What is the two-week wait? – Symptoms and tips after treatment

The two-week wait or 2WW is defined as the timeframe from the end of fertility treatment or ovulation, and the moment when she can take a pregnancy test.

The 2WW covers a period of two weeks during which all women pay special attention to the most common pregnancy symptoms, which may indicate whether their IVF or IUI treatment has been successful or not.

Moreover, the 2WW comes along with different symptoms and concerns for these women and their partners, as in most cases they are unaware of what to do and not to do throughout this time period.

What is the 2WW in IVF?

It takes around 15 days from the insertion of the semen sample (artificial insemination) or the embryo transfer (in vitro fertilization) up until the pregnancy test. And the same applies after ovulation, a period known as days post ovulation or DPO.

Although some may think it is a short period of time, the truth is these two long weeks turn out to be an emotional roller-coaster ride for some intended parents.

On the one hand, they may feel euphoria, hope, and illusion for the new family member; on the other hand, stress, anxiety, helplessness, and nervousness before the idea that the result of the pregnancy test may be negative.

This moment is known as two-week wait, 2WW or TWW, since usually the period of time during which a woman or couple has to wait to take a pregnancy test and be able to get an accurate result involves two weeks.

Beta-hCG hormone

Human chorionic gonadotropin (hCG) is a hormone released by the embryo from the moment of implantation to the maternal uterus, and later by the syncytiotrophoblast (i.e. placenta).

This hormone triggers progesterone production by the corpus luteum, which allows the development of the endometrium—a.k.a. uterine lining—with the subsequent fetal development.

As fetal development progresses, beta-hCG levels keep on increasing eventually up until the second or third month of pregnancy. From this stage on, they will start diminishing.

This is the reason why experts do recommend to wait for at least 15 days to take the pregnancy test, since if taken too early, hormone levels may be insufficient as to be detectable with this measuring instrument. If taken in due time, results you may obtain are more accurate, thereby preventing you from getting a false positive or negative result.

Bearing the two-week wait

The two-week wait symptoms

First of all, it should be noted that feeling symptoms during the two-week wait does not mean that pregnancy has been achieved. During the first days, the embryo has not attached to the uterus yet.

After an infertility treatment, the symptoms you are likely to feel are related to the side effects of ovarian stimulation medications, as well as to the progesterone capsules that you have to continue using even after having finished the treatment.

The following are some of the most common symptoms associated with the two-week wait:

• Lower back pain
• Cramping and ovarian pain
• Spotting or brown discharge
• Frequent urination
• Watery or yellowish vaginal discharge
• Abdominal bloating
• Headache
• Swollen breasts
• Headache and nausea
• Mood swings
• Fatigue and sleepiness
• Constipation
• Insomnia

Other symptoms reported by women include dry/cottonmouth, thirst and hunger, stomach cramps, diarrhea, elevated basal body temperature, cramps in the pelvic area, gassy stomach, acne and pimples, hot flashes, general malaise, shortness of breath, etc.

The two-week wait symptoms

Tips during the two week wait

Once the woman has been inseminated or the embryo transferred to her uterus, there is nothing left she can do but to wait for the moment when she is able to take a pregnancy test. To sum up, this period is often an emotional roller-coaster for the future parents.

Embryologist Aitziber Domingo gives us some recommendations to consider after embryo transfer:

We advise all women to lead a normal life, but without much effort. A 24-hour rest period is recommended, but this does not mean being in bed or on the couch, but rather not doing too many intense activities, such as Zumba for example.

Aitziber Domingo (embryologist) about the 2WW

The following are some tips to survive the 2WW:

• Continue with your normal lifestyle: This is essential, although always following medical advice for each particular situation. Keep yourself busy with work and leisure activities, as it prevents oneself from overthinking. Complete bed rest is not advisable.
• No need for bed rest: Time off work is not necessary unless it poses a risk for you, e.g. lifting heavy weight. In any case, you should always follow your doctor's instructions.
• Try not to become obsessed with the symptoms: It is complicated, but fundamental at the same time. Many women do believe they are experiencing non-existent symptoms, or tend to exaggerate mild nausea, general malaise, or pains which may not be linked to pregnancy, but they end up associating them inevitably.
• Prepare yourself for a negative outcome: Despite advancements in reproductive medicine allow for the achievement of consistently high success rates, pregnancy is not always achieved. Even if a woman ends up pregnant, it may not work on the first or second tries. Being mentally prepared for a negative result may help you cope with failure, and subsequently avoid frustration.
• Keep a positive attitude and stay calm: We know it is not easy, but it is indeed highly advisable, as it helps reducing stress and anxiety levels. Many couples take up breathing routines and relaxation exercises during the 2WW.
• Support each other: As regards couples, mutual support and respect are crucial elements when enduring such a journey. Understand each other's feelings and emotions is crucial.
• Avoid discussing the topic again and again: You can talk about it of course, but preventing it from becoming the only topic of conversation, regardless of whether you are talking to a friend, a relative, or your own partner.
• Psychological support: Seek professional support if you think it may be helpful, as it usually turns out to be a great relief for some couples.

