Common Concerns About the Post-IVF 2 Week Wait

Cramping after embryo transfer, bed rest, sex, and other questions

woman lying on bed reading a book with her doc
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Both IVF treatment and the two-week wait afterward are stressful. You may be hyper-aware of everything going on in your body, worrying about every cramp or odd twinge you feel. You're also likely to have many questions. Are cramps after an embryo transfer a good sign or a bad sign? What about spotting? Are there IVF early pregnancy symptoms to know about? We've got answers to these common questions.

Cramping After Embryo Transfer

Cramping can strike fear in the hearts of some IVFers and hope in others. Fear, because they worry this is a sign their period is coming or that maybe the cycle has failed. Hope, because maybe cramps are a sign of implantation and maybe they're pregnant. Here's the good and bad news: mild cramping and pelvic discomfort are very common. Cramping during IVF shouldn't be seen as a sign of your coming period nor as a possible sign of pregnancy.

The medications and procedures of IVF make quite an impact on your reproductive organs. Fluid buildup around the ovaries can cause pelvic tenderness and bloat, and this tenderness will likely continue until your period comes. If you get pregnant, the pelvic discomfort may go on for a few more weeks.

Also, the egg retrieval procedure and the later embryo transfer can cause slight cramping in the days immediately after. While mild to moderate cramping can be normal, call your doctor if the cramping is not relieved by over-the-counter pain medications.

When to call your doctor: If the cramping is especially severe, accompanied by heavy bleeding or feelings of nausea, contact your doctor right away. These may be signs of ovarian hyperstimulation syndrome (OHSS) or ovarian torsion. These conditions require immediate medical attention.

Spotting or Light Bleeding

Light spotting is relatively common.

According to available research, it occurs in 7 to 42 percent of IVF cycles. You may experience light spotting after egg retrieval, after embryo transfer, or later in your luteal phase.

While you should report any unusual bleeding to your doctor, spotting alone is not necessarily a good or bad sign. Spotting that occurs halfway through the two-week wait is sometimes attributed to what's known as implantation spotting. Implantation spotting is said to be caused by an embryo implanting itself into the uterine wall.

Another possible cause for spotting is progesterone supplementation via vaginal suppositories. Vaginal progesterone suppositories can cause the cervix to be extra sensitive. If you have sexual intercourse, you may experience light spotting, but this is nothing to worry about.

When to call your doctor: If you're bleeding heavily, or if you're experiencing pain or severe cramps, contact your doctor right away.

Sexual Intercourse After IVF

Common practice has been to ask couples to abstain from sexual intercourse during part or all of an IVF treatment cycle. Some doctors are concerned that sex may lead to infection or interfere with embryo implantation. However, other doctors think it's fine and even recommend sex after IVF.

A 2000 study in Australia decided to look at whether sexual intercourse is harmful to the IVF process. Not only did they find that sexual intercourse wasn't harmful, they found that couples who had sex around the time of embryo transfer had higher viability rates at 6 to 8 weeks post transfer. The study showed that semen seems to play a positive role in embryo implantation and development.

As always, consult with your doctor if you're unsure if you should engage in sexual intercourse.

Bed Rest After IVF During the Two-Week Wait

Prescribing bed rest to women after embryo transfer was once common practice.

Bed rest suggestions ranged from lying down for just 10 minutes post transfer to five days of convalescing.

Despite how common the practice was, research has found no benefit to bed rest during the two-week wait. In fact, a number of studies found possible negative effects of bed rest. The women who got up right away after embryo transfer had higher pregnancy rates and lower miscarriage rates.

If your doctor has prescribed bed rest, discuss whether he or she really believes this is necessary. Is she just prescribing it to help you feel better about the cycle? If your doctor doesn't prescribe it, don't put yourself on bed rest just in case. Research says your odds of success will be better with regular activity.

Stress and IVF Success

Here's some good news for you: there's no need to stress about stress. Two large studies found that stress levels did not have a negative effect on IVF outcomes. You can't stress yourself into a negative pregnancy test.

However, researchers did find that IVF leads to stress, which isn't surprising. Also, IVF failure can lead to depression and anxiety. Getting support to help you cope with treatment-related stress is important for your own well-being. You don't need to feel alone.

Things you can do to reduce fertility treatment stress include:

Pregnancy-Like Symptoms

Sensitive breasts, nausea, fatigue, cramping, light spotting—could these be signs the cycle has been successful?

Here's the truth: all those symptoms can and do occur even if you're not pregnant. In fact, even if you have no pregnancy symptoms, you may be pregnant. It's really impossible to tell.

Pregnancy symptoms can be attributed to side effects of progesterone supplementation, the fertility drugs you're taking, and even stress. Who doesn't feel nauseated and fatigued during IVF? Try your best not to obsess too much about how you feel.

    Pregnancy Tests During IVF

    You're probably anxious to pee on the stick as soon as possible, but here are three good reasons not to test too early:

    • The "Trigger Shot" taken during IVF treatment contains hCG, the same hormone that at-home pregnancy tests detect. If you test too early, you'll just be picking up on the injected hormones.
    • The odds of getting a positive pregnancy test before six days past the embryo transfer, if you had three-day embryos transferred (or four days past the transfer, if you had five-day embryos transferred) is very small.
    • A negative pregnancy test will cause needless worry.

    Absolutely do not take a pregnancy test before 10 days have passed since your last trigger shot. After that, you can start testing, but you're better off waiting until the day before your scheduled blood test, the quantitative hCG blood test (or beta).

    hCG Levels and Twins

    While your hCG levels may be higher than normal if you conceive twins, the normal range for a singleton overlaps with normal ranges for twins. An early pregnancy test can be an early sign you're going to have twins, but it may just be a very healthy singleton.

    You also can't assume you didn't conceive multiples if your early tests are negative. Normal levels of hCG vary quite a bit. The only way to confirm whether you have twins or not is an ultrasound.

    A Word From Verywell

    It's normal for your mind to be overflowing with questions during the post-IVF two-week wait. As always, your doctor is the number one source for any medical questions and concerns you have, since he or she can provide an answer that's specific to your situation and medical history.

    Sources:

    Boivin J, Griffiths E, Venetis CA. "Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ. 2011 Feb 23;342:d223. doi: 10.1136/bmj.d223.

    Gaikwad S, Garrido N, Cobo A, Pellicer A, Remohi J. Bed rest after embryo transfer negatively affects in vitro fertilization: a randomized controlled clinical trial. Fertil Steril. 2013 Jun 8. pii: S0015-0282(13)00609-2. doi: 10.1016/j.fertnstert.2013.05.011. [Epub ahead of print]

    Jabara S, Barnhart K, Schertz JC, Patrizio P. Luteal phase bleeding after IVF cycles: comparison between progesterone vaginal gel and intramuscular progesterone and correlation with pregnancy outcomes. J Exp Clin Assist Reprod. 2009 Oct 20;6:6.

    Pasch LA, Gregorich SE, Katz PK, Millstein SG, Nachtigall RD, Bleil ME, Adler NE. Psychological distress and in vitro fertilization outcome. Fertil Steril. 2012 Aug;98(2):459-64. doi: 10.1016/j.fertnstert.2012.05.023. Epub 2012 Jun 13.

    Tremellen KP, Valbuena D, Landeras J, Ballesteros A, Martinez J, Mendoza S, Norman RJ, Robertson SA, Simón C. The effect of intercourse on pregnancy rates during assisted human reproduction. Hum Reprod. 2000 Dec;15(12):2653-8.

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