The Two Week Wait and Test day - The Preggers Kitchen IVF Series
IVF is emotionally tough and no aspect of it more so than the tortuous two week wait. Fighting bloating, severe blues, the temptation of Google searching (no good comes from that, you naughty temptress) and endless symptom spotting. It is a real arse. There is no way round it, we all have to endure it. I'd love to provide advice on how to ace the two week wait but unfortunately, to be honest, I didn't. Not even close. This article covers my two week wait, when to do a home pregnancy test (and not to test), what the blooming heck is a Beta, why you are p*ssing your money away by obsessing over line progression and what to expect at the callously named 'viability scan'.
Surviving the dreaded two week wait
A bloated and depressed hippo
It’s tough. For me the sheer relief of having something to transfer saw me sail through the first few days on a cloud of positivity. Then I seemed to realise that clouds are just water vapour in the air, can’t sustain a heavily bloated IVF patient, and I fell back to earth. Along with the two week wait being a naturally stressful time, progesterone can bring on the blues, resulting in a daily pity party. To add to the sheer enjoyment of the depressing wait, I also had depressing weight – post egg collection bloating that was so severe it made me look 4 months pregnant. Oh the irony. Post collection bloating is supposedly quite common, induced by the trigger injection (containing the hormone hCG) encouraging the development of the non-harvested follicles. I was slumping about my days like a depressed hippo with a negative outlook on life. This was despite my best efforts to make the term PUPO stand for ‘positive’ until proven otherwise. It just couldn't shake those blues.
Google is NOT your friend – obsession with success rates
I did everything that is not recommended during the two week wait. Google and I became the best of friends. I was particularly interested in the success rates for transfers of different stages and ages of embryo, as I wanted to be realistic about how high or low to keep my hopes. Not that statistics matter, because it makes no difference to my case. But there I was, searching for success rates of ‘5 day blastocysts’, ‘top quality blastocysts’, ‘hatched blastocysts’. Was it hatched? I think he said hatched. Or did he say hatching? Or maybe he said expanded? Hatched and expanded don’t even sound similar. Concentrate Amber, what did he say? This was followed by searching for images of all of these types of blastocysts with a hope of matching mine to a picture, like a high stakes game of Pairs. Although I couldn’t quite remember what our embryo looked like and I didn’t have my desired ‘jinx’ photo. Asking myself which one looked most like a penis covered in genital warts didn’t help me either (see here for context). I think he said hatched. Definitely hatched. And so my searching for success rates continued.
What is the success rate of IVF?
Then I struck lucky with exactly what I was after. The Lister Clinic has a relatively detailed IVF Pregnancy Calculator. You pop in your age, whether a day 5 blastocyst was transferred or a day 3 non-blastocyst, FSH level, AMH level, and the number IVF cycle you are on and the calculator magic’s up a percentage of success to either delight or horrify your troubled two week wait mind. It is based on the Lister Clinic’s own statistics, so the methods and processes used at that clinic, along with the success rates, are going to vary from your own clinic. This invariably impacts the accuracy of the number spat out by the calculator, but my logical brain had long departed and this was just what I was after. It placed my success rates of a pregnancy at around 75%.
What are the signs of implantation? Symptom hunting
So hopes were soaring high. But I didn’t have any symptoms:
No implantation bleeding - None for me. What does implantation bleeding even look like? Is it like spotting, or like a period? Is it dark, bright or watery blood? The resulting Google image search was a clear reminder that it is not possible to unsee things. Up popped photos of people’s gungy, bloodied tissues. Gross, don’t Google it. But I needed to compare other people’s implantation bleeding to…to what? I didn’t have any. So why was I Googling it?
Cramps – Not really. The one departure from the norm were cramps around 12 hours after egg transfer, which I put down to my womb making a justified objection to having a stick wiggled around inside it earlier in the day. Fair play. A few twinges here and there but it could have just been tight pants. I had squeezed my bloated hippo arse into a new set of knickers, necessitated by ruining all my old comfy ones with pessaries. An embryo implanting or a tight bit of elastic? It was anyone’s guess.
