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After Your IVF Procedure

What To Expect After Your Embryo Transfer

Dr. Ramirez discusses what to expect after the IVF Embryo Transfer:

The Day Of The Transfer

After we discharge our patients from our surgery center, we send them home with instructions to go about the rest of the day and ensuing two weeks with normal, reduced activity. There is no need to be on bed rest. All our patients have different medication protocols that they go home with.

The 8-14 Day Wait (often referred to as the “two week wait (2WW)”:

So we have now come to the end of the IVF procedure and the maximum that our technology can help a person to achieve a pregnancy. We are at the point where we have to wait to see if the next steps happen on their own. If a day #3 transfer was done, it will take approximately 7 days for the remainder of the process to be completed and for the pregnancy test to be positive. For that reason, I do my pregnancy tests at 8 or 9 days post transfer. For a blastocyst transfer, you only need three more days to get a positive pregnancy test.

I know that some clinics want to be absolutely sure so they wait for 14 days but the problem with that protocol is that an early chemical pregnancy will be missed, and in my opinion, it is important to know if a chemical pregnancy occurred or not. This event is important to know because it verifies that the patient can become pregnant with IVF and that the last steps the body needs to take naturally (implantation) actually occurred. With that knowledge the patient can be reassured that this treatment can work, that her body can do what it needs to do, and it is just a matter of getting a perfect embryo into her womb for her to be successful. The majority of chemical pregnancies occur because the embryo is genetically abnormal. It would be good to know that those last steps, those steps that are beyond our technology, can occur on their own.

Post Transfer Pains

The body is a fluid and dynamic structure and there will be many sensations that patients report during this period. Some will report many types of “pains”, some will have “cramping” and some will have “bleeding”. Most of these symptoms are not of any consequence but cause patients to needlessly worry.  Some doctors have referred to these “pains or cramping” as implantation related. That may be the case but no one knows for sure. Certainly with implantation, the uterus is undergoing changes and cramping tends to be one way that uteri react. So, if the timing is appropriate, namely at the point where implantation would be expected as described above, then these sensations could certainly be related to it. Of course, onset of ones period can also be heralded by cramping but this is usually accompanied by bleeding.  If adequate hormone replacement is given in the luteal phase of the process, then the period should not start until the medications are stopped.  That is the cause of the onset of the bleeding and cramping associated with a period; it is the withdrawal or abrupt drop in hormone levels.  Some will claim that this is the uterus “stretching or growing” but this could not be the case at this point in the pregnancy. The embryo is like a mere fleck of dust within the cavity and not big enough for the uterus to begin “growing.”

Some patients will experience sharp or stabbing pains, on the other hand, that may not be from implantation but more from the ovaries.  About three days after the retrieval, the ovaries will refill with fluid and this stretching of the follicles and ovaries certainly can cause “pain” in one side or both sides.  I believe this is the “pain” sensation that most patients have during this period of time. If this pain becomes severe and not relieved with simple pain medication such as Motrin, Ibpuprofen, Naproxen or others, then it could be a serious problem. Post IVF complications causing severe pain include Ovarian Hyperstimulation Syndrome (OHSS), Ovarian torsion (twisting), Ovarian hemorrhage, Ectopic pregnancy and Pelvic infection. If the pain is mild, then intervention is probably not required but if severe, it could be one of these serious medical problems that will require medical treatment because they could be life threatening. You should know, however, that these complications are very rare. On the other hand, if you have had a positive pregnancy test and these symptoms occur, impending miscarriage could be another source of cramping or pain.

Bleeding After Embryo Transfer

Bleeding within this period of time is also a very common complaint.  In my blog, “Women’s Health & Fertility”it is the most common subject searched and commented on (see “Bleeding After Embryo Transfer” for my post as well as my answers to all 229 questions from women all over the world regarding this subject)! In most cases, this is a very light bleeding (pink or red) or spotting. Some will refer to this as “implantation bleeding” although, I don’t think this can explain all of the causes because the timing is often not right. Again, in most cases this bleeding is inconsequential but it could also indicate problems such as inadequate hormone support for the luteal phase, thereby causing the endometrial lining to start to slough.  It could also indicate that the period is starting or that an abnormal pregnancy exists or is being miscarried. When the bleeding is light, I usually will reassure my patients that no intervention is required.  For one, there is no intervention that can be done, other than checking hormone levels and increasing the progesterone if the level is inadequate.  Secondly, this could be normal, if in fact it is implantation bleeding.  Thirdly, if vaginal progesterone is used, the progesterone may be causing the cervix to be more delicate or friable and therefore cause cervical bleeding. This is the most common reason in my opinion though this is unproven or based on studies.

One cause of light bleeding that does need medical attention is when it occurs after the pregnancy has already been diagnosed. This bleeding may be a sign of an ectopic pregnancy (pregnancy in the tubes, ovaries or elsewhere but not in the uterus).  Your doctor needs to be made aware of this if you have already been diagnosed with a positive pregnancy test.  In my experience, where I use vaginal progesterone on all patients, I see almost 90+% of them complain of some light bleeding.

The only worrisome bleeding is if the bleeding is heavy like a period or more. This could mean that the period is starting, because no implantation occurred or could be an early miscarriage if it did. It can also occur in a multiple pregnancy, such as a twin, if one of the fetus’ is lost. When we went through IVF over a decade ago, my wife also had heavy bleeding after our IVF cycle. It occurred at about 8 weeks gestational age and was very heavy, with large clots. I was sure that she had lost the pregnancy but an ultrasound showed that the pregnancy was still there and viable. She went on to have a successful pregnancy and delivered a beautiful, normal and smart daughter.  I never did figure out what this bleeding was from. So if bleeding occurs, it is not necessarily indicating the end of the pregnancy. There are other medical causes of bleeding once the pregnancy is established, but that would be a totally different topic and is more pregnancy related than IVF related.