The Day of the Transfer
After patients are released from the clinic, they are sent home with instructions to go
about the rest of the day and ensuing two weeks with normal, reduced activity. There is
no need to be on bed rest. All our patients have different medication protocols that they
go home with.
The 12-Day Wait 
We have now come to the end of the IVF procedure and the maximum that our
technology can help a person to achieve a pregnancy. We are at the point where we
have to wait to see if the next steps happen on their own. If a Day 3 transfer was done,
it will take approximately seven days for the remainder of the process to be completed
and for the pregnancy test to be positive. For that reason, you can do your pregnancy
tests at eight or nine days post-transfer. For a blastocyst transfer, you only need three
more days to get a positive pregnancy test.
Some clinics want to be absolutely sure, so they wait for 12 days, but the problem with
that protocol is that an early chemical pregnancy will be missed. It is important to know
because it verifies that the patient can become pregnant with IVF and that the last steps
the body needs to take naturally (implantation) actually occurred. With that knowledge,
the patient will be reassured that this treatment can work, that her body can do what it
needs to do, and it is just a matter of getting a perfect embryo into her womb for her to
be successful. The majority of chemical pregnancies occur because the embryo is
genetically abnormal. It would be good to know that those last steps, those steps that
are beyond our technology, can occur on their own.
Post-Transfer Pains
The body is a fluid and dynamic structure and there will be many sensations that
patients report during this period. Some will report many types of pain, some will have
cramping, and some will have bleeding. Most of these symptoms are not of any
consequence but cause patients to needlessly worry. Some doctors have referred to
these “pains or cramping” as implantation related. That may be the case but no one
knows for sure. Certainly with implantation, the uterus is undergoing changes and
cramping tends to be one way that uteri react. So, if the timing is appropriate, namely at
the point where implantation would be expected as described above, then these
sensations could certainly be related to it. Of course, onset of one’s period can also be
heralded by cramping, but this is usually accompanied by bleeding. If adequate
hormone replacement is given in the luteal phase of the process, then the period should

not start until the medications are stopped. That is the cause of the onset of the
bleeding and cramping associated with a period; it is the withdrawal or abrupt drop in
hormone levels. Some will claim that this is the uterus “stretching or growing,” but this
could not be the case at this point in the pregnancy. The embryo is like a mere fleck of
dust within the cavity and not big enough to cause the uterus to begin growing.
Some patients will experience sharp or stabbing pains, on the other hand, that may not
be from implantation but more from the ovaries. About three days after the retrieval, the
ovaries will refill with fluid and this stretching of the follicles and ovaries certainly can
cause pain in one side or both sides. This is the pain sensation that most patients have
during this period of time. If this pain becomes severe and not relieved with simple pain
medication such as Motrin, Ibpuprofen, Naproxen or others, then it could be a serious
problem. Post-IVF complications causing severe pain include ovarian hyperstimulation
syndrome (OHSS), ovarian torsion (twisting), ovarian hemorrhage, ectopic pregnancy,
and pelvic infection. If the pain is mild, then intervention is probably not required, but if
severe, it could be one of these serious medical problems that will require medical
treatment because they could be life threatening. You should know, however, that these
complications are very rare. On the other hand, if you have had a positive pregnancy
test and these symptoms occur, impending miscarriage could be another source of
cramping or pain.
Bleeding After Embryo Transfer
Bleeding within this period is also a very common complaint. It is the most common
subject searched and commented on. In most cases, this is a very light bleeding (pink
or red) or spotting. Some will refer to this as “implantation bleeding,” although, this may
not explain all of the causes because the timing is often not right. Again, in most cases,
this bleeding is inconsequential, but it could also indicate problems such as inadequate
hormone support for the luteal phase, thereby causing the endometrial lining to start to
slough. It could also indicate that the period is starting or that an abnormal pregnancy
exists or is being miscarried. When the bleeding is light, no intervention is required.
First, there is no intervention that can be done, other than checking hormone levels and
increasing the progesterone if the level is inadequate. Second, this could be normal, if in
fact it is implantation bleeding. Third, if vaginal progesterone is used, the progesterone
may be causing the cervix to be more delicate or friable and therefore cause cervical
bleeding. 
One cause of light bleeding that does need medical attention is when it occurs after the
pregnancy has already been diagnosed. This bleeding may be a sign of an ectopic
pregnancy (pregnancy in the tubes, ovaries, or elsewhere, but not in the uterus). Your
doctor needs to be made aware of this if you have already been diagnosed with a

positive pregnancy test. In our experience, where we use vaginal progesterone on all
patients, we see almost 90+ percent of them complain of some light bleeding.
The only worrisome bleeding is if the bleeding is heavy like a period or more. This could
mean that the period is starting because no implantation occurred, or it could be an
early miscarriage if it did. It can also occur in a multiple pregnancy, such as a twin, if
one of the fetuses is lost. When we went through IVF over a decade ago, my wife also
had heavy bleeding after our IVF cycle. It occurred at about eight weeks gestational age
and was very heavy, with large clots. I was sure that she had lost the pregnancy but an
ultrasound showed that the pregnancy was still there and viable. She went on to have a
successful pregnancy and delivered a beautiful, normal, and smart daughter. I never did
figure out what this bleeding was from. So if bleeding occurs, it is not necessarily
indicating the end of the pregnancy. There are other medical causes of bleeding
once the pregnancy is established, but that would be a totally different topic and is more
pregnancy-related than IVF-related.