Constant weeing – Now, I did have this. I was plagued by the need for night time wees. This can sometimes be a symptom of early pregnancy and so whilst my newly acquired (and very annoying) nocturnal habit should have brought some comfort, it didn’t. The reason being that the explanation for frequent urination in early pregnancy is likely to be hormonal, caused by the presence of hCG and increased progesterone. What IVF does is artificially pump hCG into your system via the trigger shot and place you on a high dose of progesterone. Add to that the need to stay hydrated by drinking approximately 2 litres of water daily, and I’m sorry pee, but I just couldn’t trust what you were telling me. IVF is in itself wee inducing.
Increased heart rate – Not properly measured, but I felt like my heart rate was up, sometimes a possible indication of early pregnancy. It is also an indication of an extremely stressed lady suffering through a never ending two week wait.
Feeling like my period was coming – This is what clinched it for me. Despite riding high on the Pregnancy Calculator of a clinic I hadn't attended, my expectations of a successful result plummeted as that all too familiar feeling crept into my uterus. I could feel my period coming. For me it is a heavy, full, churning feeling, like a storm was brewing in my womb. This sensation usually arrives around 5-7 days prior to the arrival of Aunt Flo and like clockwork it started up a week into my two week wait. In my mind that was it. I knew that early pregnancy can feel like your period, that progesterone could mirror pregnancy symptoms and anything can mean everything or nothing in this stage. You just cannot tell because it all feels the same. But when all you have is past experience of the arrival of a much unwanted period, your mind struggles to cling on to hope.
Pregnancy test day
To Test or Not to Test
Not a question Shakespeare ever asked but one highly relevant to me. At my clinic, official test day was 11 days after a 5 day transfer. They provided me with an at home pregnancy test. A proper one, not the £1 for a pack of 20 from Amazon that have been festering in my bathroom cupboard for years as I never got close enough to a missed period to test. It was so smart and official that it even came with its own plastic cup to collect the urine (rendering my much used and loved plastic top from a deodorant can redundant) and dropper to accurately place urine on the testing surface (I usually adopt the strategy of 'spray and hope'). It was a revelation. An accurate and professional test that was beyond question. I splashed a fortune on an accompanying blue dye pregnancy test (blue dye tests aren’t the best, my top tip is to get one with pink dye) along with my Amazon cheapies. So that would be three tests, of varying quality – much like my embryos.
So official test day was 11 days after transfer, but this fell on a Sunday and if there is one thing to remember it was that Sundays did not exist in my IVF timetable as the clinic was closed. So my official test day was pushed to the Monday. I was needed at work that day (not that my levels of concentration allowed me to produce anything of quality, with that Monday expected to be of no exception) and the idea of testing, getting negative news and then going in to work and pretending to care about anything was just too much to bear. So after a quick trawl of Instagram to confirm that most people have an obvious second line at 10 days post 5 day transfer I unilaterally changed my test day to the Saturday. This would give me a whole two days to come to terms with the result and may even enable me to pretend to be a human being in the office on the Monday. I would still do the official test on Monday, the one provided by my clinic, but the shop bought blue dye test and the Amazon cheapie would have their time in the spotlight two days before.
How soon after IVF can you do a home pregnancy test? Testing too soon - can show a false positive
The two week wait is always bad. Couple it with fertility treatment and it morphs into total torture. The temptation is to test early and get it over with, as it is the not knowing that causes the struggle. However, I was wary of this strategy, as testing too early following a trigger shot could create false hope. According to Conceive Easy trace amounts of hCG can remain the body for as many as fourteen days after hCG injections. The rule of thumb that doctors use is that it takes one day for each 1000 units of hCG to leave your body. So, in order to ensure the most accurate result from a home pregnancy test, doctors recommend waiting a minimum of two weeks after taking hCG injections before testing. In my case I was given 10,000 units of hCG and therefore it would have taken 10 days for the trigger to have fully left my system. If I had taken a pregnancy test within 7 days of my embryo transfer, what I could have seen on the test was a faint second line of false hope. The longer you can wait, the better the chance that all of the remaining traces of hCG will be out of your body and what you will see on the test is the true reflection of whether your body is creating hCG.
