The Two-Week Wait: what are the symptoms, and how do you get through it?

That time between the embryo transfer and the pregnancy test, is referred to as “the two-week wait”, and is one of the most difficult stages of any fertility journey.

We asked Trudi, our Nursing Director, to give us a run down what it means to be in the two-week wait, what symptoms to listen to (and which ones to ignore!) and how to survive this anxious time.   

What is the 2 WW?

The two-week wait is the period of time between embryo transfer and the pregnancy test. 

Depending on the development and age of the embryo that was transferred, the “two-week” waiting period may vary. However, on average it’s around 12 days.

When does embryo implantation happen?

Following the transfer of a blastocyst embryo, the process of implantation will generally start within 1-2 days and takes around 5 days to complete.  

To put this into context, in a natural pregnancy with a menstrual cycle of 28 days, this implantation would happen between the 19th and 23rd day.

Some patients may feel the embryo implantation as a sharp pain, some may experience implantation bleeding, and a lot of patients don’t feel a thing.

What can I expect in the first few days after transfer?

In the first few days at least, symptoms are usually associated with the side effects of any ovarian stimulation or ovulation medication you’ve been on, or continue to be on – for example progesterone.

Which makes the first few days really confusing for some patients, as they may feel very different to how they feel usually, and may contribute this to early signs of pregnancy.

hCG; the pregnancy hormone

The hormone released by the embryo when it implants in the mother’s uterus is called human chorionic gonadotropin (hCG).

This secretion of hCG into the bloodstream generally doesn’t start until around 24 hours after the completion of the implantation process. This hCG triggers your body to create more oestrogen and progesterone and it’s these hormones altogether that help thicken your endometrium and tell your body to stop menstruating.

The correct balance of these three hormones sustains and supports the pregnancy.

Initially, hCG promotes the release of progesterone by the corpus luteum. Eventually, the placenta takes over the production of progesterone for the rest of the pregnancy and this generally happens between weeks 7 and 12.

The hCG level gradually increases during foetal development, and then around 12 weeks, it starts to decrease.

When do the first symptoms of pregnancy start?

Each patient experiences the process of embryo implantation differently and it’s important to remember that in the first few days, the embryo hasn’t fully implanted in the uterus yet.

Some women don’t experience any symptoms, and others will notice every little change in their body. 

We have a lot of patients who are hyper-alert about every single symptom their body is displaying, paying close attention to any type of symptoms they experience: swollen breasts, headaches, pain in the ovaries, among other symptoms, trying to look for signs that help them find out whether they are pregnant or not.

Many of the early signs of pregnancy could signal something else, and it’s important to remember that there is not one single symptom that is 100% associated with a pregnancy.

Most common symptoms during the two-week wait

It’s important to remember that these symptoms are not an exhaustive list, and some patients may not experience any at all. The only true sign will be a positive pregnancy test.

• Nausea and vomiting
  • As soon as there’s enough hCG in your blood to see a positive result on a pregnancy test, you may start to feel a little sick. Remember, too, that morning sickness can happen all day long!
  • Nausea and vomiting can also present as the result of elevated levels of oestrogen and progesterone from treatment, or from the general stress and anxiety of the treatment and the wait.

• Light spotting / implantation bleeding
  • You might get light spotting when the embryo implants in your womb. Sometimes this is brown blood, something light red blood, but if you get more than you would expect on the last day of your period, contact your clinic.
  • Spotting can occur for a multitude of reasons including the use of vaginal progesterone and the embryo transfer procedure itself. We do not recommend stopping your progesterone until you’ve received clear instructions from our clinical or nursing team.

• Abdominal cramping
  • Implantation can also lead to abdominal cramping or even a pinching sensation, which would occur around the same time as the spotting.
  • Confusingly, these can also be mistaken for PMS cramps, which is unhelpful when you are early pregnancy symptom spotting!
  • Bloating and constipation can also lead to abdominal cramping as the intra-abdominal space becomes crowded. This is not detrimental to implantation or pregnancy.

• Bloating and Constipation
  • Progesterone is the gift that keeps on giving! It supports the early stages of pregnancy, but also slows down the muscles in your digestive system, leading to gassiness, bloating, and constipation.
  • We recommend increasing your water and fibre intake around this time to keep things moving. If you get severely constipated, contact your clinic.

• Breast pain
  • Tenderness in the breasts is one of the very first signs of pregnancy, but also confusingly, sore breasts are also common when you have PMS—so it could be signalling the opposite.
  • This is a very common effect from elevated levels of progesterone, which is why your breasts often feel tender for a week or so before your period starts.

• Sleepiness
  • Your body is expending a lot of energy to support your pregnancy, and that, coupled with the surging pregnancy hormones, can make you feel sleepy. 
  • Sleepiness can also be a biproduct of the treatment process itself. The appointments, medication, worries and anticipation of the transfer itself takes a lot of physical energy. Once the transfer is done and suddenly there are no more appointments and everything has quietened down, your body can take that as an opportunity to rest and replenish those spent energy stores.

• Missed period
  • This is the biggest sign of a pregnancy, and a hint that you should probably take a pregnancy test.  
  • Even in the event of bleeding, a pregnancy test should still be taken at the recommended time as bleeding does not rule out that implantation has occurred and it is important to be vigilant of the possibility of an ectopic pregnancy.

