By Dr David Wilkinson, Medical Director at City Fertility Centre Melbourne. 
After all you have been through to try to achieve a pregnancy, there is finally the two-week waiting phase until your pregnancy test, to stretch your patience once more!
Suddenly, during this phase, many people become hyper-aware of any changes and sensations they experience, wondering if it could indicate something either one way or the other. My best advice is to try to relax and distract yourself.
These two weeks are considered the final phase of IVF. Called the luteal phase, it is the period of time between embryo transfer and the pregnancy test. These two weeks would be equivalent to the part of a non-stimulated 28-day cycle that happens between day 15 and 28.
Progesterone and/or estrogen medication are working in your body to help produce the same levels of hormones that would normally occur naturally in the early stages of pregnancy. These also help prepare the lining of the uterus for implantation. Once transferred, the embryo needs to implant itself into the uterine lining, usually on about day 20 of the cycle, and then continue to grow into a fetus for pregnancy to occur.
Why do you have to wait to do a pregnancy test?
It takes about 10 days for all traces of the hormone you used as the trigger to be cleared from your body and in turn for less than 10% of it to show up in a blood test. This is why we wait 14 days to make sure the new pregnancy is producing enough of the hormone hCG (human chorionic gonadotropin) to be detected in a blood test. This is the most accurate indication of pregnancy.
It is important to note that this may not be the case for a frozen embryo transfer cycle, as the hCG trigger injection may not be used with all patients.
I do not recommend home pregnancy tests before the two-week mark as they can deliver false results, both positive and negative. One reason for this is that the hCG injection given to mature and release the eggs and as a booster can give a false positive urine test, which only adds to the emotional rollercoaster. Two weeks is generally the mark when we can have confidence in the results, whether the patient has undertaken a fresh or frozen embryo transfer.
What is going on in your body during these two weeks?
The hormone medication given to you to optimise your body for pregnancy may be having an impact on you emotionally and physically. You may feel more prone to tears, anxiety and irritability. You may also experience some cramping, spotting or light bleeding, abdominal bloating, fatigue, and breast tenderness. While any change can be alarming, they are normally fine and do not indicate whether you are pregnant or not. However, any extreme symptoms should be reported to your doctor immediately.
What should you focus on in these two weeks?
- Limit activity for the first 24 hours after transfer.
- Gradually increase activity over the next few days to non-strenuous non-aerobic activity and return to work when ready – your treating specialist will guide you if you are unsure.
- Eat healthily and stay hydrated.
- Keep busy by planning meaningful or fun distractions.
- Practise your favourite relaxation activity to keep stress levels down.
- Set aside a time slot each day (15-30 minutes) to think about your journey and write down your thoughts or discuss them with someone. This may help you to stay aware of and process the range of feelings (i.e. fear, excitement etc.) that often occur during this time.
- If you are feeling overwhelmed by the range of emotions, or are finding it exceptionally hard to deal with the stress of waiting and not coping, you are not on your own. Call your treating specialist, IVF nurse or counsellor for help. You can also get in touch with support groups such as Access Australia www.access.org.au.
If you are pregnant, what is next?
With your obstetrician you will determine the expected birth date for the baby. This is determined from the start of your last menstrual cycle. Your first pregnancy ultrasound is then usually scheduled for between 6 and 7 weeks’ gestational age.
If you are not pregnant, what are the next steps?
If you have a negative pregnancy result, we will work closely with you to support you during this time. Your nurse will advise you to stop your medications and you will meet with your specialist to review your past cycle and make a decision together on what the next best steps are.
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