Medical Contribution By Dr. Melissa Esposito

You’ve already waited months, maybe years, to finally get to this point. You’ve entered the dreaded “two-week wait.” This is the time between the end of your fertility treatment cycle and your beta hCG blood test – the test that provides the information whether or not you’re successfully pregnant. It’s a brief period of time that’s usually filled with both hope and anxiety, so fertility experts like Dr. Melissa Esposito of Shady Grove Fertility’s Frederick Office get a lot of questions from patients about these long 15 days.

Here are Dr. Esposito’s answers to the most commonly asked questions:

What is happening and what am I waiting for exactly?

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. After that period of time has passed, we can be reasonably sure that the test results are accurate.

Why do you recommend I not take a home pregnancy test during this period of time?

Home pregnancy tests (HPT) can render false positives if taken too early because part of the medication protocol in many of our treatments includes an injection of hCG to help the woman’s eggs mature. Traces of the administered medication can still be in your bloodstream and detectable by a test, even if implantation has not occurred.

That said, I understand how anxious infertility patients are during this time. So I tell them that if they absolutely must use HPT’s, wait until the morning of your beta hCG (blood) test. I don’t recommend they drive themselves crazy with testing every morning. Plus, I have had patients who had negative HPT but positive beta tests.

What is a good result for a first beta test?

We feel that any number over 100 is a good start.

Once you receive a positive beta test, why are additional tests performed every 48 hours after the first positive one?

We’re looking for the level of hCG to rise by a certain amount over time, to indicate that the embryo is implanted and functioning well at that point. If the number is rising about 66% to doubling, we’re relatively confident that it’s likely a viable pregnancy.

Some patients ask what the “normal range” is, but there’s really no particular range because it all depends on the number from the first beta.

I should add that 5% of normal pregnancies have betas that won’t rise like we hope, and about 5% of non-viable pregnancies have betas that rise normally. So the beta hCG tests alone are not entirely predictive of successful pregnancy.

Why will some women feel pregnant during this time, while others have no pregnancy symptoms?

I actually attribute a lot of the early pregnancy symptoms that some women have to the hormone supplements that we prescribe. Usually our patients are taking estrogen and progesterone through their 10th week of pregnancy. Those hormones at that level will make many women feel the minor discomforts associated with early pregnancy.

We forewarn patients that some will feel symptoms, like nausea, and some will not, so they should avoid reading such symptoms as indicators of pregnancy.

Why do some women feel period-like symptoms?

The process of implantation can cause mild uterine cramping and spotting. In fact, it’s so common that I look at it as a somewhat positive sign. Even through the early first trimester, cramping is quite normal due to the increased amount of blood flow going to the uterus.

Can women travel or exercise during this time?

We tell all of our patients to be careful during the first five days after their treatment. Additionally, they should refrain from sexual intercourse and engage in only very minimal or no exercise. It’s precautionary as some of these activities may cause uterine contractions that might impair the implantation process. There’s also a greater risk during that time of ovarian issues arising, since the ovaries are often slightly enlarged at that point. After those first few days, patients may return to exercise, but we still ask that they avoid high impact activities.

We’d also rather patients to avoid travel during those first few days post-treatment. This is primarily so that we can be closely available for examination should any problems develop.

Do women who have just gone through treatment need to adjust their diet?

Thinking positive, we ask that patients start making nutritional choices as if they’re already pregnant as early as during the stimulation point in their treatment cycle. That means no sushi or other raw or undercooked meats, avoiding high-mercury fish and soft cheeses, and no alcohol. We also think that they should stay away from high soy diets to avoid phytoestrogens – a natural compound found in plant products which can produce estrogenic effects in women – which might impact their uterine lining.

Besides adjusting their diet a little, I tell my patients to do whatever they can to de-stress their lives. Try not to let fertility treatment run your life, find healthy ways to take your mind off the anxiety.

I know that the two-week wait is the toughest part of the whole treatment journey for a lot of patients. All of our staff do whatever we possibly can to minimize the tension and make the time pass safely, if not seemingly more quickly!