• After an IVF Embryo Transfer: What You Need to Know

      A lot of anxiety builds up after an embryo transfer. Questions and worries swirl around until the two week wait (2ww) is over. Should I be on bed rest for the first two days? Are the embryos going to fall out? What foods should I eat? What foods should I avoid? How active can I be during the two week wait? How much spotting is normal?

      Let's take it one step at a time so you can see what the post-transfer period is like.

      An image depicting the process of an ultrasound-guided embryo transfer. Note the ultrasound wand and the path the catheter has to take to transfer the embryos in the optimal spot.

      Immediately Post-Transfer: First 60 Minutes
      After the embryo transfer is complete, your bed will be wheeled from the procedure room into a private room, all while you remain laying flat on your back. Most clinics have a 30- or 60- minute rule, in which they want you to remain laying flat for 30 or 60 minutes.

      Almost all embryo transfers are conducted with the assistance of ultrasound guidance. While the reproductive endocrinologist inserts the catheter and positions it inside your uterus, another member of the medical team is monitoring the transfer via a trans-abdominal ultrasound. This makes it possible for your RE to see the optimal place to release the embryo(s).

      All ultrasounds work best if the sound waves travel through fluid (versus air or tissue), so you will likely have a very full bladder before the transfer starts. After waiting for the procedure to begin (have you ever known a doctor to be on time?) and several minutes of having your abdomen pushed on with cold hands and a cold gel-covered ultrasound wand during the transfer, you will feel like you are about to burst.

      The need to empty your bladder after embryo transfer is often mentioned by patients as one of the most uncomfortable parts of the process. The good news is you don't have to sacrifice comfort to increase your perceived chances of success. Your doctor doesn't want you to be unnecessarily uncomfortable, and he/she will be happy to have their staff help you - with a bedpan. Don't pass up the opportunity to relieve your bladder, no matter how self-conscious or embarrassed you may feel about the bedpan. Given that you've already dropped your pants for the doctor and his/her staff every time you see them, it really isn't such a stretch to use the bedpan. If you feel like you need to go, just do it. Your nurse won't care in the slightest and your bladder will thank you.

      After the Embryo Transfer: Instructions for the First Two Days
      After you are released from the clinic or outpatient center, you will be given post-transfer instructions. Doctors will have different discharge instructions depending on a patient's medical history and their own preferences. In general, Reproductive Endocrinologists recommend:

      • no heavy lifting for 48 hours
      • no strenuous physical activity, such as running or zumba aerobics for 48 hours
      • no tub baths or swimming for 48 hours
      • no douching, tampons or using a bidet
      • no alcohol, smoking or recreational drug use
      • no intercourse and no orgasms (this stays in effect until you can see a fetal heartbeat via ultrasound or you have a negative pregnancy test)

      Unless advised otherwise, you can:

      • return to work immediately (assuming it does not require heavy lifting, physical exertion or being submerged in water)
      • engage in light activity (housework, driving, shopping)
      • travel
      • engage in sexual activity other than intercourse for your partner's pleasure - no orgasms for you! (this stays in effect until you can see a fetal heartbeat via ultrasound or you have a negative pregnancy test)

      Won't My Embryos Fall Out if I Walk Around?
      Thankfully, they won't. You will probably feel like tiptoeing around on a layer of foam for at least the first few days, and if that makes you feel better then go ahead and do it. But there's no need. Remember that in a spontaneous pregnancy, the egg is released from the fallopian tubes, the sperm travels all of the way up the vaginal tract, through the cervix, all the way through the uterus and into the fallopian tube. Fertilization typically takes place inside the fallopian tube, which is where the egg and sperm usually meet. The tiny embryo moves through the tube and into the uterus, where it can, given the right circumstances, implant in the uterine wall.

      If oocytes or embryos could "fall out" of the uterus, not many people would get pregnant at all. The uterus is defined as a potential space; that is, it is completely closed with the inside walls all touching, and can expand as needed to create space for a growing baby. Think of your uterine walls like a deflated balloon made out of sponge. In its normal, resting state the balloon will be small, the spongy walls will all be touching, and there will be no air inside. If you start to inflate the balloon, it expands to accommodate the volume of air that is put inside it. But while it is deflated and the walls are touching, you could put a marble inside and it would stay where it is until you start to inflate it.

      Does Spotting Mean Its Over?
      No. Please breathe now - you're turning a remarkable shade of blue. Your body has been going through a lot during your IVF cycle. Hormones, injections, stress, egg retrieval (if it is a fresh cycle) - none of these should be discounted. And during the transfer your doctor probably used a speculum so he/she could visualize your cervix, then the catheter had to pass through the cervix, and then the catheter may have irritated a tiny bit of the lining. In addition, you are likely on some hormone supplements including progesterone, which can cause spotting. Any of these things could cause a little spotting, and not necessarily immediately.

      There is another thing that can cause spotting, and this is a happy possibility: it's called implantation spotting. Implantation spotting happens when the embryo burrows into the uterine lining and implants, so that it can begin growing. Implantation spotting often looks different from other types of spotting; the color is a light pink or light brown and it may be "streaky" in appearance.

      Some women say that in addition to spotting, they also feel some mild cramping a little before or at about the same time the spotting begins. The feeling typically does not last long, as the embryo is quite tiny and only causes a mild disruption in the uterine lining.

      Not everyone experiences implantation spotting, so it is one of those aspects of the post-transfer period that tends to make women question everything. Are the cramps the beginning of my period, or are they implantation cramps? Is that spotting implantation spotting or is it the beginning of my period? I don't have any spotting or cramping - so maybe the embryo didn't implant! And on and on, until we are in a two week frenzy of anxiety and nerves.

      Next ...
      The IVF Two Week Wait Defined
      The IVF Two Week Wait: Early Pregnancy Symptoms
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