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Coping with the two – week wait

Andreia Trigo, RN BSc MSc
Founder of Enhanced Fertility Programme, Enhanced Fertility Programme

Category:
Embryo Transfer, Emotions and Support, Success Rates

Embryo Transfer And Two-Week Wait: How to Reduce Stress

Embryo Transfer And Two-Week Wait: How to Reduce Stress

How to deal with the two-week wait post embryo transfer? How to make it more bearable and minimize stress connected to waiting for the big news? How to avoid taking the pregnancy test too early?

If you are going through the two-week wait or you are preparing for IVF/egg donation treatment in the nearest future, this webinar is everything you are looking for. Watch the video recording above to find out how to make the most of this difficult time without worrying too much. Our guest speaker was Andreia Trigo from inFertileLife – a fertility coach and a TEDxSpeaker based in the UK.

In the webinar, Andreia discusses stress-fighting techniques and strategies that you can use to effectively cope with the IVF two-week wait, to keep negative thoughts at bay and reduce stress to a minimum while getting on with your daily life. Make sure you check this webinar before your embryo transfer appointment.

Emotional rollercoaster

Andreia started with addressing all the emotions that accompany anyone who is going through their journey. The anger, the frustration, the worry, the fear, the disappointment. All of these feelings are normal, and no matter what you are feeling right now or during the two-week wait, you need to remind yourself that is normal. Andreia explained that helping patients deal with emotional distress takes around 80% of the work because if you can manage your emotions, you can carry on with the treatment. However, if you are not able to manage your emotions, that is the number one reason for people to stop fertility treatment.

Many times we feel that we have an emotion that is triggered by an event in our lives. We feel that not only we cannot control that emotion, but we don’t know where it came from and that we can’t change it.  This roller coaster has a proper medical name, and it’s called the process of grief. Initially, when we are faced with a circumstance that we aren’t expecting, we might feel the shock and the denial. Then we might feel the anger, or we might feel depressed. The great thing about the process of grief is that we understand that it’s a process, and it’s naturally unexpected. The bad thing about a process of grief is that it’s not linear, so we go back and forth, and the two-week wait is precisely one of those times when we go back and forth with these feelings and emotions.
Andreia highlighted that it’s completely normal and expected, so no one should be blaming themselves.

When I was initially diagnosed there was that time before and after I knew I had a problem. The time before when I was a young woman, I was a daughter, I was a sister, and I was part of a big family,
I had an identity as someone who wanted to be healthy, and like any young 17-year-old, I wanted to grow and change the world.
Then when there was this particular challenge of being diagnosed with infertility, all these roles and identities disappeared from my life, and I only focused on my fertility and what I could not have in my life. My journey since then was rediscovering myself and making sure that no matter what my fertility journey brings, there will be space in my identity and my life for it.

Hierarchy of needs

In the pyramid shown on the slide, Andreia names & explains the hierarchy of our needs:

  • physiological needs
  • safety
  • love & belonging
  • esteem
  • self-actualization

Having all these other roles in your life is about meeting all these needs that are so important. We forget that we get so focused on reaching fertility goals that we completely forget all these other things.

During the two-week, there are five important things, that any woman going through it might be experiencing. Andreia discussed all of them in detail and provided some useful strategies to overcome them. These are:

  • obsessing about pregnancy symptoms
  • thinking about ‘what-ifs’
  • negative thoughts
  • too much time
  • no one understands

Schedule time to obsess about symptoms

As a nurse, Andreia assures there is no such thing as pregnancy symptoms, at least in that initial stage of two weeks. You might be, and you might end up with a positive pregnancy test, and you’ve had no symptoms whatsoever. Sometimes you have symptoms, and you end up with a negative pregnancy test. Therefore, the first strategy is scheduling time to obsess. If you schedule a time, let’s say 15 minutes from 8:00 to 8:15, it’s your time to obsess about these pregnancy symptoms. It might be the time when you go on Instagram, and you talk to your TTC crew, and you can ask about their own experience. You’ll have at least those 15 minutes where you think about it.

