Symptoms After Embryo Transfer – Most Common Positive Signs

By BSc, MSc (embryologist), BSc, MSc (embryologist) and BA, MA (fertility counselor).
Last Update: 12/15/2016

The symptoms to expect after IVF embryo transfer may vary from woman to woman. If pregnancy occurs, the patient may start feeling positive embryo implantation signs from the 8th day post transfer onwards. However, a woman can feel no symptoms at all but have become pregnant anyways, which would mean the treatment has been successful.

Embryo Transfer (ET) is a simple, painless procedure which consists in placing the embryo(s) in the patient's uterus. The only thing to consider is attending the doctor's office with an almost full bladder. This will make it easier for the cannula transfer to be monitored by ultrasound scan.

When to expect symptoms

After an IVF cycle, what follows is a period known as two-week wait, commonly abbreviated as 2WW or TWW. As the name suggests, it is a time period of 15 days during which embryo implantation is expected to occur. If pregnancy takes place—the levels of human chorionic gonadotropin (hCG)—the pregnancy hormone, will start rising.

Surviving this stage can be tough for some couples, as they are expecting their treatment to be successful and therefore early pregnancy symptoms to show up. But at the same time, by taking a pregnancy test too early, you put yourself at risk of getting a false negative result, as your hCG levels may not be enough to be detectable yet.

Should the transfer be done on day 5 (i.e. blastocyst embryo transfer), women can take a pregnancy test earlier than in cases when the embryo is transferred on day 3. This is because the beta-hCG hormone is detectable from the 14th day after fertilization, so the sooner the transfer is done, the longer the waiting period.

In humans, a fertilized ovum is most likely to adhere to the wall of the uterus about 8 to 9 days after ovulation. Nonetheless, this period depends on each woman and can range between 6 and 12 days. For an IVF cycle to be successful, the interaction of two elements is of utmost importance:

From the 8th day onwards, a woman may start feeling common implantation daily symptoms in case it has occurred, which can include nausea or morning sickness, food aversions and taste changes, breast tenderness, a slight rise in body temperature, missed period, and a rise in basal body temperature.

It should be taken into account that each woman may experience the beginning and course of pregnancy differently. This means that some may feel all the above listed signs, while others just a few of them, or no symptom at all. In some cases, early pregnancy symptoms just come and go, without it being a warning sign in principle.

Post embryo transfer symptoms

Patients who undergo IVF, with or without ICSI, should take additional supplements of progesterone to sustain their endometrial lining. Because of that, it is not possible to know whether the patient feels these symptoms because of an actual pregnancy or as a side effect of progesterone supplements.

This hormonal treatment may trigger pregnancy-like physical symptoms even if the treatment is not successful in the end. Women are likely to notice the following signs, whether embryo implantation has taken place or not:

  • Abnormal vaginal discharge: It usually appears during the first days after embryo transfer due to the woman's elevated hormonal levels after having taken progesterone vaginally. It can be just a spotting with more or less dark brown blood.
  • Breast changes: It is not uncommon to notice that your breasts become harder, softer, or more swollen than normal. In addition, you may notice some kind of tickle all around your nipples, and that your areolas have become darker.
  • Fatigue: It is due to an increased level of progesterone in your body. With natural pregnancy, this hormone increases its concentration gradually in order to sustain the uterine lining, which is where embryo implantation takes place.
  • Nausea: It is due to the hormonal increase which takes place within the woman's body. Nausea is indeed a typical pregnancy symptom, although not every woman presents it.
  • Constant urge to urinate: It is due to the hCG hormone. Many women undergoing this treatment inject themselves hCG shots after the transfer in order to help sustain the pregnancy in case it occurs. It may be caused by a real pregnancy or as a consequence of the injections.
  • Absence of menstruation: Your period is expected to show up approximately 14 days after the embryo transfer.

Although they are almost unimportant and less frequent, the following symptoms may also appear: insomnia, loss of appetite or desire to eat, constipation, bloating, twitches around the inner thighs, etc. Should these symptoms prevent you from leading a normal lifestyle, do not hesitate to see your doctor in order to deal with them properly.

When to be concerned after ET

An ectopic pregnancy is one of the most warning factors affecting IVF outcomes. The incidence of ectopic pregnancy is estimated to range from 1 to 3% for in vitro fertilization cycles. It is not only a cause for miscarriage after IVF, but one of the most dangerous complications derived from it.

Ectopic pregnancies occur when the embryo adheres to a part of the female reproductive system other than the uterus. Although the most common site is the Fallopian tube, it can implant to the ovary, cervix or any other part in the abdominal cavity.

The following is a list with the concerning signs and symptoms to look after, which tend to appear between weeks 5 and 14 after confirming a pregnancy:

  • Pain: It is probably the main indicator, and usually appears in the form of cramping, similar to that caused by the PMS (premenstrual syndrome). Abdominal pain may appear as well.
  • Bleeding: It is a side effect of the hormonal stimulation of the uterine cells that grow, regardless of whether the embryo is developing. It can be a heavy bleeding or a very light one.
  • Signs of pregnancy: As hormonal changes occur as in any other intrauterine pregnancy. Normal symptoms include breast tenderness or a missed period.
  • Shoulder pain: Caused by bleeding from the end of the tube, whether it is already ruptured or not. Often, women feel it while lying down.
  • Sickness: Vomiting, diarrhea, etc. are likely to occur, as if the woman had a gastrointestinal disease.

