The stretch of time between ovulation and when a pregnancy test can reliably confirm pregnancy results is called the “two-week wait.” For obvious reasons, it’s a tedious time as women search for early pregnancy signs and symptoms in a ceaseless “am I/aren’t I” cycle of self-doubt. But for women who have undergone fertility treatments, the two-week wait is its own special type of hell since the results of not only your pregnancy, but also your fertility health, your finances and your general well-being dramatically hang in the balance.
After my first embryo transfer, I tried to find sanity by chronicling any pregnancy symptoms in my journal. But rather than a log of early pregnancy signs and symptoms, the result is something more akin to a diary of a woman slowly becoming unhinged. Below are some unedited excerpts that I will share here in case it helps others to feel a little less crazy, during this otherwise crazy time. 🙂
Early Pregnancy Symptoms: The Outrageous Things I Thought…When I Thought I Could Be Pregnant.
Two Days Post Transfer (2dp5dt):
Searching for signs of early pregnancy symptoms during the two-week wait is undoubtedly the hardest part of the entire IVF process. I have also found it to be a very lonely time. In the absence of my busy team of doctors and nurses, I suddenly feel vulnerable and exposed during a time when I need the support and medical assurance the most. With each passing day, small whisperings of insecurity bloom into feelings of self doubt and suddenly I’m questioning everything I once felt so sure of: Did I move too much after the transfer? Should I be eating this instead of that? Does exercise negatively impact implantation? Are my progesterone levels high enough? Was that a period cramp, or a pregnancy pang?
Today is my second day of bedrest and I have never wished a week away more in my entire life. I feel as if all my coping tools have been taken away from me and I’m left confined to my bed with nothing to do but will this to work through the sheer act of worrying. I’ve given up coffee “cold turkey” and its making this time even worse as I feel cranky and groggy with a consistent, dull headache. I was so excited for this transfer, but I’m now seeing how anticlimactic this event really is. Seven more days to go!
Three Days Post Transfer (3dp5dt):
I returned to work today and instantly regretted it. My morning commute, which involves both a boat and a bus, was agony as I felt like every bump encountered was the inevitable demise of my little embryo. I actually made the bus driver pull over seven blocks early so that I could walk the rest of the way to work. But then I realized I was walking and carrying my heavy computer bag, and so I felt even worse (the nurse said to refrain from lifting anything heavy). Ultimately, I decided that “the real world” is a bit too much for me right now. I’ll be working from home tomorrow.
Four Days Post Transfer (4dp5dt):
Welcome to the fourth day of hell. I haven’t been this challenged emotionally or mentally in a long time. My entire support system and regular routine have been stripped from me: I can’t work out, I can’t drink coffee, and I can’t focus on my job.
My two new best friends are indecision and guilt. After several minutes of perseverating, I decided to have a cup of black tea this morning, then spent the rest of the afternoon feeling horrible that I did. Even though I told myself I wouldn’t, I’m monitoring my body and obsessing over every twinge, every quiver, every burp, every yawn. This morning I blew my nose and I thought: “Could this mean I’m pregnant?” Yesterday I felt some afternoon fatigue (like I do every single day of my life) and I thought: “Could this mean I’m pregnant?”
My husband keeps telling me to just “let it go” and stop worrying. But this is easy for him to say, as his body isn’t the vessel for a $30,000 microscopic being who hasn’t decided if it’s here to stay yet. How can you “let go” of something if it’s physically apart of your every action?
Five Days Post Transfer (5dp5dt):
I have no symptoms today and if I were a betting woman, I’d say that I’m absolutely not pregnant, as I feel so completely normal. However, since I physically witnessed a doctor insert that embryo into my uterus five days ago, I’m going to still play those 50% odds and hold out some hope.
I was in such a foul mood this morning until I finally decided to make my first cup of coffee since transfer (come to mamma!). Sitting here sipping this I’m in much better spirits and I wanted to note here that I really want to enjoy this unique time because no matter the outcome, it will all be over in a few days. It’s been all- consuming and it’s been tortuous, but it’s also been a completely new experience for us and I’ll never forget it.
Six Days Post Transfer (6dp5dt):
I took a home pregnancy test today with my first morning urine (FMU) and it’s negative and I’m gutted. I know that the game’s not over until your official beta test, but I know what this means and it doesn’t look good.
