Medical contribution by Matthew T. Connell, D.O.

Matthew T. Connell, D.O., FACOG, is board certified in obstetrics and gynecology and reproductive endocrinology and infertility. Dr. Connell has published numerous peer-reviewed scientific manuscripts, book chapters, and review articles in many leading scientific journals, and has been invited to present and consult nationally in the fields of endocrinology, infertility, and reproductive immunology. He sees patients in SGF’s Waldorf office.

The two-week wait before you have your beta pregnancy test can seem like an eternity. Each day seems longer than the last, and the question “Am I pregnant?” goes through your mind hundreds of times a day. You might become hyper-aware of your body’s every sensation. To help navigate this time period, we’ve gathered frequently asked questions and asked SGF physician Dr. Matthew Connell to answer them.    

What is the two-week wait?

The two-week wait is the period between the end of your fertility treatment cycle and the beta hCG blood test — the test that determines if you’re pregnant. It takes about two weeks from the time a fertilized egg implants in the uterine wall to start emitting enough of the hormone hCG (human chorionic gonadotropin) to be detected by a blood test. We sometimes call the test a “beta” because the test measures a beta chain portion of the hCG hormone molecule and is officially named a beta hCG test. 

Should I take a home pregnancy test after fertility treatment?

We recommend that you refrain from performing a home pregnancy test as it can render false results, either a false negative or a false positive. A false positive result may be due to the fact that in many of our treatments, hCG, the same hormone that measures pregnancy, is given to trigger ovulation in many of our patients. Traces of the administered hCG can still be in your bloodstream and detectable by a test, even if implantation has not occurred. 

A false negative might occur as a low level of hCG may be undetectable in a urine test despite a pregnancy starting, as home pregnancy tests are less sensitive than the blood hormone tests. 

On average, about two weeks following your intrauterine insemination (IUI) or embryo transfer you will come back for your pregnancy test. This reliable pregnancy test is done by blood draw and measures the hCG levels produced by the developing embryo.  

What is happening to my body during the two-week wait?

During this time, you may feel as if you are about to start your period. Your body has been through a lot and the medications you’re taking are designed to promote the optimal environment for pregnancy. You may experience some cramping, spotting or light bleeding, abdominal bloating, fatigue, and breast tenderness. While you may be slightly alarmed to experience some of these symptoms, they are normal and do not signify that you are or are not pregnant. 

Do I take medications during the two-week wait?

Yes. Most patients need to continue to take progesterone supplements in order to produce the same levels of hormones that would occur in early stages of pregnancy. 

While most patients will supplement their progesterone via pill or vaginal insert, patients who are using donor egg or frozen embryos will use the injectable form of progesterone for their cycles. 

Additionally, patients who undergo in vitro fertilization (IVF), donor egg, or frozen embryo transfers may also be prescribed estrogen supplements to help thicken and maintain the uterine lining. 

Please do not stop taking these medications until you have been advised by your medical team to do so. 

Can I continue my normal day-to-day activities during the two-week wait?

We tell all our patients to be cautious during their first 5 days after their treatment. We recommend that you refrain from strenuous physical activities as well as sexual activities during that time as they may cause uterine contractions that might impair the implantation process. There is also a greater risk during that time of ovarian issues arising since, for many patients, the ovaries are still slightly enlarged at that point. 

After those first few days, you can start light aerobic activities such as yoga, swimming, moderate walking, and lightweight training on a stairmaster or elliptical trainer. Activities that can get your heart rate up, but are not demanding, are suggested rather than high-impact activities such as jogging or aerobics. 

Do I need to adjust my diet during the two-week wait?

No special diet is required, but we recommend that you start making nutritional choices as if you’re already pregnant. This means eating well-balanced meals, no sushi or other raw or undercooked meats, avoiding high-mercury fish and soft cheeses, no alcohol, and continuing to take a preconception supplement. 

Learn more about preparing your body for a healthy pregnancy.

Can I travel during the two-week wait (or thereafter if pregnant)?

Traveling during the two-week wait is acceptable as it does not affect the ability for an embryo to implant. We do, however, prefer that patients do not travel beyond the range of reasonable medical care in the event of side effects that would call for medical care. 

What levels of hCG will determine if I’m pregnant?

A blood hCG number over 100 is considered a good first beta. Higher numbers cannot predict a multiple pregnancy, only the ultrasound can determine that. 
Additional beta tests will be performed every 48 hours after the first positive test to confirm the hCG level continues to rise. If the number continues to increase, we’re more confident that it’s likely a viable pregnancy. 
We will then have you come in for ultrasounds, usually between six and seven weeks, to determine if the embryo continues to develop into a fetus. At about eight weeks, we’ll refer you back to your OB/GYN to continue your prenatal care. 

If I am pregnant, how do you ‘count’ how far along we are?

As soon as it is determined that you are pregnant, we revert to the obstetrical counting/dating system. This is done to avoid using one set of dates from the time of an IUI or IVF versus another set of dates used by obstetricians. The OB doctors determine pregnancy dating to be from the last menstrual period, at least two weeks prior to ovulation. Obviously, we often know more about when ovulation may have occurred than they usually do, but for convention, we add two weeks to our dates to conform with the OB. As an example, if we know when ovulation was triggered and an IUI or IVF was performed, your beta might be two weeks after. If it is positive, the OB would say you are 4 weeks pregnant, not two, and therefore we do, too. 

What are my next steps if I’m not pregnant?

If you are not pregnant, your care team will advise you to stop your medications. You will have the opportunity to talk with your physician to review the past cycle and decide together about your next steps. 

How long after a failed cycle can I do another cycle?

While your physician will determine the timing of a new cycle, it’s not always necessary to take time off between cycles unless otherwise directed. Many of our patients can begin their next treatment cycle immediately. For others, a cycle of rest may be recommended. 

Editor’s note: This blog was originally published in 2014, and has been updated for accuracy and comprehensiveness as of March 2023.

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