False symptoms during the two-week wait

Every pregnancy symptom can have another cause:

• Lack of menstrual cycle can be from the progesterone supplementation or a hormonal imbalance
• Weight gain can be hormonal or lifestyle
• Sore breasts can be from the prescribed hormone medication or from the presence of an oestrogen-producing ovarian cyst

What are the most important things to remember during the two-week wait?

We know this stage of any fertility treatment brings with it a lot of anxiety and fear, with a lot of patients symptom spotting every single change in their body.

We asked our team for their top tips to help you during your two-week wait.

• Be kind to yourself, don’t put any pressure on yourself to be the social butterfly you might usually be, take this opportunity to have some downtime, maybe a few early nights.

• Don’t compare. Remember that every body is different, and because everyone has had a different experience to get to this point, everyone’s symptoms will be different.

• STAY OFF GOOGLE!! And all the fertility chat rooms. As difficult as it may be, it’s not helpful to compare your symptoms to someone else’s.

• Treat your body as if you’re pregnant; limiting exercise, following dietary guidelines as if you are pregnant, and avoid smoking, drinking alcohol or too much caffeine.

• Try to keep your mind occupied and find friends and family you can trust to give you the support you need.

How can I manage my emotions during my two-week wait?

Be realistic, and listen to yourself.

Whilst some people prefer to maintain a positive mindset throughout, others might find it difficult to remain positive if they have been though several treatment cycles.

While there are benefits to being optimistic and engaging in positive thinking, this can sometimes deny difficult emotions in favour of a cheerful and often falsely positive façade.

We all have painful emotions and experiences. Those emotions, while often unpleasant, need to be felt and dealt with openly and honestly to achieve acceptance.

It’s important to validate that it’s OK to feel like this during any stage of your fertility treatment, and for some, this negativity and fear continues after a positive pregnancy test if they’re anxious about maintaining the pregnancy.

Don’t be afraid to ask your friends and family for the support you need. Tell them if you need them to maintain a positive mindset for you and equally, tell them if you just need someone to be realistic for you.

You may feel that you need additional support from someone unrelated to your treatment. The British Infertility Counselling Association (BICA) is a register of specialist practitioners who are qualified to help you navigate all stages of your fertility journey and your clinic will be able to refer you to a BICA-registered counsellor.

Clinical advice for your two-week wait

We know this time is really difficult for all our patients, it’s an unavoidable part of IVF and the stage a lot of our patients’ dread.

Hormone medication can cause physical symptoms similar to those experienced by patients during the early stages of pregnancy.  For this reason, these symptoms do not indicate the success of the fertility treatment or the result of the pregnancy test.

It’s quite normal not to feel any symptoms. It doesn’t mean anything in terms of the result, because until the pregnancy test is performed, it is impossible to know whether a woman is pregnant or not.

Equally, it’s important to be careful with over analysing every single symptom. Of course, it’s understandable that this happens as a patient tries to find signs that help to recognise whether the test result will be positive or negative.

But, this is the stage of any fertility treatment cycle that we have to let Mother Nature manage. And therefore, we have to be patient, which we know is torture!

You should also remember to take care of yourself. Activities that we enjoy and that help us forget about the treatment for a while, shouldn’t be forgotten.

When should you take a pregnancy test after embryo transfer?

We always recommend patients do an at-home pregnancy test around 10-14 days after embryo transfer – although you will be advised the exact date after your embryo transfer procedure.

The reason why it’s important to wait is that your hormone levels may be too low and not correctly confirm the pregnancy. By waiting, the result of the pregnancy test will be more reliable, and a false positive or negative result can be avoided.

After you have received a positive at-home pregnancy test, you are invited to come in for a blood test, known as the Beta Blood Test, so we can establish the range of hCG, and then you’ll need to come back again in around 48 hours’ time, where we expect this to have roughly doubled.

This is also not an exacting science and at best gives us an indication of how we think the pregnancy may be progressing at the time of testing.

What is a false-positive pregnancy test?

The pregnancy test is positive, but no embryo implantation has taken place.

The main cause of this would be medication taken during your fertility treatment.

A false positive result may occur if the test was taken shortly before insemination or transfer, when traces of the medication may still be present in the blood.

What is a false-negative pregnancy test?

The pregnancy test result is negative, even though the patient is pregnant, this can be the result of a few different scenarios. It could be that:

• the pregnancy test was taken too early and the amount of hCG is below the detectable limit of the test.
• the pregnancy test was expired at the time. Pregnancy tests rely on a chemical reaction to show either the presence or absence of hCG hormone. If the chemical reagent has degraded it won’t react accurately so always check the expiry date of your test.
• the instructions set out in the test weren’t followed. For example; if you’re drinking large amounts of fluids this can dilute the urine making the available hCG significantly lower than in concentrated ‘first’ or ‘second’ urine. Read the instructions for the particular test that you’ve chosen to make sure you are adhering to the conditions that will give the most accurate result.

This is why it’s important to wait until when your clinic advises you to do your pregnancy test.

It’s important to mention here, that false positive results are not the same as biochemical pregnancies.

In a biochemical pregnancy, implantation has occurred, meaning the test result is correct. However, the embryo stops developing at a very early stage shortly after implantation, meaning hCG is present, but it’s too low because the embryo does not develop further.