As I sat alone in the bathroom, I felt so enraged in that moment that I felt like hurling the cup filled with my FMU straight across the room. Don’t worry, I did not. I think the most upsetting thing to me is that I just don’t understand the reason why. I’ve spent hours today doing some online research in an attempt to make some sense of it all. I’ve summarized some of what I’ve learned below:
Is there a chance I’m taking the pregnancy test too early?
According to this implantation timeline, blastocysts implant between 0 – 5 days after transfer, with the fifth day being the latest. Once implantation is complete, the cells that will eventually become the placenta start to emit human chorionic gonadotropin hormone (hCG) into the blood stream. The level of hCG during this time (which is also labeled as “week 3” of pregnancy) is between 0-50 mIU/ml (thousandths of an International Unit per milliliter), with the amount significantly increasing every 48 hours.
The most sensitive pregnancy test on the market is First Response Early Results (FRER) which can detect hCG at concentrations as low as 6.5 mIU/ml (thousandths of an International Unit per milliliter) in your urine. As this study by Consumer Reports indicated: “That’s almost sensitive enough to detect any pregnancy soon after implantation.”
I tested today with two different type of home pregnancy tests:
- A Wondfo test that detects 25 mIU/ml of hCG
- A FRER test that detects just 6mIU/ml of hCG
And both tests gave me that glaringly, single red line with no trace of any second line. It’s as clear a negative as I ever got one and made me feel the exact same as we did when we were trying naturally and I’d get those blatant single lines. However, this time, I’ve sunk thousands of dollars and time into it and I just can’t believe it’s as if we never had a viable, good graded, tested and approved 5-day embryo physically placed into my uterus.
The lack of hCG in my system at this time leads me to believe that our embryo did not successfully implant, and arrested sometime after transfer. Advanced Fertility helped me answer my next questions:
So what causes implantation failure?
When IVF fails there was implantation failure, but we do not know whether the failure to implant was due to a problem with the embryos or a problem with the uterus. Most fertility specialists believe that in more than 95% of IVF failures it is due to arrest of the embryos.
So I guess I should conclude that even though our embryo made it to blastocyst stage, and even though it made it through biopsy, and even though it made it through freezing, and even though it made it through thaw…it STILL arrested when in utero, which is its prime environment. Not to be so reductive, but WTF.
So what causes embryonic arrest?
Embryonic arrest is quite often due to chromosomal or other genetic abnormalities in those embryos that made them too “weak” to continue normal development and sustained implantation.
Unfortunately, these issues are mostly a “black box” at the present time – unless we do preimplantation genetic screening, PGS, for chromosomal status on the embryos prior to transfer, we can not know if they are likely to be competent.
This is even more maddening considering the fact that we did spend the extra time and money to conduct this type of screening on all of our embryos. Moreover, the embryo transferred was deemed “chromosomally normal” and “100% competent” for transfer. So again, WTF.
Despite ALL of these factors that we have controlled for, it still looks like we are ending up on the other side of the 50% statistics for IVF success, and I couldn’t be more disappointed and upset.
Seven Days Post Transfer (7dp5dt):
I woke up this morning and tested again with a FRER. And it was negative. Again.
I told myself I wasn’t going to get angry. I told myself I wasn’t going to cry. Then I spent the next 10-minutes sitting on the edge of the tub yelling and sobbing.
I pulled myself together and ate breakfast with my husband, fully resigned to the new knowledge of not being pregnant. Then I spent the rest of the morning looking up the rate that hCG enters into the bloodstream and then into your urine. After a few hours of research, I convinced myself that the jury is “still out”…even though I know in my heart it’s a done deal.
I’m really trying to keep in mind that at this exact same time last week, that little embryo was not even inside me yet. When I think of it that way, it seems absurd to expect a positive pregnancy test, even with the sensitivity of FRER. It would have had to hatch out of its shell, attach itself to the uterine wall, burrow deep, complete implantation, and start secreting hCG levels that are high enough in the blood stream to be processed by the kidneys and make its way into the urine.
Could this truly be why the clinics don’t test you until 9 or 10 days after transfer? Could this truly be why the nurses and REs tell you NOT to take a home pregnancy test? From all of my research, that seems to lend itself to some credibility. But then why in the world do scores of women get early HPT tests from FRERs on 6dp5dt? These IVF forums are truly messing with my head.
I also have to be real with myself and acknowledge the fact that so far I have had no pregnancy symptoms. Zip. Zero. My slightly different “fluttery cramps” (which literally might not have even be that different) have completely dissipated and all I have now are the low, deep aches of an approaching period. And that’s it. Not even a hint of breast tenderness, not even a whiff of nausea!
