IVF and the Two Week Wait

Your Questions Answered on Bed Rest, Sex, Cramps, Pregnancy Symptoms, and More

Woman on bed rest after IVF reading a book, having normal cramping after embryo transfer
If your doctor suggests bed rest after IVF, ask why. Current research suggests regular activity would be best. Emely / Cultura / Getty Images

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? These are just some of the questions you may have during the two week wait of an IVF treatment cycle.

IVF treatment is a stressful time. The two week wait is stressful. Put the two together and yikes!

You may be hyper-aware of everything going on in your body, worrying about every cramp or odd twinge you feel.

You may also have lots of questions.

Should you be on bed rest? Is it okay to have sex? What about all this stress you're feeling... can stress keep you from getting pregnant?

As always, your doctor is the number one source for any medical questions or concerns you have.

With that said, here are some common questions and answers. Hopefully they will put your mind at ease - as much as is possible, anyway!

Is Bed Rest Required 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 recommending bed rest for up to five days.

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 transfer had higher pregnancy rates and lower miscarriage rates.

If your doctor has prescribed bed rest, discuss whether she really believes this is necessary. Is she just prescribing it just to help you "feel better" about the cycle?

If there's no medical reason for bed rest, don't assign yourself it.

Research says your odds for success will be better with regular activity.

Can Sexual Intercourse Be Harmful After IVF During the Two Week Wait?

Common practice has been to ask couples to abstain from sexual intercourse during part or all of an IVF treatment cycle.

Doctors were concerned that sex may lead to infection or interfere with embryo implantation. However, this was all assumed. Research hadn't been conducted to confirm or deny the concerns.

A 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.

Semen seems to play a positive role in embryo implantation and development. It's not just for transferring the sperm to the egg!

As always, consult with your doctor if he has recommended you abstain from sexual intercourse.

However, if your doctor has not asked you to abstain from sex, don't feel you should abstain "just in case." The research says that having sex may actually increase your odds for success!

I'm So Stressed Out. Will Stress During the Two Week Wait Reduce my Odds for IVF Success?

I've got 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.

They did find that IVF leads to stress. (No surprise there.) And IVF failure can lead to depression and anxiety.

Getting support and help to help you cope with treatment-related stress is important for your own well-being. You don't need to feel alone! There's help out there for you.

I've Notice Some Light Bleeding. Could This Be Implantation Spotting? Is This a Bad Sign?

Light spotting during the IVF two week wait is relatively common. According to the research, it occurs in 7% to 42% of 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 a necessarily a good or bad sign.

Spotting that occurs mid-two week wait is sometimes attributed to "implantation spotting," or spotting caused by the embryo implanting itself into the uterine wall.

However, whether implantation spotting is a real event is a matter of debate.

Another possible cause for spotting is progesterone supplementation via vaginal suppositories. They have been associated with an increased risk of spotting.

If you are bleeding heavily, or if you are experiencing pain or severe cramps, contact your doctor right away.

I'm Having Cramps. Does This Mean I'm Going to Get My Period?

Cramping can strike fear into the bravest of IVFers.

Here's the good/bad news: mild cramping and pelvic discomfort during the two-week wait of an IVF cycle are very common.

Cramping during IVF shouldn't be seen as a sign of your coming period nor as a possible sign of pregnancy. (See more on pregnancy symptoms below.)

The medications and procedures of IVF make quite an impact on your reproductive organs. The egg retrieval can cause slight cramping in the days immediately after as can the embryo transfer itself.

The main cause of cramping are your sensitive ovaries, which become slightly swollen from fertility drug stimulation.

While mild to moderate cramping can be normal, report to your doctor if the cramping is not relieved by over-the-counter pain medications.

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.

I Think I'm Having Pregnancy Symptoms. Could I Be Pregnant?

Sensitive breasts, nausea, fatigue, cramping, "implantation spotting" - could these be signs the cycle has been successful?

Here's the honest truth: all those symptoms can and do occur even if you're not pregnant.

In fact, if you have none of the so-called "pregnancy symptoms", you may also be pregnant. It's really impossible to tell.

Pregnancy symptoms can be attributed to side effects of progesterone supplementation and even the IVF cycle itself. Who doesn't feel nauseated and fatigued after all the IVF stress?

So, try your best not to obsess too much. But since I know you will anyway, here are some links to drive yourself crazy with. Just don't go overboard!

When Can I Take a Pregnancy Test During IVF?

I know you're dying to test 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 post embryo transfer, if you had three day embryos transferred (or four days post transfer, if you had five day embryos transferred) is really, really small.
  • A negative pregnancy test will cause needless worry.

Absolutely do not take a pregnancy test before 10 days have passed since your 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).

I Got a Positive Pregnancy Test Earlier Than I Expected! Does This Mean I'm Having Twins?

All My Early Pregnancy Tests Have Been Negative. Does This Mean I'm Not Having 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 may be an early sign you're going to have twins. Or, it may just be a very healthy singleton!

You also can't assume you didn't conceive multiples based on a later pregnancy test. Levels of hCG vary quite a bit.

The only way to confirm whether you have twins or not is an ultrasound.

More on twins:

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.

Khaldoun Sharif, Arri Coomarasamy. Assisted Reproduction Techniques: Challenges and Management Options. (John Wiley & Sons, 2012)

Li B, Zhou H, Li W. "Bed rest after embryo transfer." Eur J Obstet Gynecol Reprod Biol. 2011 Apr;155(2):125-8. doi: 10.1016/j.ejogrb.2010.12.003.

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.

Rezábek K, Koryntová D, Zivný J. "Does bedrest after embryo transfer cause a worse outcome in in vitro fertilization?" Ceska Gynekol. 2001 May;66(3):175-8. [Article in Czech]

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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