By Dr David Wilkinson, fertility specialist at City Fertility Melbourne
After an embryo transfer, one of the most significant milestones is waiting for your pregnancy test result. Often referred to as the “two-week wait”, this period can bring a mix of emotions, including hope, excitement, anticipation, and uncertainty.
Understanding what is happening during the two-week wait, what symptoms you may experience, and when to take a pregnancy test can help you feel more informed and supported as you navigate this stage of your IVF journey.
These two weeks are considered the final phase of IVF. Called the luteal phase, it is the period of time between embryo transfer and the pregnancy test. These two weeks would be equivalent to the part of a non-stimulated 28-day cycle that happens between day 15 and 28.
Progesterone and/or estrogen medication are working in your body to help produce the same levels of hormones that would normally occur naturally in the early stages of pregnancy. These also help prepare the lining of the uterus for implantation. Once transferred, the embryo needs to implant itself into the uterine lining, usually on about day 20 of the cycle, and then continue to grow for pregnancy to occur.
One of the most common questions patients ask is whether they can take a home pregnancy test before their scheduled blood test.
It takes about 10 days for all traces of the hormone you used as the trigger to be cleared from your body, and in turn, for less than 10% of it to show up in a blood test. This is why we wait 14 days to ensure the new pregnancy is producing enough hCG (human chorionic gonadotropin) to be detected in a blood test. This is the most accurate indication of pregnancy.
It is important to note that this may not be the case for a frozen embryo transfer cycle, as the hCG trigger injection may not be used with all patients.
I do not recommend home pregnancy tests before the two-week mark, as they can deliver false results, both positive and negative. One reason for this is that the hCG injection given to mature and release the eggs, and as a booster, can give a false positive urine test, which only adds to the emotional rollercoaster. Two weeks is generally the point at which we can have confidence in the results, whether the patient has undergone a fresh or frozen embryo transfer.
During the two-week wait, it is common to notice physical and emotional changes as the hormone medication given to you to optimise your body for pregnancy may be having an impact on you emotionally and physically. You may feel more prone to tears, anxiety and irritability. You may also experience some cramping, spotting or light bleeding, abdominal bloating, fatigue, and breast tenderness.
While any change can be alarming, they are usually fine and do not indicate whether you are pregnant. However, any extreme symptoms should be reported to your doctor immediately.
Although the waiting period can feel long, there are practical ways to support your physical and emotional wellbeing.
- Rest and take it easy for the first 24 hours after embryo transfer, then gradually return to your usual daily activities as advised by your fertility specialist.
- Avoid very strenuous or high-impact exercise unless advised otherwise by your fertility specialist, but continue normal daily activities and gentle movement such as walking.
- Eat a balanced, nutritious diet and stay well hydrated.
- Prioritise sleep and allow yourself adequate time to rest and recover.
- Practise relaxation techniques such as mindfulness, meditation, gentle yoga, reading, listening to music, or spending time outdoors to maintain your stress levels.
- Consider setting aside a short period each day to reflect on your thoughts and feelings through journaling or talking with a trusted friend, partner, or counsellor. This may help you stay aware of and process the range of feelings (such as fear and excitement) that often arise during this time.
- Reach out to your fertility specialist, IVF nurse, or counsellor if you have concerns or would like additional support during this stage of treatment.
With your obstetrician, you will determine the expected birth date for the baby. This is determined from the start of your last menstrual cycle. Your first pregnancy ultrasound is then usually scheduled for between 6 and 7 weeks’ gestational age.
If you have a negative pregnancy result, we will work closely with you to support you during this time. Your fertility nurse will advise you to stop your medications and you will meet with your specialist to review your past cycle and make a decision together on what the next best steps are.
The two-week wait often brings a mix of hope, excitement, uncertainty, and anticipation. Whatever you are feeling during this time is completely normal.
Remember that you do not have to navigate it alone. Your fertility specialist, nurses, counsellors, and loved ones are there to support you. Take care of yourself, be patient with the process, and know that support is available whenever you need it.
