Surviving the two-week wait
If you have been trying to conceive, then you are probably very familiar with the dreaded “two-week wait” (2WW). The 2WW is the two weeks after your fertile period when you are ovulating and trying your hardest to conceive and are (patiently!) waiting to see whether you’re pregnant.
Many articles, blogs, and even books have been written on how to manage and survive the 2WW. The internet is full of talk of signs and symptoms that you may or may not experience during this time that might tell you whether you are pregnant.
Now, while everyone wishes for that day at the end of the 2WW when they pee on a stick and see those glorious two blue lines indicating a positive pregnancy test, it’s important to separate fact from fiction and understand what the two-week wait really means and how to interpret any symtoms you feel (or don’t feel) during this period.
When the 5- to 12-day-old fertilized egg or blastocyst attaches to the lining of the uterus, something known as implantation bleeding might occur. This can cause light bleeding or spotting, which might even go unnoticed. If it happens, know that it is completely normal and doesn’t require a visit to the emergency room, although many patients do call our fertility offices in a panic!
Don’t worry if you see this. In fact, it might be a good sign of an upcoming positive pregnancy test! However, only one third of pregnant women will experience implantation bleeding. The majority of women who are pregnant will not have this symptom and will still conceive. Also, if you have done fertility treatment and are on any blood thinners, such as baby aspirin, then spotting or bleeding can be more frequent and may or may not indicate pregnancy.
The bottom line is, don’t obsess over checking your underwear or liner a million times a day, because whether you see implantation bleeding or not, you certainly could be pregnant.
Early urine testing for pregnancy
How early is too early, and how soon can you see a positive test? So many dollars are spent by women buying over-the-counter urine tests in an effort to detect a positive pregnancy test as early as possible. So, how soon can you really start testing?
These days, certain urine tests are highly sensitive and can detect very low levels of beta hCG, the hormone produced by a developing pregnancy. Most doctors recommend waiting until the first day of a missed period or two weeks after ovulation to reliably show a positive pregnancy test. If you’ve done fertility treatment, the same holds true: two weeks after ovulation or intrauterine insemination (IUI). For IVF, we recommend blood testing 12 to 14 days after embryo transfer. That being said, with the increasing sensitivity of over-the-counter urine tests (which go to 20 mIU/mL as the lowest detectable value), urine tests can be positive nine days after ovulation or fertilization or as early as six days after embryo transfer.
The downside of early testing is that you might detect a biochemical pregnancy — i.e. a pregnancy that otherwise would not be viable and would result in a late menses. Or, if you’ve done fertility treatment, you might have picked up some of the fertility drugs that contain hCG, which is identical to pregnancy-produced hCG and would show up as a positive test.
In the end, it’s best not to test early and rather to wait until a missed period or when your doctor tells you to come in for a blood test to most accurately predict a true pregnancy.
Breast tenderness, nausea, headaches, mild back cramping, abdominal cramping
Many women swear they know exactly when they conceived, down to the minute, because they started to feel these symptoms. The truth is that hCG levels are not high enough at this early stage before a positive urine blood test to produce reliable symptoms, such as breast tenderness, headaches, and cramping. Also, for those patients who are on hormones such as estrogen and progesterone after fertility treatment, they might experience these “false” symptoms as a side effect of the hormones, and this doesn’t necessarily indicate pregnancy.
However, by about the fifth or sixth week of pregnancy, when blood and urine testing is positive, you can certainly expect to feel these symptoms, and often they are a good sign to predict a viable ongoing pregnancy.
Destressing during the 2WW
So, what can you do to destress and not obsess during the 2WW?
Plan some relaxing activities
Go to the spa, meet up with friends, or plan a short getaway! Nothing beats a little fun during the 2WW to make this period less stressful and pass more quickly. Plan something special with your significant other, and use this time to have fun and enjoy each other’s company!
Make a contingency plan
While everyone hopes that this cycle of trying will be their last — and, trust me, we as fertility doctors want all of our patients to get pregnant — it is important and helpful for most patients to have a plan for their next steps. If you are trying naturally, think about things you can do in subsequent cycles to increase your chances. Maybe it’s been six months or a year of trying already, and it’s time to book an appointment with a fertility doctor. If you are already undergoing fertility treatment, see your doctor and make sure you know what the next steps will be if this cycle does not work out. This can make you feel more in charge of your future, which is empowering!
Finally, relax and be positive!
It will ultimately happen. As we fertility doctors say, there is a way for everyone to have a family!