By following these tips, not only you can help reduce the duration of the 2WW but also cope with taking the sought-after pregnancy test and face the outcome, whatever it might be.

Tips for surviving the two-week wait

FAQs from users

How long do I have to wait to take a pregnancy test after IVF?

In vitro fertilization consists of several phases. The first of these is ovulation induction which goes from menstruation to ovarian puncture (when eggs are removed from the ovary). This phase usually lasts between 10-14 days.

After egg retrieval, the second phase begins which is the "laboratory phase" when the eggs are fertilized and the embryos allowed to evolve. Embryos can be transferred between the second and fifth development days.

When the embryo transfer is performed on the 5th day of the embryonic development (blastocyst stage), the pregnancy test (b-hCG in blood) is scheduled 10-12 after the transfer. This would be the luteal phase which goes from the transfer to the pregnancy test.

What symptoms are common during the 2WW?

Anything can happen during 2WW. Since not noticing any symptoms to begin to feel the typical symptoms of pregnancy: tiredness, nausea, abdominal discomfort like menstruation... Sometimes you can even bleed a little.

What are the tips for handling two-week wait?

Dr. Carolina Arboleya answers this question in the following video:

It is true that these are very sensitive days on many levels because it is a bit like the end of assisted reproduction treatment. They are those days prior to the moment in which we will know if there is a pregnancy or not. The general recommendations are always to lead a healthy lifestyle. It is true that it is not necessary to rest on those days, far from it. You have to have a quiet, normal life. What does this imply? Well, logically on those days we are not going to run a marathon, we are not going to carry heavyweights, we are not going to make great efforts, but we can lead a normal life with complete peace of mind. Try to be accompanied by family and partner, have a good diet and try to control those nerves that it is normal and logical that they may appear.

What are the symptoms during the 2WW with egg donation?

In the case of a transfer of donated embryos or an oocyte donation, the symptoms may be minor since the woman has not gone through a process of ovarian stimulation and, therefore, the hormonal medication administered has been reduced.

What should you eat during the two week wait?

Broadly speaking, following a balanced diet which includes fruits, vegetables, meat, fish, etc. is the most advisable. Some specialists recommend including dried fruits and nuts, as well as gelatin, which is a protein-rich food. On the other hand, eating ham is unadvisable, as it increases the risk of having toxoplasmosis in case you're pregnant.

As for what to drink, alcohol and fizzy drinks should be avoided at all costs. Staying hydrated is a must, so pay attention to drinking plenty of water. Include orange juice and isotonic drinks as well, given their high content in mineral salts.

What are the symptoms during the 2WW with blastocyst transfer?

The symptoms after an embryo transfer are the same whether the embryos were day 3 or blastocysts. In the case of blastocysts, being a more developed stage, 2WW is reduced by a few days. However, it is recommended to wait at least 10-12 days to take the pregnancy test.

Is it normal to have a swollen belly during the 2WW?

Yes, this is a typical side effect of the hormonal medication used for ovarian stimulation. It is also normal to have swollen breasts and feel cramping in the abdominal and lumbar area.

Is travel recommended during the 2WW?

There is no problem in going away for a few days to relax, whenever it is without getting too tired or making great efforts. In case of nausea, a long car trip can increase the anxiety and cause vomiting.

Recommended readings

The pregnancy test after the beta-pregnancy test measures the levels of the beta-hCG hormone. In order to be able to interpret these results, we recommend you to visit the following article: What are the normal values of beta-hCG hormone?

In the case of IVF or oocyte donation, a two-week wait begins at the time of embryo transfer. If you want to learn more about this technique, you can continue reading in the following post: Embryo transfer.