The second strategy is called the quick state change. This is an easy technique. Usually, we feel that we cannot control our emotions, but with this technique, you will be able to change the way you feel about something. Let’s say you are sitting in a coffee shop, and you see someone sitting at a different table, you see that person is sad. Even without talking to that person, you can see that this person is sad. The reason why that happens is that when someone is sad, we assume a certain posture. When I think about a time in my life when I was sad, I would say that my shoulders were down, my head was down, my muscles were tensed, maybe I was crying, and what I also know about this time in my life is that I was focusing on something. Every emotion is associated with a certain body posture, and it’s because we’re using a certain language. The trick is that if we change one of these three things in the triad, we can change the way we feel. If you’re sad, anxious, depressed or if you have negative thoughts coming through your mind, you can change your posture. You can think of a time in your life when you were super happy, super excited. As soon as you think about that time, you’re changing your focus, and then your shoulders are back to normal, your head is up.

For a quick state change, all you have to do is either change your body posture, your focus or your language. This is something that you can do if you are obsessing about pregnancy symptoms during the two-week wait.

Use relaxation techniques & write it all down

Usually, the what-ifs are things in the future that hasn’t happened yet, but they are occupying time in our minds. The first strategy is called the body scan. It’s a mindfulness technique that takes about 2 to 3 minutes, and you can find it on many websites. The body scan takes you through your whole body, it makes you relax several parts of your body. It’s a way of bringing you back to the present moment.

There are also amazing audio recordings with breathing exercises, you will notice that if you are stressed or anxious, your breathing tends to be quite fast or quite shallow, so these breathing exercises will prompt you to breathe differently. That will change automatically the way you feel.

Another exercise that will help you manage all the what-ifs is meditation. Meditation is about noticing your thoughts. You might be thinking, what if this doesn’t work, and instead, you try to say to your voice in your head: ‘thank you for sharing, now you can go’, and then you come back to the present moment. Meditation is about noticing, so, for example, there’s a glass of water, and you notice the shape of the glass, the size, the smell of the water and then you taste it, and that’s what mindfulness meditation is all about. Again, there are lots of recordings about mindfulness meditation and how to include it in our lives, it is proven that it prevents us from thinking about the past that we can no longer change or worry about the future that hasn’t had happened. This is one of the most powerful things we can do to manage all these ‘what-ifs’ in our minds.

Another strategy is called journaling or writing it down. If we are feeling a certain emotion, we are filling it in a part of our brain called the amygdala. This is the emotional part in our brain, but as soon as we write down this emotion, so let’s say you’re feeling sad and you’re depressed, but as soon as you get at least of paper and you’ll write that you’re feeling this way, you are labelling this emotion. As soon as we are labelling it, it moves from the irrational part of our brain to the rational part of our brain.

Challenge your thoughts

Everyone has negative thoughts, we will always have them. There will always be a part of our brain that is going to think: ‘oh my god – this is not going to work’, especially if this journey has been going on for a long time. One way of changing it, and it’s our strategy number five, is with affirmations. Affirmations are a way of controlling these negative thoughts in our minds. In psychology, there is something called a self-fulfilling prophecy, this means that you have a thought in your mind, and it might be that this is not going to work, what the self-fulfilling prophecy says is that because I have this negative thought, all my actions that I’m going to take maybe unintentionally are going to lead me not to have these results. Affirmations are a way of changing these negative thoughts. You might be standing every morning in front of the mirror in the bathroom, and you’ll say: my body is healthy, and I am ready for this pregnancy, and you say it’s so frequently that it becomes a belief. Unintentionally, your body will take the actions to meet their beliefs, it is a very powerful way of managing negative thoughts.

There is a lot of research involving gratitude and how it changes the waves in our brains. The more we express gratitude, the more we see it around us. It’s good to force yourself to identify at least 2 or 3 things each day that you are grateful for. If you are in a relationship, you don’t have to write it down, but you turn to your partner and tell him that you are grateful for these last few days or you’re grateful because he called you at lunchtime or he did the shopping, whatever it is, just expressing gratitude can get you back on the right track.

Strategy number six is a bit challenging, but it works. This is the technique of challenging our thoughts. We’re having negative thoughts, and we’re going to look for evidence that challenges these thoughts. You need to create a table, and the table will have thoughts, emotions (1-10), the evidence that supports that thought, the evidence that refutes that thought, and what will conclude that emotion.

