The Two-Week Wait After Embryo Transfer
The two-week wait is the stretch between your embryo transfer and your pregnancy test. After weeks of appointments, scans and injections, everything suddenly stops, and there is nothing to do but wait. For many people it is the hardest part of the whole cycle.
It is rarely a full two weeks. After a day 5 transfer, most clinics test nine to eleven days later. But those days can feel very long, and every twinge feels like a sign. Knowing what is happening in your body, and what it does and does not mean, makes the wait far easier to live through.
On this page
What is happening
A day 5 embryo, a blastocyst, usually begins to hatch from its shell and attach to the lining of the uterus within a day or two of transfer. Over the following days it burrows in, and the cells that will become the placenta start producing hCG, the pregnancy hormone that a test detects.
None of this can be felt, and none of it can be helped along by anything you do. The embryo is far too small to fall out when you stand, cough or go to the toilet. Bed rest does not improve the chances, and some studies suggest it may slightly lower them, so most clinics encourage you to carry on with normal, gentle daily life.
The medication
Most people take progesterone through the wait, as a pessary, gel, injection or tablet, and sometimes oestrogen too. After a fresh cycle, the drugs used to grow the eggs leave your own hormone production out of step, and after a frozen transfer your body may not be making enough progesterone on its own. The medication keeps the lining ready for the embryo.
Take it exactly as prescribed, at the same times each day, and do not stop it until your clinic tells you to. That usually means carrying on until the test, and for several more weeks if it is positive. If you miss a dose, call the clinic and ask what to do rather than doubling the next one.
The day of your transfer
Set a recurring phone alarm for every dose of progesterone before you leave the clinic. With your mind on everything else, it is the easiest thing in the world to forget.
Symptoms tell you very little
Sore breasts, bloating, cramps, tiredness, mood swings and spotting are all common in the two-week wait. They are also exactly the side effects of progesterone. That is why symptoms in these days tell you almost nothing, in either direction.
Plenty of people with every symptom get a negative test, and plenty with none at all get a positive one. If you can, let the symptoms come and go without reading anything into them. The test is the only answer.
When and how to test
Your clinic will give you a date for a blood test, usually nine to eleven days after a day 5 transfer. The blood test measures the exact level of hCG and is the most reliable answer. Many clinics repeat it two days later to check that the level is rising as it should. If you are being treated abroad, the clinic will tell you how to have it done at home and send them the result.
Testing early at home can mislead you. If your cycle used an hCG trigger injection, traces of it can show as a faint positive for up to about two weeks after it was given. Testing too early can also give a negative when the pregnancy is simply not yet detectable. Most clinics recommend waiting for the test day.
The night before test day
Decide where you will be when the result comes, and who will be with you. Having that settled in advance means you hear the news, whatever it is, somewhere you feel safe.
Warning signs
Light spotting or mild cramps are common and usually nothing to worry about, though it is always fine to call your clinic. Call straight away, day or night, if you have:
- Severe pain in your abdomen
- Heavy bleeding
- A fever or feeling very unwell
- A swollen, tight abdomen, rapid weight gain, nausea and vomiting, or shortness of breath
The last group are signs of OHSS, ovarian hyperstimulation syndrome, which can develop or worsen after a fresh transfer, especially if you produced many eggs. It is uncommon with modern protocols, and very treatable when caught early.
Getting through the wait
The people I have seen cope best with the two-week wait plan it rather than simply enduring it. They keep busy with things that need some attention: work, if it is not too stressful, films, walks, a project, meals with friends. They decide in advance how much they will look things up online, and they agree with their partner how they will talk about it.
Gentle exercise such as walking and swimming is usually fine. Avoid hot tubs and saunas, and keep caffeine and alcohol to your clinic's advice. Sex is fine for some and discouraged by others, so follow your own clinic's guidance.
If the result is negative, give yourself time before deciding what next. A follow-up appointment with your doctor, once you are ready, is where you look at what the cycle showed and plan the next step together. Many people go on to succeed with their frozen embryos or a further cycle.
Frequently asked questions
When can I take a pregnancy test after embryo transfer?
Usually nine to eleven days after a day 5 transfer, on the date your clinic gives you. See when and how to test.
Is bleeding during the two-week wait a bad sign?
Light spotting is common and often nothing to worry about. Heavy bleeding or severe pain needs a call to your clinic. See warning signs.
Should I rest in bed after transfer?
No. Bed rest does not improve the chances, and normal gentle activity is encouraged. See what is happening.
Do symptoms mean I'm pregnant?
Not reliably. Progesterone causes the same symptoms as early pregnancy. See symptoms tell you very little.