more Th2.
Can bromelain help with implantation?
There are a number of articles and reports proving and disproving the properties of bromelain and how these properties may affect implantation. According to a report published in 2016 by the Encyclopedia of Food and Health, bromelain has anti-inflammatory properties and is used to prevent postsurgical inflammation and trauma, as well as pain relief for those suffering from osteoarthritis and joint injury. The report also mentions that bromelain supplement is used to reduce the incidence of various cardiovascular disorders as it is an inhibitor of blood platelet aggregation - preventing the coagulation of blood. The report clearly suggests that bromelain, which is primarily found in pineapples, has anti-inflammatory and anticoagulant properties.
In addition, a study by Diabetologia published in 2002 looked at a number of proteases - a type of enzyme that specializes in breaking down proteins, to see their effects on the immune system. The study, which looked at trypsin, papain, chymotrypsin, and bromelain, showed a selective inhibition of pro-inflammatory cells (Th-1) but not anti-inflammatory cells (Th-2), and concluded by saying:
“ Proteases have pleiotropic immunological effects supporting an immunomodulatory potential for the intervention of chronic inflammatory diseases”
The Journal of Immunology published a study titled “Bromelain, from Pineapple Stems, Proteolytically Blocks Activation of Extracellular Regulated Kinase-2 in T Cells”, where they showed how bromelain blocks the activation of Th0 cells. Th0 are the precursors of Th1 (proinflammatory) and Th2 (anti-inflammatory), so in essence, it can be said that bromelain inhibits inflammation.
On the other side of the argument are those that claim that there is no scientific data justifying the benefits of bromelain. On an article published in 2019 by the New York Times, Dr. Tomer Singer, a reproductive endocrinologist at Shady Grove Fertility, was quoted saying that:
“ There’s no evidence in the literature that says consuming pineapple prior to an embryo transfer will improve implantation”
Likewise other articles claim that there is no scientific data showing whether eating pineapple core or taking bromelain supplements improves the chances to conceive. The article summarizes its review by saying that:
“ There are no published, peer-reviewed studies on the topic”
Embryo Transfer and Acupuncture
The idea of doing acupuncture before and after an embryo transfer goes back to 2002 when a German paper was published by Dr. Wolfgang E. Paulus. He was able to show that patients doing acupuncture (a protocol that became known as the Paulus protocol) before and after an embryo transfer had a success rate of 42.5% versus a 26.3% success rate of those not doing acupuncture.
Womb Warriors
Without disregarding the anti-inflammatory and anticoagulant properties of the pineapple, there are those who believe that the pineapple became an icon of IVF due to its sweet interior and thorny exterior. There’s evidence suggesting that those women who have decided to go through IVF to conceive are more loving and attached toward their children than non-IVF mothers. This loving tendency makes them very sweet and it’s usually compared with the sweetness of pineapple. IVF-mothers not only have the highest drive to motherhood, but they are also willing to put themselves through some of the most exhaustive procedures. Their willingness to get through hormone injections, vaginal sonograms, egg retrievals, embryo transfers, and the possibility of a failed cycle, makes them extremely tough. This toughness is usually compared with the thorny exterior of a pineapple. Known as “Womb Warriors”, these women are tough in the outside with pointy defense, but sweet in the inside. A common quote in some IVF forums:
“ Be a pineapple: Stand tall, wear a crown, and be sweet on the inside”
Conclusion
While the anti-inflammatory and anticoagulant properties of bromelain in living humans are inconclusive, there are some studies in animals and in human cells showing these properties. Whether eating pineapple core can help with implantation or not, pineapples contain high levels of vitamin C and can strengthen the immune system. In addition to pineapple there’s always acupuncture. Several studies have shown that doing acupuncture right before and right after an embryo transfer increases the implantation and birth rate.
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