Let’s say your thought during this two-week wait is that: this embryo transfer is not going to work, and the emotion that is triggered in you is sadness or helplessness, whatever it is. Try to write that emotion, and put the intensity of that emotion, let’s say it’s 10, so the worst. Then, let’s try to look for the evidence that supports this thought: why do you think it is not going to work? You might think that this is not going to work because you’re not having any of those pregnancy symptoms. Look at what evidence you have to prove that this thought is not real, it can be that you have prepared much better this time, as opposed to the other two times when you’ve had an embryo transfer. It may be that this transferred embryo was of better quality, the clinic used a different strategy, this could be some evidence that makes you believe that this thought is not accurate. Therefore, write down all of these, the evidence that refutes the thought, the conclusion. Once you have reached this conclusion, that initial emotion of sadness will no longer be that extreme as it was at the beginning, it would no longer be that 10 out of 10 because you have put things into perspective.

Embryo Transfer And Two-Week Wait: How to cope with Negative Thoughts?

Keep yourself busy

You might have a lot of free time during this two-week wait. Some people prefer to carry on doing work, and others prefer to take time off work. There’s no right or wrong way of doing it because there are people who avoid work and get pregnant, and there are people who go to work and get pregnant. However, if you have a lot of free time, one way of coping with the two-week wait is to keep busy. During this time, you might get a chance to engage in activities that you usually didn’t have time for before. It might be something that gives you meaning or pleasure, such as reading a book, going for a walk, cinema, having a massage, whatever it is something that gives you peace and pleasure. You can try and focus on something that gives you that sense of accomplishment.

Strategy number eight is about putting yourself first during this two-week wait. No matter what emotions you are feeling just notice them, don’t fight them, it’s okay not to be okay and allow yourself to feel whatever you are feeling without judging. Protect your well-being and your mental health. If during this two-week wait you don’t want to be around people, don’t be. If you want to meet a particular friend, meet with them. Do whatever you need to do to put yourself first and your well-being.

Get Support

The last problem is that no one understands, and you are right, no one understands unless they have been through it. What you need to do is find other people who have been through it because they will understand. We’re talking about getting unbiased professional support, it might be an NLP or CBT Coach, it might be a counsellor, a psychologist. These people will have the ability to give you some outside help with some practical strategies and techniques. These strategies might help you manage your emotions or help you manage some conversations, for example, with your partner or family, friends. These people who specialize in fertility support will be able to help you during this two-week wait.

Finally, professional support is not the only way of getting support, especially during the two-week wait when no one else understands. It’s extremely important to find your network, it might be family, friends or you can look for support on social media. There’s a lot of Facebook groups, there’s a huge community on Instagram where you can be completely anonymous, create an anonymous name for yourself and just find this gigantic crew of people who are going through it. People who will listen to you when you complain, or when you are unsure or when you are anxious, so it’s an amazing place to be. Finding your support network either from any of these resources will be so helpful.

Embryo Transfer And Two-Week Wait: How to Reduce Stress - Questions and Answers

Do you think it is beneficial to do pregnancy tests every day while on the 2-week wait to see if you have a chemical pregnancy? I’ve never done this and have had five implantation failures so far sadly… but 5 more embryos left in the freezer on my 3rd cycle.

Definitely, don’t test every day. Actually, those pregnancy tests that we get from the pharmacy or you can get over the counter are not the most accurate tests and it takes 2-weeks for the hormone to be in your urine so there is no point testing because you might think it’s a negative pregnancy test when it’s actually positive. So, there is no point testing and our advice to patients is never do home tests during the 2-week wait. Absolutely wait for the 2-weeks. It’s all about managing your anxiety so you can wait for those 2-weeks. Now the fact that you’ve had five implantation failures means that the more you do, the more likely that it will be successful. That’s what we know. Usually …. [42:19] settled in the first cycle. That’s what data shows everywhere in the world, so don’t be disheartened but it may take a few tries for it to be successful. It means that in the beginning, your doctor tries to understand how your body responds to all the medications, all the drugs, all the interventions. So, the more you do, the better it is. It’s good that you have five more embryos left in the freezer for your 3rd cycle, I would say. If you want, I can have a chat with you free of charge over the phone. You can schedule it and we can see if there is anything that we can do in terms of lifestyle or in terms of environmental factors that could be affecting your implantation, and see if there’s anything that you could do ahead of that 3rd cycle to try and make it successful. But, again, it would be your 3rd cycle and usually, 3rd cycles are more successful than the first and the second so don’t be disheartened—you are on the right track.

