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 Mechanicsburg and Lancaster, Pennsylvania, offices.

Whether you are trying to conceive on your own or undergoing fertility treatment the two week wait can seem like an eternity. This is the time between suspected ovulation – or in the case of those undergoing fertility treatment, the time of insemination or transfer – and when the first pregnancy test can be taken resulting in reliable results.

Women, especially those in treatment, find themselves hyperaware of their bodies and asking themselves “Am I pregnant?”, “What should I do about this”, or “What does that mean?” on a daily basis, increasing the difficultly of the wait. To help navigate the curiosity and unknowns, we gathered some question from our community, ran them by Dr. Connell, who sees patients in our Mechanicsburg and Lancaster offices, and came up with answers to your most pressing two week wait questions.

Q: What is the two-week wait?

A: It takes about two weeks from the time an embryo implants in the uterine wall to start emitting enough of the hormone hCG (human chorionic gonadotropin) to be detected by a blood test. This period of time is referred to as the two week wait. The blood test – officially called a beta hCG blood test – detects hCG and is the most accurate indication of pregnancy. We simply refer to the test as a “beta” because it actually measures a beta chain portion of the hCG hormone molecule.

Q: Should I take a home pregnancy test after fertility treatment?

A:  We recommend that you refrain from performing a home pregnancy test as they can render false results, either a false negative or 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 may 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 these are less sensitive than the blood hormone tests we administer.

On average, two weeks after your IUI or embryo transfer you will come back to our Center for your pregnancy test.

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

A: 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 have taken 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.

Please note, if after your treatment you feel excessive bloating, shortness of breath, chest pain, or lower abdominal pains, you may have ovarian hyperstimulation and should call your clinical team immediately.

Q: Do I take medications during the two-week wait?

A: Yes, patients are often prescribed progesterone and/or estrogren to take throughout their two week wait.

Progesterone supplements are given so women may produce the same levels of hormones that would occur in early stages of pregnancy. While most patients will supplement their progesterone via vaginal insert, patients who are using donor egg or frozen embryos will use the injectible form of progesterone for their cycles.

Additionally, patients who undergo 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 the medical staff to do so.

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

A: We tell all of our patients who have had an embryo transfer to be cautious during their first five 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 non impact light aerobic activities, such as walking and gentle swimming.

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

A: No special diet is required during the two week wait, but we recommend that you start making nutritional choices as if you are already pregnant. This means eating well balanced meals, no sushi or other raw or undercooked meats, avoiding high-mercury fish, soft cheeses, no alcohol, and continuing to take prenatal vitamins.

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

A:  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.

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

A: 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, our Center will refer you back to your OB/GYN to continue your prenatal care.

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

A: As soon as it is determined that you are pregnant, we use the same obstetrical counting or dating system as your OB/GYN. 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 2 weeks prior to ovulation. So although you may have taken the first pregnancy test just two weeks after treatment, you would be considered four weeks pregnant.

The first early pregnancy ultrasound is usually scheduled for you between six to seven weeks Gestational Age, roughly four to five weeks from your IUI or embryo transfer.

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

A: If you aren’t successful, your nurse will advise you to stop your medications. You will have the opportunity to talk with your physician to review the past cycle and make a decision together about your next steps.

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

A: While your physician will determine the timing of a new cycle, it is not always necessary to take time off between cycles unless otherwise directed. Many of our patients are able to begin their next treatment cycle immediately and for some a cycle of rest is recommended or preferred.

We know that these two weeks can be a very stressful time. Visit the SGF Facebook page if you’re looking for ways to help pass the time and get support from patients who understand what you are going through during this period of time. If you have any questions, please don’t hesitate to call your nurse.

Editor’s note: This blog was originally published in 2014, and has been updated for accuracy and comprehensiveness as of December 2020.

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