Written by Laura Cooke
In vitro fertilization (IVF) treatment can be an emotionally taxing process, with hormones running high and hopes hanging in the balance. It’s no surprise, then, that the two-week wait between having an embryo transfer and taking a pregnancy test can leave your nerves totally shredded.
People undergoing IVF understand that there’s no guarantee it will lead to a successful pregnancy, which is where much of the anxiety comes from. The chances of an embryo transfer leading to a live birth range from 28% to 79%, depending on the quality of the embryos.
Following your egg collection, the fertility clinic will have graded your embryos for quality in line with the embryo grading chart. They should have explained where yours sits on the chart and — if you have more than one embryo — which one they have chosen to transfer. Remember that factors such as the age of the parents determine an embryo’s quality, and preimplantation genetic testing will be taken into account if you’ve chosen to have it.
In those tense two weeks following your embryo transfer, you may find yourself scrutinizing every twinge, hoping for an indication that the treatment has worked. That’s a completely normal reaction, but if possible, try to keep your cool. Instead, remember that although some people who’ve had a successful embryo transfer may display symptoms of early pregnancy in the first couple of weeks, such as bloating and nausea, others don’t experience anything at all.
“There is no one symptom that has a 100% correlation to a successful implantation,” explains Tiffanny Jones, MD, a practicing endocrinologist and fertility specialist in Dallas, Texas.
It gets more complicated because fertility drugs can make it harder to spot telltale signs of pregnancy. “Fertility drugs during a transfer are composed of the same hormones [that arise] during a natural menstrual cycle and early pregnancy,” says Dr. Jones. As a result, this cocktail of medications — designed to stimulate egg production and prepare the body for receiving the embryo — can lead to side effects that mimic the signs of early pregnancy, such as tiredness and sore breasts.
While Dr. Jones advises it’s best to be “cautiously optimistic” while you wait between transfer and test, she does point to some positive signs that may indicate that your embryo transfer has been successful. But again, it’s worth remembering that if you haven’t noticed any of the following, it doesn’t necessarily mean your IVF treatment hasn’t worked. Every person is different, and our bodies work in very different ways.
Watch out for sore or enlarged breasts, as this can be one of the very first signs of a successful embryo transfer. “Breast tenderness typically happens early in pregnancy. [Although] some women also have cyclical breast pain due to changes in their hormone levels during their menstrual cycles,” explains Dr. Jones. It could also be caused by the estrogen you’ve been taking for your IVF cycle, so this may not be a reliable standalone sign of a successful transfer.
A small amount of blood in your underwear or noticed when going to the bathroom may be caused by the embryo embedding itself into the lining of the uterus, signaling the start of a pregnancy. “Some patients may have spotting about a week after a transfer. That can be due to implantation,” says Dr. Jones.
Confusingly, however, spotting after an embryo transfer may not always be a good sign. If you experience it, try to stay calm and contact your health care provider if you have any concerns. “Bleeding can, in some circumstances, also be a sign of an unsuccessful transfer,” Dr. Jones explains. “Bleeding at the start of a period can signify a loss of progesterone, which occurs when implantation has not taken place.”
Alternatively, it’s very possible that spotting in this two-week period has only occurred as a result of the IVF hormones you’ve been taking throughout your cycle. In short, while it could be a good sign, some light bleeding may not be the best standalone indication of a successful (or unsuccessful) transfer.
If you feel bloated in your lower abdomen, similar to the feeling you may have at the start of your period, then this may be another positive sign. That’s because progesterone levels rise in early pregnancy, and as Dr. Jones explains, “Progesterone is known to cause symptoms of bloating.”
However, it’s important to keep an eye on any bloating, particularly if it’s coupled with pain. While rare and unlikely, this combination of symptoms can be an indication of ovarian hyperstimulation syndrome (OHSS), a potentially serious condition that occurs when the ovaries swell due to excess hormones from injectable fertility medication. Severe OHSS only occurs in 0.5% to 5% of IVF patients. If you think you may have OHSS, you should seek medical attention immediately.
