What happens after embryo transfer?

There is not much a patient can do after the embryo transfer. What we use and what we recommend is that they should consider themselves pregnant as soon as we have transferred the embryo because if everything works as expected, the embryo is going to implant 24 to 36 hours after the embryo transfer. So we tell them there is not much they can do to change the outcome and that they should behave as if they were already pregnant, that is leading a completely normal life but avoiding strong physical effort, risky situations, and being especially aware of what they eat and drink. But, apart from that, everything is going to be as if they had got pregnant naturally. So we prefer not to stress them with an excessive rest and we encourage them to lead a normal life.

Well, no. Actually after the embryo transfer, we need to cross our fingers and hope for the best because we are no longer seeing what is going to happen. We could see the embryo develop until Day 3 or 5 depending on when you do the embryo transfer but right after that, you just have to trust that the embryo is going to complete the development and do all of the biological and biochemical changes that had to do for a correct implantation into the endometrium.

The time between the embryo transfer and the pregnancy test is the time of the implantation. It takes around 2 weeks after the transfer. Some clinics try to measure the progesterone level a few days after the transfer to see if you need additional support of progesterone. However, it is not evidence-based but clinics are more reassured if you have a sustainable high level of progesterone. Some people are on pessaries, some are on injections, some on cream – so whatever is recommended to you is advisable to carry on taking.

These 2 weeks are a waiting period. The most important thing is that you have to be at a stage of being relaxed but during normal activity. Just wait until the pregnancy test and see. A negative pregnancy test means that we have to stop the medication, have a follow-up and then discuss what next. If you have frozen embryos, we can discuss a frozen embryo transfer. If there aren’t any embryos frozen, then we can take time to discuss what other plans to make.

However, once the pregnancy test is positive and there is positive quantitative beta hCG and we make sure that it is in the right sort of level, we plan for the scan. The scan is usually within 6 or 7 weeks from your last period. Obviously, if someone had previous miscarriages or previous ectopic pregnancies, we tend to bring them an early scan. The early scan means 5- 6 weeks. However, in normal circumstances, we usually advise having this scan around 6 to 7 weeks. Why? 7 weeks is more than enough to detect a fetal heart. Once we detect a fetal heart, you are still recommended to carry on with your medication until 12 weeks. Most clinics recommend having it till 12 weeks. However, I have to say that it is still not proven or evidence-based that we need all this time. Some people say that up to 8 weeks is more than enough. However, we feel reassured and you feel reassured that this medication is meant until 12 weeks. So from 7 weeks, we can have another sort of scan by 10 weeks and then plan the first-trimester scan around 11 weeks plus 5 to 13 weeks plus 6.

Very good question. If the transfer is performed on Day 5 of the embryo development, the embryo which is usually ready to nest around the day six or seven, should be implanting, nesting, in the next two days or so following the transfer. Honestly, there are hardly any signs of the implantation itself. The embryo at that point has about two tenths of a millimeter in diameter and its attachments to the endometrium and the beginning of the process of the implantation, you cannot feel at all. There might be actually one sign, that’s kind of typical for these initial two weeks, there might be a slight spotting or even a weak bleeding sometimes as the embryo nests it breaks some of the capillaries and starts to communicate with the mother’s organism. Sometimes this pool of blood, this little pool of blood, can actually escape from the uterine cavity and can present itself as a spotting or bleeding. If that happens, no panic, keep taking your medications and bed rest is recommended for the duration of the spotting. As soon as it’s over, then you can get more active again. Otherwise, the other signs of an early pregnancy such as nausea or headaches or pressure in the breasts usually come later in the process – not during those first two weeks before we perform the pregnancy test. So during these initial 14 days, we really need to be patient and we need to wait for the test result.

What happens after the embryo transfer? So if there is a positive pregnancy test, is the next step. So it’s necessary to wait for testing. It is a very stressful time. The most difficult part of treatment, I think. Slight bleeding can occur that can be a result of implantation. Stronger bleeding is usually a bad sign. Of course, it’s necessary to tell the doctor about it. But unfortunately, there is no possibility to treat it. If there is strong bleeding, we can’t do anything to stop it. Sometimes, we add some medication, but it’s very individual and it depends on many factors. Slight bleeding is OK, strong bleeding is a bad sign.

After a positive pregnancy test, stronger bleeding can occur. It’s also a result of the embryo growing inside of the endometrium, and it is quite common. Approx. 60% of women have some bleeding during early pregnancy. It is not directly a bad sign. I know it’s stressful, but it is not a reason to go to the emergency, for example, at two o’clock in the morning. At this point, we can’t do anything to avoid miscarriage. It’s better to wait till the morning and see your gynecologist for an ultrasound. After the ultrasound, we will know more. Strong bleeding similar to period may occur, but many times, it’s nothing wrong and an ultrasound can confirm the pregnancy.

Usually, 14 days after a positive pregnancy test, we can see the pregnancy inside of the uterine cavity with cardiac activity. It’s the most important thing to see the cardiac activity of the embryo.

After the embryo transfer, because of the medication, the patient will see some changes in her body. Also, if she succeeds, because of the early pregnancy, she will see things like breast swelling, bloating, clear virginal discharge, slight pain, pelvic pain, even small bleeding like spotting, these are normal things, and in some women, mood changes also. But these are not seen 100% in all patients. Some might have only bloating, only swelling, only bleeding, or all of them, or none of them. These are only subjective symptoms but they can have them, and most of the patients have at least one of them. This is a normal thing – these changes in the body.

Also, you may feel some increase in appetite, this is very important because of the medication, the slight depression-like symptoms, you can see a little increase in appetite. Also, defecation can be a problem. Patients can sometimes have diarrhea, and sometimes constipation. Most of the time the constipation is caused by progesterone. If you cannot go to the toilet every other day, maybe you need some support, like some suppository – please ask your doctor. Otherwise, you will experience a normal life, and in 10 days you can do the blood test and see the results.

After we transfer the embryos, the next step is the embryo implanting. That is what should happen inside your womb. That implanting could be sometimes something that some women feel, and sometimes it is not felt at all. Then, there is this waiting time for the pregnancy test. Those two weeks or ten days of wait are really difficult for the patients. We know that it’s terrible. Because basically, you’ve been up until the day of the embryo transfer. You’ve been very busy with lots of injections, lots of appointments, lots of phone calls, so lots of blood tests. Your life was all about that. And then suddenly, from the day of the embryo transfer, everything stops and there are no more phone calls, there is no more blood taken. It’s just the medications to continue.

In that period of time, we understand, that patients can feel a bit alone and abandoned in a way. So it’s very important to have support during that time and to do things that you are happy doing. Even if that means online shopping or proper shopping, retail therapy always helps or booking a holiday, etc. Look after yourself during that time, because it can be quite difficult the moment after you have your embryo in. You don’t know whether it’s implanting or not, whether it has implanted already or if you’re pregnant or not, so it can be quite worrying as well.

If you are worried, it is always better to discuss it with your doctor, the nurse, or the counselor. The clinic hasn’t abandoned you, you’re still a patient. So if there is any worry at all, it’s better to get in touch and share your worries. But other than that, just wait and see.