Postitive test result and utter disbelief
Three years and three months of failing to conceive and a strong feeling that my period was imminent. It is safe to say that I was expecting a negative result. I had even planned my negative result message to my family and friends. It was humorous, light hearted and hopeful for the future. None of which I actually felt.
So I used two test sticks, a blue dye one and an Amazon cheapie. Forcing myself to leave the bathroom during the 2 minute test period and venture down to the kitchen to make a cup of tea. On returning my initial glance confirmed what I was anticipating - a single line. But then, actually, is that?! On taking a closer look I was in utter disbelief. There were faint second lines on both tests. Shocked, thrilled, immediate tears. Finally, could this be it?
What is the BETA is everyone talking about?
Beta tests, also known as the quantitative hCG blood test, measures the level of the pregnancy hormone hCG in the blood. This is the same hormone that is tested in a home pregnancy urine test and creates that all important yet elusive second line. But unlike pee sticks, which just tell you whether hCG is present (yes/no) a Beta test provides the exact level in the blood. In most healthy pregnancies (there are exceptions to this) the levels of hCG will double every 48 to 72 hours. HCG reaches its peak level around 8 to 11 weeks after conception and levels then decline, remaining steady for the rest of the pregnancy. Beta tests appear to be incredibly common in other countries, even sometimes seeming routine. But from my experience, not in the UK. Certainly my clinic does not routinely undertake Beta tests. It is weeing on a stick all the way.
Obsession with line progression
In the absence of a BETA test it is easy to become obsessed by line progression on home pregnancy tests. Are the lines getting darker? Are they double the darkness of two days ago? Is that even a valid ‘thing’ to look for on a pee test? Is the test line darker than the control line? But it seems to be drying lighter, does that mean that my baby is disappearing? Why are the blue ink ones so sh*t? Oooh, the First Response ones are dark but my Amazon cheapie is just a squinter, which one do I believe?
I spent countless hours panicking about my line progression, including googling for images (Oh, there’s Google again. I swear it is the vehicle of mischief for the neurotic). I wanted to see other people’s line progression against their documented Beta tests, to see how dark a line would appear with ‘normal’ Beta results. The funny thing (as in odd, definitely not hilarious) is that there really isn’t a normal hCG level. Research entitled Strips of Hope: Accuracy of Home Pregnancy Tests and New Developments showed the variation in reference ranges for hCG in the urine for each day of pregnancy (see illustration). The duration of pregnancy refers to days since ovulation (with ovulation given as LH surge + 1 day). There is huge variation in 'normal' hCG levels in early pregnancy. What is most important is that the hCG levels progress and continue to rise, not what the actual level is. Can you judge a sufficient rise using just pee sticks? They are so open to interpretation that I sincerely doubt it.
Different brands of home pregnancy tests cannot accurately be compared against each other because they may test different levels of hCG in the urine and because the appearance of the line will vary between brands. Constantly peeing on tests seems to be a natural neurotic response to getting a long awaited for positive result, as it is easy to be paranoid of the dream slipping away. But I’m not sure that it is a constructive use of time, money or worry power. I was quite literally p*ssing my money away. When you get to this stage, all you will see on your Instagram feed are other people’s BFP test results, and I can guarantee you every SINGLE blooming one will be darker than yours for the same number of days post ovulation or transfer. I guarantee it.
You know that you are going too far when you get genuinely excited about a morning wee, because it is tip top quality stuff, and you rank your loo visits by expected quality:
first morning urine – liquid gold, doesn’t get any better than that.
Second morning wee, still some good stuff in there, let’s not be dismissive.
Mid-morning urine – what is the point of you? Honestly, why are you plaguing me? You bring nothing to the table.
Afternoon/evening wees – can be good and you spend the whole loo visit counting how many hours it has been since the last time you went, to calculate whether sufficient time has passed to (quite literally) p*ss away another expensive test.
I returned to my days as a toddler, bouncing up and down doing my wee dance, desperately trying to hold on. My comment to my husband Joe of “Don’t make me laugh otherwise I’ll pee my pants” received he justified response of “Why don’t you just go to the toilet then?” Who was this temptress? No, no NO! “I’m brewing up a test worthy one. I can’t go yet, I must…hold…..on……” It was miserable, totally weird and told me absolutely nothing about whether or not my little one was likely to be a survivor. If I were to do it all over again I would ditch the sticks after test day. You feed nothing but my paranoia.