The 2-week wait is the most stressful part of the IVF journey. From a male perspective, I have to say this is the most helpless I feel during the journey. On an emotional level I am by my partner’s side in every step towards our goal, but the physical side to what my girlfriend is going through leaves me feeling helpless and like a bystander. Is there any advice you can give that could make a small difference in this difficult period?

I think the fact that you are open to being here on this webinar, and the fact that you are open to talking about it already speaks so much about you as a partner. So, I would say you’re already doing more than most partners do. The fact is that during this 2-week wait what you can potentially do is just temper her a bit more. Ask her what would she like to do that would give her pleasure. What would give her a sense of accomplishment? What can you do with her that keeps her busy and takes her mind off it? Maybe get involved in those mindfulness recordings with those breathing exercises if she’s getting anxious or maybe practise the affirmations or share any gratitudes that you have found on that particular day. Maybe all of these little things together will help her, but I think you’re doing an amazing job just being as present in the journey as you are. You’re doing so well.

Do you think a productive distraction or throwing yourself into work could work? Will it work for everyone?

There is not one strategy that will work for everyone. Everyone is different so you just have to think what would help you. I know some people prefer to just do work and for them work might be something that is really enjoyable and something that is really relaxing but other people might find that work is a really stressful environment. So, it will depend on what works for you during this 2-week wait. Particularly during this time in the journey, I would say focus on doing something that gives you a sense of pleasure and if work gives you that sense of pleasure then yes, definitely. Or, if you find pleasure in different things, just put yourself first. Good luck!

I had 2 x 3 day embryos transferred last Friday. I then caught my husband’s flu, cough, chest infection, fever on Friday evening. I think I may have caught an infection from the catheter as I had stabbing pains for 2 days, which have now stopped. Will the illness have affected the transfer? I have no symptoms but it is early.

It might not affect the transfer. So, like I said, there is no way of absolutely knowing, from my experience. We can have everything right and still not have a positive 2-week wait and sometimes we’ve been to work and we’ve drunk wine and we’ve done all the things that we supposedly shouldn’t do or we’ve been ill like you and it’s still positive. I would say don’t lose hope. It might be bad but it’s still positive. I hope you do get better and keep us posted. We’ll be rooting for you.

What environmental factors would you say can damage implantation?

I wouldn’t say there is one factor alone because there are many factors that can affect implementation. One might be because of a problem with the embryo itself or it might be due to the uterus lining. We don’t know. There are lots of things that can affect implantation. When we talk about environmental factors, for example we talk about reducing the amount of plastic that we have in around us in our lives. So, that might be food that we eat that comes in plastic containers or it might be Tupperware at home, that sort of thing. We also talk about smoking in environments that might affect air quality or sperm quality. It might be caused by a man having the computer on his lap. There are a lot of environmental factors that can affect the quality of eggs and sperm and can ultimately affect implantation. So, we will never know what exactly might have caused that implantation to fail, but there are a lot of things that we can do preventively to actually have more chances of making it successful.

If it’s not a problem with the egg, what are the other common reasons for failed implantation?

It might be a problem with the sperm itself. It might be a problem with the uterus lining. Actually, last year there was a unit in the south of Portugal that found that there was a special enzyme that would also affect implantation and that was something that we didn’t know until then. So, I think there are so many things about conception that the medical community is still not aware of and even if we try to control every aspect, then we still don’t have all the answers. But, what we do know is if we have a good quality egg and good quality sperm and together they turn out to be a good quality embryo and the uterus lining is sufficiently thick then there are more chances of implantation happening. That’s all we know.

My husband and I are in the 2-week wait with our surrogate with donor eggs after IVF failure with our own eggs and 3 implantation failures with donor eggs. Can you give some advice on how to de-stress while we wait for the news?