A common sign that your period has arrived, mild cramping can also be an encouraging indication that an embryo transfer may have been a success. Some people experience cramping during early pregnancy as progesterone causes the muscles and ligaments to become looser and more flexible to accommodate a baby.
It’s pretty unpleasant, but nausea can be another sign of a successful transfer as your body starts to feel the effect of pregnancy hormones. It’s worth noting that nausea caused by a successful embryo transfer is not the same as regular nausea and vomiting in pregnancy, which usually doesn’t kick in until four to six weeks into pregnancy.
You may notice an increase in vaginal discharge following your embryo transfer. This increase is common in early pregnancy as it helps to prevent any infections from traveling from the vagina into the uterus. Healthy vaginal discharge is thin, clear or milky white, and with only a mild smell. If you have concerns about unusual discharge, be sure to speak to your doctor.
Fatigue is something that a lot of people experience in early pregnancy, and this can start from day one, thanks to a steep rise in progesterone levels. So if you’ve found yourself nodding off in front of the television earlier than before, there’s a chance it could be a promising sign of a successful embryo transfer.
Don’t lose hope if you haven’t experienced any of these symptoms. It is possible to have no symptoms whatsoever after an embryo transfer and still be pregnant. In fact, it’s very common, according to Dr. Jones. “Most women will not have noticeable signs of a successful embryo transfer,” she says. “Not having breast tenderness, spotting, bloating, nausea, etc. does not mean a transfer was unsuccessful.”
You’ll need to wait around two weeks before taking a pregnancy test following your embryo transfer, although your clinic may advise slightly differently depending on your circumstances, so you should follow their guidance. It may feel like two of the longest weeks of your life, but medically there’s a good reason why you should wait to take a test.
Pregnancy tests search for human chorionic gonadotropin (hCG), a hormone that’s only produced in pregnancy. It starts to appear once the embryo has implanted, and the hCG levels build over time. Testing too early (before these levels have had a chance to rise) may lead to a false negative.
“Human chorionic gonadotropin can be reliably picked up in the blood as soon as days post embryo transfer. For a test to become positive — whether it be a blood or urine sample — the concentration of the hormone has to reach a certain threshold. Testing too early can lead to a patient stopping medications that are supporting a pregnancy too soon,” Dr. Jones explains, adding that prematurely coming off medications may result in a miscarriage.
There’s also a chance that testing too early could lead to a false positive in some patients. This is because hCG is used to trigger egg maturation during IVF cycles, so if it’s taken too early, a pregnancy test may pick up the hormone due to this and not because it’s a sign of pregnancy.
“Some patients undergo a fresh transfer 3 to 5 days post egg retrieval. In those patients, testing too early could lead to a false positive test due to lingering hCG in the blood and urine from the trigger shot,” says Dr. Jones.
Discovering that your fertility treatment hasn’t worked can be deeply upsetting, whether it’s your first time or not. So be kind to yourself and know that whatever feelings you may be experiencing — grief, sadness, frustration, anger, or something completely different — are totally normal.
Once you’ve taken the time you need to accept it, if you feel ready to, you can go back to your health care provider to review the cycle and discuss what other options are open to you. If you’re struggling emotionally, you may wish to seek counseling and support from a therapist or from loved ones. Some global organizations you could look to for support include:
- Resolve (US)
- The Fertility Foundation (UK)
- Access Australia
- Fertility Matters (Canada)
It can be very hard not to analyze every ache or change in the days and weeks after an embryo transfer, and nobody can be blamed for looking for answers. But remember that no symptom — or lack thereof — is a firm indication that you are or aren’t pregnant. So try to maintain that “cautious optimism” that Dr. Jones suggested, lean on your loved ones throughout the waiting period, and soon enough you’ll be able to take a test to find out for certain if your IVF embryo transfer has been successful.