If undetected, the embryo will continue to grow inside the tube, which eventually can tear the tube and result in excessive intra-abdominal bleeding. Signs of a ruptured tube can include: shock or collapse, increased heart rate, dizziness, pastiness, etc.

An ectopic pregnancy can be diagnosed by tracking the rate of rise in blood levels of the beta-hCG hormone and a pelvic vaginal ultrasound. Usually, hCG levels doubling every 2-3 days throughout the first nine to ten weeks is a reassuring indicator. A slower rate commonly suggests a potential miscarriage.

For more information, please visit the following article: What is an ectopic pregnancy?

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

FAQs from users

Which symptoms can be considered "bad" signs after embryo transfer?

By Sara Salgado BSc, MSc (embryologist).

After an embryo transfer, women are advised to visit the fertility clinic again if they feel any of the following symptoms, which are considered to be negative:

  • A heavy, period-like bleeding appears within 14 days, especially in cases of frozen embryo transfer.
  • A severe, persistent abdominal pain.
  • Your general state of health gets worse with symptoms such as flu-like general pain, migraine, fever, etc.

At the doctor’s office you will undergo any tests required in order to determine what is causing these unusual symptoms after the embryo transfer. There, you will be provided with the most suitable treatment for your particular case.

What are the most common symptoms after embryo transfer with donor eggs?

By Sara Salgado BSc, MSc (embryologist).

When a woman conceives with donor eggs, the symptoms she is expected to feel in case of a successful outcome are those of any other natural pregnancy. The only difference may be due to the side effects derived from the fertility drugs recipients should take for endometrial preparation.

The following post may provide you with further information: Early pregnancy signs after donor-egg IVF.

Is it normal to notice flu-like symptoms after embryo transfer?

By Sara Salgado BSc, MSc (embryologist).

Experiencing cold-like symptoms and a stuffy nose is a common post embryo transfer symptom, actually. This phenomenon is commonly known as "IVF cold", and includes sneezing, nasal congestion and even coughing. As other symptoms, IVF colds are caused by changing hormone levels, whether you become pregnant or not. In fact, women taking birth control pills or undergoing hormone replacement therapy are likely to feel them too.

I have zero symptoms but got a BFP, is that normal?

By Sara Salgado BSc, MSc (embryologist).

Yes, symptoms are not an essential requirement for IVF to be successful. As explained earlier, it varies on a case-by-case basis. A woman not feeling common symptoms may get a positive pregnancy test (commonly referred to as BFP or Big Fat Positive), while others noticing every symptom listed above may end up not being pregnant.

When should I take a pregnancy test after a donor-egg embryo transfer?

By Rebeca Reus BSc, MSc (embryologist).

Like in any other IVF procedure, after an embryo transfer with donated eggs, women have to go through the two-week wait or 2WW, a time period necessary for beta-hCG levels to be detectable by a pregnancy test.

The presence of the hormone hCG in blood increases gradually from embryo implantation up until the end of the third trimester approximately. This, along with other hormonal changes, is the reason why the common pregnancy symptoms appear (nausea, vomiting, etc.)

How likely am I to have OHSS symptoms after embryo transfer?

By Sara Salgado BSc, MSc (embryologist).

It is estimated that 5% of women will develop mild symptoms of OHSS in IVF treatment, while the incidence of severe OHSS is less than 1%. Common symptoms include: pain, vomiting, nausea, diarrhea, abdominal distension, etc.

You can find more details on this side effect of ovarian stimulation here: Ovarian Hyperstimulation Syndrome (OHSS).

I'm feeling thrush symptoms after embryo transfer, what is the cause?

By Sara Salgado BSc, MSc (embryologist).

In some cases, fertility specialists prescribe antibiotics prior to embryo transfer in order to prevent the presence of bacteria and other organisms to interfere with IVF outcomes. The use of antibiotics can cause women to develop candidiasis (vaginal yeast infection), as they can change the balance of those "good" microorganisms which help keep a healthy vaginal environment.

Nevertheless, there is no scientific proof that taking antibiotics improves the outcomes of IVF embryo transfers, so women who are prone to yeast infections should consider the use of antibiotics as just a preventive measure.

What are the common symptoms after embryo transfer if you get pregnant with twins?

By Sara Salgado BSc, MSc (embryologist).

When a woman is pregnant with twins, her beta-hCG levels are considerably more elevated than those of singleton pregnancies. Also, she might experience exaggerated pregnancy symptoms, yet it depends on each woman, as explained above.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.


Authors and contributors

 Rebeca Reus
Rebeca Reus
BSc, MSc
Degree in Human Biology (Biochemistry) from the Pompeu Fabra University (UPF). Official Master's Degree in Clinical Analysis Laboratory from the UPF and Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). More information about Rebeca Reus
 Sara Salgado
Sara Salgado
BSc, MSc
Degree in Biochemistry and Molecular Biology from the University of the Basque Country (UPV/EHU). Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid (UCM). Certificate of University Expert in Genetic Diagnosis Techniques from the University of Valencia (UV). More information about Sara Salgado
Adapted into english by:
 Sandra Fernández
Sandra Fernández
Fertility Counselor
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández

Find the latest news on assisted reproduction in our channels.