I think we’ve covered so many strategies today. It’s good that you are here to begin with and it’s good that you’ve listened to these strategies today. Again, I would say start by keeping yourself busy with activities that give you that sense of pleasure or sense of accomplishment. Maybe try to look for those videos on YouTube where you can look for the body scan. Mindfulness or breathing exercise really tend to help, as does writing things down in a journal, or thinking about things you are grateful for during your journey. If you do happen to have any negative thoughts that might come into your mind, maybe because you already had these failures and you might be thinking it’s not going to happen, then again do that table that I spoke about. Complete the table and that will guarantee to help you reduce your anxiety and your stress levels. Good luck!

I’m doing my first implantation in March. This is the first time we are doing IVF. I work as a dog groomer. Do you think it would be best for me to have time off during the 2-week waiting period?

You can take time off if you prefer, or you could go to work as well—it’s not something that is contraindicated. What would be contraindicated after the embryo transfer is visiting a sauna or if you happen to work in a swimming pool? But, apart from that, as a dog groomer you don’t have to stop your job during those 2 weeks. I wonder if it is something that you enjoy doing if it’s something that would give you pleasure and at the same time keep you busy—then, by all means, continue doing it. It wouldn’t be a problem.

I like to do some sports and drink one cup of cappuccino. Can I do these during the 2-week wait?

What you wouldn’t be able to do is anything that is high-intensity training. So, I would say don’t run a marathon. Don’t do HIT training, but aim for light sports instead like going for a walk, that sort of thing. Yes, you can carry on doing this but don’t do water sports or anything that is too intense. In terms of caffeine, like in a cappuccino, would you consider maybe decaf or does it have to be cappuccino? But, again, we usually say to minimize the amount of caffeine we have during the fertility journey but there is no proof that removing it altogether will be a guarantee. So, if drinking one cappuccino will help you cope with the 2-week wait, then you can have that cappuccino and I hope you enjoy it and have lots of pleasure having that cappuccino.

Is it ok to drink some wine at dinner or a cocktail during the 2-week wait? I wonder because in a natural pregnancy we would have not known yet that we are pregnant and would our lives normally.

Exactly! So, what I can tell you is that, as health care professionals, if it’s a planned pregnancy we would advise the woman to start taking some supplements and we would tell them to avoid drinking alcohol—if it’s a planned pregnancy. But, lots of people end up pregnant and they haven’t planned it and they have drunk alcohol and the pregnancy still happens and the babies are healthy, so it has to do with moderation. If you feel that you want to have wine or a cocktail during the 2-week wait you may do so. If that helps you or if you absolutely have to drink, by all means do so. But what we know is that there is a link between alcohol and some abnormalities in babies, so if you are able to avoid alcohol that would be best but if you want to drink then, by all means, have some. Like you said, there are people who end up pregnant and they do have alcohol in their lives, so we can’t guarantee that it was that glass of wine that made me have a negative pregnancy test. We will never be sure and there are lots of people who are able to just say: ‘I’m going to go through this 2-week wait and I’m going to relax and I’m going to live life as normal and then, you know what, if it turns out that after the 2-week wait the test is positive, then great!’ So, yes, if you want to have that some wine at dinner and if it helps you during the 2-week wait when you feel bad, then by all means.

Some people advised me to go on a gluten-free diet during the 2-week wait. Can it help?

Are you allergic to gluten? That would be the only reason when we would think about going gluten-free during the 2-week wait or at any other time of the journey of our lives. So, if you are gluten-free, yes. But if you’re not there’s actually evidence that removing gluten completely from your diet can actually be unhelpful. I say that you don’t have to put yourself on a gluten-free diet unless you absolutely have to for your own health.

What are my chances of success in terms of the probability of it going well?

That’s a very good question but the answer changes every time, so it depends on your own circumstances, on your own health, on the quality of your embryo. I can talk about the general idea. In the first cycle, the chances of getting pregnant are around 20%. When you reach the 3rd cycle, the cumulative chances are around 50%. So, we can tell you that once you’ve reached cycle number 3 you have more chances of a positive pregnancy test when compared with the first. But, again, there are lots of things at play here. The things that can affect pregnancy tests include smoking, extreme exercise, or not moving enough. There’s a certain BMI range so being too overweight or too underweight can be unhelpful. All these things can affect your success with IVF but usually, it tends to be 20% for the general population, 20% and then around 50% cumulative chances around the 3rd cycle.

