Very good question. If the transfer is performed on Day 5 of the embryo development, the embryo which is usually ready to nest around the day six or seven, should be implanting, nesting, in the next two days or so following the transfer. Honestly, there are hardly any signs of the implantation itself. The embryo at that point has about two tenths of a millimeter in diameter and its attachments to the endometrium and the beginning of the process of the implantation, you cannot feel at all. There might be actually one sign, that’s kind of typical for these initial two weeks, there might be a slight spotting or even a weak bleeding sometimes as the embryo nests it breaks some of the capillaries and starts to communicate with the mother’s organism. Sometimes this pool of blood, this little pool of blood, can actually escape from the uterine cavity and can present itself as a spotting or bleeding. If that happens, no panic, keep taking your medications and bed rest is recommended for the duration of the spotting. As soon as it’s over, then you can get more active again. Otherwise, the other signs of an early pregnancy such as nausea or headaches or pressure in the breasts usually come later in the process – not during those first two weeks before we perform the pregnancy test. So during these initial 14 days, we really need to be patient and we need to wait for the test result.
After the embryo transfer you should not feel anything related to implantation. In fact, there are no symptoms related to implantation. You can have some symptoms that are related to the ovaries. If you have had your pick up recently or even in the spontaneous cycle for frozen embryo transfer, you can feel the same things that any patient can feel during the normal cycle that are related with ovulation, with some bleeding that can appear in your womb but those symptoms are not related with implantation.
This is a very frequent question, and if we could find any signs of implantation, we will know if it is a successful or unsuccessful attempt earlier than 10 days after an embryo transfer. Unfortunately, there are no special signs of implantation. So, we need to wait for 10 days after an embryo transfer, then check with a pregnancy test.
Actually after embryo transfer – no, you shouldn’t feel anything. Of course, maybe the side effects of progesterone but nothing else. What patients usually feel, sometimes not always, is when the embryo actually implants, they start to feel some sort of feelings… sort of the different types of feelings that came by the hand of the estradiol levels and the hormone changes that the body starts to experiment with after implantation.
The embryo transfer procedure can cause mild uterine cramping and/or discomfort, while the medications and increased hormone levels can also cause varying symptoms. As it can take a full week for embryos to imbed fully into the uterine wall it is difficult to say exactly when an embryo has implanted and relate any discomfort to that precise moment. Some patients do not feel any discomfort at all.
Some people feel it, not straight after the embryo transfer, but after a couple of days, which is the time it will take the embryo to implant. Some people feel something like a cramp, which can be felt like period pain. Some people have even some bleeding or spotting. And then if they test positive, then retrospectively, they think okay, that probably was the implantation. But the fact that you feel that pain or that spotting doesn’t necessarily mean that the test is going to be positive. But there’s been some evidence that yes, sometimes people feel it.
And that is physically, perfectly expected, there’s a perfect explanation, because obviously the embryo starts digging in the uterine cavity, and starts finding its own spot. Then during that process, it will cause changes in the uterine cavity and the womb that might reflect in contractions or period pain. Sometimes also, the digging will probably cause a little bit of bleeding, and that is why there is spotting that can be related to embryo implantation.
Unfortunately, subjective signs of implantation are very unsure. So the surest thing is a pregnancy test. Sometimes, there might be some small bleeding a few days after transfer. Many patients are stressed by this thing. But it’s quite normal because it’s a result of the implantation of the embryo. Usually, it’s a good sign if it is only small bleeding. So it’s the most common sign of implantation. Other things like some pain or pressure in the abdomen are common they don’t mean anything. Before ultrasound and HCG, there may be some signs of pregnancy, and many of them are very unsure. So we can only find out 100% that a woman is pregnant after 15 weeks of pregnancy. So subjective things are not sure, and we cannot predict the result of the embryo transfer based just on the symptoms.
Because of the medication, estrogen and progesterone, patients feel the same symptoms during the waiting period and during the early pregnancy, exactly the same. These are subjective things. A patient may have many symptoms during this waiting period and cannot get pregnant and sometimes during this period, you might not feel anything and still get a positive result. So, according to the subjective symptoms, I cannot say anything conclusive. Usually, we can see slight bleeding that we call implantation bleeding that occurs on the fifth to the seventh day, otherwise, there are no positive or negative symptoms – even during this waiting period.
I would say that IVF procedure and embryo transfer are completely different than a natural pregnancy. With a natural pregnancy, yes, you can feel it, because the progesterone level gets higher and then beta hCG kicks in and you can feel that you could be pregnant at very early stages. However, the major difference with IVF is that you are already on a medication that mimics the pregnancy state. When you are given a trigger injection, like Ovitrelle or beta hCG, this again is a pregnancy hormone. The other one is progesterone that you are having. So you are having progesterone in very high doses for two weeks. To be honest, to feel that you are pregnant despite this medication that is already giving you this sensation is probably not accurate. The evidence is that sometimes people are not pregnant after these two weeks and they don’t have the period only because the medications are on. Once we stop the medication, you go back to having a menstrual bleed and then we start again. So it’s very difficult to feel anything at this time. It’s only because of the medication that you are on. Maybe if you are not on a medication, which is like a natural pregnancy, then yes. However, in the implantation, it’s very difficult to feel anything.
This is quite a common comment. I have a lot of patients that say that they felt that the outcome was going to be negative at some point because they didn’t feel what they were supposed to feel. Unfortunately, there is no way of knowing if the embryo has implanted or not. The thing is that these kinds of treatments are artificial treatments, so you are going to be on hormones. The conditions of your body are going to be very different from those that you have in your natural cycles. This may be misleading when you’re feeling that your breasts are more tender than usual, and this may mean that you’re pregnant. The hormonal levels are going to be higher and this may have some side effects, which are not bad for you but may make you feel completely different from a normal cycle.
The only thing that has sometimes been related, and that’s a quite common question, is the so-called implantation spotting. That means that 2-4 days before the day of the pregnancy test, the patient has very light bleeding like for 24 hours, that’s all. They spontaneously disappear, and they call us because they think they’re going to have their period, and we say, okay, don’t be worried sometimes this may mean that the embryo has implanted.
Anything else like feeling tenderness in your breast, feeling bloated, feeling pressure in the belly, these are kinds of things that can be related to the size of the ovaries, to the hormones you’re taking but not necessarily to the fact that you are, or you are not pregnant. Don’t expect to feel the implantation, don’t expect all the symptoms and signs that you have to give you any hint, any clue about whether you’re pregnant or not. The only way of being sure is if you have a positive or a negative pregnancy test.
