That time between the embryo transfer and the result of the pregnancy test, also called the two week wait or beta hCG, is one of the most difficult phases of fertility treatment is nothing new. Today, we at IVF-Life would like to talk about the symptoms that may occur during this process and give you some advice on how to better manage the waiting period.

For this purpose, we have talked to our specialist Raquel Pascual, nurse and psychologist at the IVF-Life clinic in Madrid.

Patients who have experienced the seemingly never-ending beta hCG waiting period know how difficult it is to cope with it. In this article, with the support of our specialist, we would like to help you determine the symptoms that may appear during the two week wait and give you some tips to better cope with this period.

Two week wait: What is it?

The two week wait or beta HCG waiting time is the period of time from embryo transfer and until the pregnancy test. To determine the result of the pregnancy test, the hCG levels, which can be found in the urine or blood of pregnant women, are determined.

Depending on the stage of embryonic development at which the embryos were transferred, the duration of the Beta HCG waiting period may vary. On average, however, it is about 14 days, therefore called “two week wait”. As fertility specialists, we know that the two week wait is associated with a lot of anxiety and fear and that during this time we keep a close eye on every little change in our body.

Hormone level: Beta-hCG

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

It promotes the release of progesterone by the corpus luteum and thus enables the development of the uterine lining and the growth of the foetus.

The beta-hCG level gradually increases during fetal development. From the second or third month of pregnancy, this level then begins to decrease.

It is recommended to wait at least 10-14 days after embryo transfer before taking a pregnancy test. Before these 10-14 days, the hormone level 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.

How do I recognise a false positive or false negative test result?

To summarise, in order to confirm the viability of the pregnancy, hCG (human chorionic gonadotropin) levels must increase exponentially until the end of the first trimester. After that, the values will decrease and remain stable for the rest of the pregnancy.

False-positive: The pregnancy test is positive, but no embryo implantation has taken place. Main cause: medication taken to induce ovulation. A false positive result may occur if the test was taken shortly before insemination or transfer. At this time, traces of the medication may still be present in the blood.

False-negative: The pregnancy test result is negative even though the patient is pregnant. The pregnancy test was performed too early. The value of the beta-hCG hormone is still below the detectable limit of the test.

Be careful, false positive results should not be confused with biochemical pregnancies. In a biochemical pregnancy, implantation has occurred, which means that the test result is correct. However, the embryo stops developing at a very early stage shortly after implantation, so pregnancy does not occur. The beta-hCG hormone is present after implantation, but it is too low because the embryo does not develop further.

IVF – How long do I have to wait before taking a pregnancy test?

According to Dr Rut Gómez de Segura (gynaecologist and fertility specialist at the IVF-Life Madrid clinic), it is necessary to wait until the luteal phase to perform the pregnancy test.

The implantation of the embryo during fertility treatment takes place between the 5th and 7th day after fertilisation. This is the optimal moment when the uterine lining is receptive and an embryo can implant. In a natural pregnancy with a menstrual cycle of 28 days, this implantation would happen between the 19th and 23rd day.

An in vitro fertilisation treatment has several phases. The first phase is the egg retrieval phase, lasting from menstruation until the follicular puncture (when the eggs are retrieved from the ovary). This phase usually lasts between 12-14 days.

After the oocytes have been retrieved, the “laboratory phase” begins. In this second phase, the eggs are fertilised and the embryos develop in the laboratory. Between the 2nd and 5th day of embryonic development, the embryos can be transferred to the uterus. According to statistics, embryos have a better implantation potential on the 5th to 6th day of development.

If the embryo transfer is carried out at the blastocyst stage, i.e. on the 5th day of development, the pregnancy test by measuring the beta-hCG concentration in the blood is planned for 10-12 days after the transfer. This period is then called the luteal phase (the phase that lasts from the transfer to the pregnancy test).

When do the symptoms of the two week wait start?

We must clarify that each patient experiences the process of embryo implantation differently and that, in the first few days, the embryo has not even implanted in the uterus yet.

Following assisted reproduction treatment, symptoms are usually associated with the side effects of ovarian stimulation , as well as the progesterone that patients continue to take during this time.

On the one hand, there are women who do not experience any symptoms during the waiting period. Others, on the contrary, will notice every little change in their body. Many women even fall into a state of hypervigilance, as our colleague and specialist Raquel Pascual calls it.

Hypervigilance is a phenomenon that many patients experience, in which women are particularly sensitive to any symptoms that appear. Of course, it is understandable that this happens during the two week wait because one tries to find signs that help to recognise whether the test result will be positive or negative.

The most common symptoms during the two week wait are the following:

• Headache and nausea
• Frequent urination
• Abdominal bloating
• Breast pain
• Sleepiness
• Lower back pain
• Light bleeding, commonly known as “implantation bleeding” – you can read more about implantation bleeding here.

As already mentioned, it is quite normal not to feel any symptoms. It does not 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.

How to cope with the symptoms during the two week wait

From IVF-Life we would like to inform you that the beta waiting period will be a difficult phase. You have to be ready to accept any kind of emotion: positive or negative. The beta waiting period is an unavoidable process during fertility treatment that all women who want to get pregnant have to go through.

We often tend to drive ourselves crazy with negative thoughts. Of course, you have to remain realistic about the possibilities and the likelihood of success of fertility treatment, but it is very important to keep a positive attitude and not lose it even if we are aware that there is a possibility that the result may not be positive.

Hypervigilance is very common during this phase of fertility treatment. Patients pay attention to any type of symptoms they experience during the two week wait: swollen breasts, headaches, pain in the ovaries, among other symptoms. By doing this, they are trying to look for signs that help them find out whether they are pregnant or not.

However, we need to be careful with this hypervigilance. Hormone medication can cause physical symptoms similar to those experienced by patients during the two week wait. For this reason, these symptoms do not indicate the success of the fertility treatment or the result of the pregnancy test.

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

Having free time and continuing to do things that bring us pleasure is very important. On top of all the stress and tension that the Beta HCG waiting period brings, we should not also deprive ourselves of the opportunity to do things that make us happy. Otherwise, it may negatively affect us.” Pascual emphasises.

Patients have to wait about two weeks after embryo transfer for the long-awaited result. We are aware that this long-desired positive result will change our lives forever. But we must not forget that many women face a rollercoaster of emotional ups and downs during the wait: Excitement, fear, joy, stress – a range of emotions that we need to control. If you need emotional support during this stage or if you have doubts about any of your symptoms, do not hesitate to contact us. 

How did you experience this time?