Would you recommend any other blog or Instagram to follow to stay really focused on being positive?

There are lots of people who are really good on Instagram. Sorry but I’ll just check my Instagram and I can tell you a few that I follow. For example, there’s a podcast called Big Fat Negative Podcast. Don’t be put off by the title! They are 2 girls who are amazing at what they’re doing and they are really positive and they do a lot of podcasts. There’s also a podcast called The Fertility Podcast—this is also an amazing person to follow. The Fertility Network UK on Instagram is also an excellent one to follow but there are lots of people to follow. If you search for fertility support or #TTC or #fertility support on Instagram, you’ll see lots of people with these positive messages.

I think we shouldn’t change our lifestyle too much during the 2week wait (of course, no smoking, no alcohol). It might be too stressful for me! The embryo transfer has happened and I think we should focus on our emotions and well-being. What’s your opinion?

100% and, you know what, sometimes I’ve seen people who think to themselves, ‘I have to do acupuncture or I have to do this or that…’ and it turns out that the 2-week wait ends up being more stressful than any other time of the journey because of all these ‘have-to-dos’. That’s why I emphasize so much to do things that give you a sense of pleasure—whatever you would actually enjoy doing—and don’t do something just because you have to. Indeed, focus on your emotions and on your own well-being. There’s nothing that we’re going to do regarding your lifestyle during the 2-week wait that will specifically make a difference. I would say lifestyle and environmental factors matter more about the quality of the eggs and the sperm. So, it’s all about the three months before egg collection or the three months before sperm collection—that’s how long it takes for the sperm or the egg to actually have better quality or poorer quality. Lifestyle and environmental factors matter more during that period than in the 2-week wait. But, of course, like you said—no smoking, alcohol, extreme exercise, bathtubs or anything like that. Those are things that your doctor will tell you about as well but focus 100% on your well-being.

I was just wondering if the embryo at the very early stage is somehow protected from the impact of alcohol—of course, just a small quantity like a glass of wine. I also heard that red wine is good for the endometrium (before the transfer).

I think historically there was this idea that red wine was good, even for circulation, but that turns out not to be true. That was something that in the old days doctors used to say but research shows that it is actually not true because alcohol is associated with a lot of consequences that, when compared with the benefits, are just not worth it. Alcohol is the number one reason for cancer, so it’s definitely not worth it. There are other things that we can do to improve circulation and, therefore, irrigation or blood supply to the endometrium as opposed to having a glass of red wine. Like I said, we usually advise people who are trying to conceive to avoid alcohol because it has bad effects on the embryo, but then again if not drinking will give you more stress or more trouble and will prevent you from from feeling good during the 2-week wait, of course, you can choose to have some and lots of people who did drink wine ended up being okay during the 2-week wait and having a positive pregnancy test. What we know, or what we have to advise, is that there is no amount of alcohol that is actually beneficial.

What are the main options if the 2-week wait doesn’t end up with the result we wanted?

If the 2-week wait doesn’t turn out with the result we wanted the key thing here is to make an appointment with your doctor and explore the reasons why maybe it wasn’t successful and start to consider what you can do differently in the plan so you can have a different result next time. I usually say it’s the plan that isn’t working so that’s what we need to adjust. We need to think about doing something different. If it doesn’t work, don’t be disheartened. Understand that maybe the 2nd cycle or the 3rd cycle will be the one that gives you your chances and all you know now is that this one hasn’t worked. It doesn’t mean that another one won’t work and exploring the options with your doctor, learning about things connected with lifestyle or environmental factors, or managing emotions, and things that you can maybe do differently might prepare you for a different result next time.

Authors
Andreia Trigo, RN BSc MSc

Andreia Trigo, RN BSc MSc

Andreia Trigo is a multi-awarded nurse consultant, author and TEDx speaker. Combining her medical experience and her own infertility journey, she developed unique strategies to help people undergoing similar challenges to achieve their reproductive goals. Her mission is to improve accessibility to fertility care and support worldwide at minimal cost to populations. She is also The Founder & Director of Enhanced Fertility Programme, the evidence-based programme that improved help for fertility, currently in use by several clinics and patients worldwide.

Disclaimer:

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