My head was filled with all that could go wrong, especially in the early days where miscarriage is unfortunately devastatingly common. The pregnancy could have disappeared as quickly as it came and there would be nothing that I could do about it. I tried my hardest to be positive, just resigning myself to deal with the worst if and when it happened. If it did work out, I didn’t want to pass on my negatively to the little one, giving birth to some kind of Scrooge. If it were a miserable little git I wanted it to be due to our terrible parenting, rather than its time in the womb. So I tried to trap Negative Nancy in the past, a moment in time reserved purely for the two week wait. Positivity Pants firmly back on, with panty liners (always be mindful of the pessaries or they’ll take you for a ride). It was hard though, to remain positive, to believe that it could actually be happening after years of being conditioned to expect the worst. I just tried my best to keep my neurosis under control.
What is a viability scan? Can you see the heartbeat at 6 weeks?
Between 6 and 7 weeks (bearing in mind everyone counts back to the date of your last period to calculate foetal gestation) a scan is offered to check whether the embryo has lodged itself in the correct place and has a heartbeat. It is the callously named ‘viability scan’, a clinical description that in no way reflects the sensitivity and emotions wrapped up in that particular ultrasound. For us, 6 weeks fell over the Christmas week so the viability of all our hopes and dreams was checked at exactly 7 weeks. The time between the positive pregnancy test and the scan felt like the longest 3 weeks of my life. Trusting that all would go well and that it could be a positive pregnancy was difficult, presumably due to the long and winding road we took to get there. Any utterances of congratulations from well-wishing parents were met with a stern look and a response of let’s wait and see, shall we.
What can you see at an ultrasound at 6 weeks?
The viability scan is yet another transvaginal scan (hello twat wand my old friend) and it is the most nerve wracking of the lot. The biggest question of the day: Will there be a heartbeat? As scans go, it was a quickie, of 5 minutes max. Due to its importance, I was expecting more from the moment, a fanfare perhaps or a cuddle or hand holding from the sonographer. But it was a kind yet professionally performed test and on reflection, fondling from the medical staff always remains inappropriate. The sonographer must have realised the tension in the room as she confirmed quickly that there was an embryo, in the uterus and with a heartbeat, before then looking closer at further aspects that interested her.
In terms of what you can actually see on the scan, please keep expectations low. The sonographer turned the screen for us to see and said triumphantly ‘Look! Here is your embryo’ whilst pointing to what appeared to an untrained eye to be a grainy black and white photo of a fried egg. I nodded enthusiastically, whilst simultaneously squinting to see whether that had the same effect as the sharpen filter on Instagram. It didn’t. ‘And here is the heartbeat, do you see it?!’. ‘Yes!’ I lied, only to make clear moments later that my confirmation was false when I questioned ‘do you mean the light grey blobby bit?’ Basically, the heartbeat appears as a slightly lighter grainy grey blob in the middle of the fried egg and the beating is represented by a it flickering between different lighter shades of grey.
My clinic didn’t provide me with feedback on the rate of the heartbeat. There is evidence that a heartbeat of over 100 beats a minute is linked with better foetal survival rates, so I was obviously keen to know. I risked being a paranoid desperado by probing for more info. ‘Is it a good heartbeat?’ ‘Yes, it’s a heartbeat’ ‘But is it a STRONG heartbeat?’ ‘It is just what we’d expect for this stage’ ‘It’s not slow?’ ‘It is what we expect’. For goodness sake Amber, let it go. There was nothing concerning her and as uncomfortable as uncertainty feels, she was providing all the reassurance she could at that stage.
And then that was it. We were discharged from the IVF clinic. All fixed and off you go. A quick meeting with a fertility nurse who talked through what drugs I needed to remain on and for how long (progesterone and Metformin (due to my PCOS) until 12 weeks) and we headed home proudly clutching a printed photo of a grainy grey blob, our little blob, in a state of disbelieving relief that maybe, just maybe, the dark days of infertility were behind us and this may be our time.