Only three more days to go until my official beta test at my doctors office. Which, thank god, because how many days can I spend in my sweats on the couch googling levels of hCG in urine? 🙂 I think the best thing to do is stop wasting my money on these expensive FRER tests and just wait until beta day. If I test on the morning of beta, I’ll know going in what to expect, but I won’t have gone through an entire FRER box in the process. Also, every time I take the test and it’s negative it throws me into an absolute tailspin – even when I promise myself I won’t let it. The downside to this strategy is that I may still foster that little hope that we are pregnant. There truly is no winning during this horrible time.
Eight Days Post Transfer (8dp5dt):
I’ve officially lost it folks. I’m roaming the streets of crazy town and I’m not sure when I’ll be back.
Last night as I was trying to fall asleep I had intense, deep uterine cramps accompanied by aching and restless legs. I started to worry about blood clots, so I hopped on the computer to research the symptoms of Progesterone (which I’ve been taking daily for over a week). Well, although rare, blood clots ARE a side effect of Progesterone. Naturally this sent me into a tailspin and I spent the night thinking that a blood clot would travel to my brain and kill me in my sleep.
Obviously, I survived. I called my doctor just to be sure and her response was a mix between an impatient sigh and a soft laugh: “You absolutely don’t have a blood clot.”
Nine Days Post Transfer (9dp5dt):
The night before the day of reckoning and I cannot tell you how happy I am that this day is almost here. It’s truly been an agonizing week and I’ve actually lost a few pounds from the stress.
I stuck to my word and have not done another pregnancy test. I’m shocked that this is the route I decided to take because I really thought I’d want to know. But taking them really caused me so much heartache.
So that leaves me to my mental state and honestly, what I feared would happen by not taking those tests has happened: I am harboring hope that tomorrow might be good and unexpected news. If I were a betting woman I would say I’m not pregnant… But would I?
Honestly, it’s so maddening because of the following facts:
- I witnessed a medical professional put a tested and approved healthy embryo in my uterus during my fertile window
- It’s 14 days post ovulation and i don’t have my period (CD 28 – I’m usually spotting/bleeding by now)
- I have had pretty significant and consistent uterine cramps almost every single day
I’ve had symptoms I’ve never had before like consistent headaches, leg cramps, and now dizziness – thats not my normal PMS.
- My negative HPT was on “day 7” but since my transfer had been so late in the afternoon (4pm) it was actually still the 6th day post transfer
- My drs, nurses, and RSS specialist instructed me NOT to test bc HPTs can not always tell and betas are the only sure thing.
- Our embryo was not hatching yet and its shell had not thinned (or else it would have been a 4, not a 3) and so we have every reason to believe it was a late implanter.
To be completely honest, these are the thoughts that have begun to percolate and grow stronger every hour since that dreadful morning on Sunday when I got my 4th negative HPT. And it feels logical and it feels sound. And then I smile to myself and think what a crazy loon I was to test so early and to not trust the process.
And then, I read a list of “common side effects” for Progesterone suppositories, and every.single.thing. that I just mentioned above, including the delay in period, are ALL listed in the top symptoms for Progesterone!
And then I think of all the negatives I’ve got before and how I’ve never seen a line yet and how so many woman see that faint BFP line on day 4/5/6…..and how, despite the cramps and the headaches, I think I pretty much feel totally normal. And then I’m back to defeat again and I wish I didn’t even go here bc it’s like being let down over and over again.
And you know the craziest, laugh out loud, thing about it all? I could put down this computer right now, march into the bathroom and take a FRER and put an end to all of this! But I wont. The good thing about finding out the bad news tomorrow is that it’s definitive….it will be closer to the end of the work day (and work week) and I’ll immediately know and can go have a glass of wine and regroup.
I guess the silver lining to all of this is that I truly do not remember a more topsy turvy time in my life and I truly do not know what tomorrow holds. I guess when you look at it that way, it’s pretty exciting. I’ve turned this one on its head so many time and looked at it at from every angle and now that I’ve not taken an HPT in a few days…I just don’t know. I’ve never been pregnant before so i don’t know what those symptoms are like, I’ve never taken Progesterone for this many days, I’ve never analyzed every single little physical symptom in my daily life so intensely, for so long.
I think I shall retire with those final thoughts…I don’t know what tomorrow will bring, but I’ve done what I could to figure it out, and the rest will just be what life is so good at delivering: a surprise.