Friday, November 27, 2009

Bleeding After Embryo Transfer


In the course of my volunteering as the Infertility Expert on About.com's AllExperts site, as well as here on my own blog, I have had many questions regarding bleeding right after embryo transfer or in the Luteal phase. What follows is an attempt to answer one of the chief concerns that IVF patients have, namely, "What if I have bleeding after my embryo transfer?" 

**For those who wish to COMMENT with questions or observations, please note that the comment section is CLOSED on this post as it has exceeded the limit Blogger allows. Solution: You are welcome to choose any other blog post to comment on "bleeding after embryo transfer" and I will be able to answer you without a problem. Just return to the home page and choose a recent post. This is the most popular blog post because it is an issue that many go through while undergoing IVF, therefore do not hesitate to comment.**

Answer:

The embryo transfer is the most crucial step in the In Vitro Fertilization procedure/process. You can have the best quality embryos, but if they are not placed into the uterus correctly, then pregnancy will not occur. That is why "transfer technique" is so important. There have been studies showing that pregnancy rates can vary by Physicians within the same group, and this is all because of transfer technique. Once the disparities between transfer techniques were corrected and unified, the pregnancy rates became consistent. For this reason, you want to seek out a Physician who has a lot of experience with embryos transfers and comparable good pregnancy rates. If you go to a clinic that has multiple doctors, ask for the pregnancy rates of each Physician or your particular Physician. Although I know that newly trained REI Physicians have to get experience, most don't have a lot of embryo transfer experience from their fellowship. So, if I were paying $10,000 or more for an IVF cycle, I would ask for a more experienced doc to do the transfer. For more details regarding post embryo transfer bleeding, pain and other symptoms, see "What To Expect After Your Embryo Transfer"

Bleeding, usually bright red blood, with the embryo transfer is an absolute no no. If blood contaminates the endometrial cavity at the time of the transfer, this will kill the embryos and pregnancy will not occur. The catheter must be placed as gently and atraumatically as possible. That is an absolute requirement. The endometrium, which is now in its fullest growth state, thickened from estrogen stimulation, can be easily scraped and cause bleeding.

At our center, we use very soft catheters, very gentle technique, ultrasound guidance and mock embryo transfers preceding the cycle, to accomplish this. The mock embryo transfer or MET is especially important so that the Physician is not learning the curves of your canal at the time of transfer but has worked it out prior. You should have the same Physician who did the MET doing your transfer. This is especially important in patients whom we consider to have a "tortuous" canal, making it more difficult to insert the catheter with care. In this type of patient I will sometimes do the MET two to three times to become well acquainted with their canal.

You should not worry if brown blood or discharge occurs at the time of transfer, it will usually manifest within the first day or so after the transfer, but not into the mid-luteal phase or later. That type of bleeding would be from a different source.

There are situations, however, when bleeding can occur but not be ominous. Sometimes a woman's cervix will bleed easily from being scraped by the speculum or irrigation or wiping. This external bleeding will not affect the endometrial cavity as long as the transfer catheter is not exposed to the blood. For example, I do not let the catheter get exposed until the introducer is well into the cervical canal, near the internal cervical os (entrance to the endometrial cavity), to begin advancing the catheter.

Bleeding that occurs later in the luteal phase, days after the transfer, is very common if vaginal progesterone is used. This has been shown in various studies using Crinone, for example. In my patients, because I use both vaginal and injectable progesterone, it is almost 90%, but the bleeding tends to occur near the time of the pregnancy test or soon thereafter. This is probably caused by some erosion occuring on the external cervix. The exact cause, however, is not clearly understood. It is usually light spotting and can be anywhere from red to brown. Red is newer blood and brown is old blood. In general I tell my patients not to worry about this. The only bleeding that I would worry about is bleeding that is red and heavy like a period. This is not good, and should not occur if the hormones progesterone and/or estrogen have not been discontinued. Some patients will experience slight spotting 3-5 days after embryo transfer and refer to this as "implantation bleeding." Whether or not this is caused by implantation is not known. Implantation should not cause bleeding. However, again, if it is not bright red blood that is heavy like a period, it should not cause worry.

I certainly hope this information will help those of you who have either queried me or who have Googled for some reassurance in this regard.

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

229 comments:

  1. Hi,
    Thanks for the explanation.
    I started spotting 2 days after the MET and continue to spot now 5 days with my periods still 10 days away. I got so concerned that I did not take the Progestrone for 3 days. The Nurses tried to assure me again that I can continue to take the prometrium.
    So I guess it is not too abnormal to spot after the MET.
    -S

    ReplyDelete
  2. Hi,

    I appreciate your explanation.After my ET, I noted that my underwear stained with brown light dark (light spotting only). Is this normal after the procedure?it happened on that day only.Then 3 days post ET, I wiped my undies, noticed a little bit of brown discharge?Is this normal?Implantation bleeding?Please advise, I am really worried


    Ladya118

    ReplyDelete
  3. I had a small amount of bright red bleeding only a couple hours after my frozen embryo transfer. I have a kinked cervix so I'm sure it was from the catheter. TAnd I'm sure that's why thate cycle was a BFN. I know I can be successful since we had success with IVF #1. How do I ensure that this doesn't happen again?

    ReplyDelete
  4. In the course of my training for IVF, my mentor told me "the embryo transfer is the most important step in the IVF process because you can have the most beautiful and excellent embryos in the lab but if you don't get them into the uterus correctly, it will fail." I remember this each and every time that I am doing an embryo transfer. Studies have shown that pregnancy rates will differ between doctors in the same group because of embryo transfer technique. That is also why pregnancy rates differ between clinics as well. If the embryo is not placed in the correct position, without causing any trauma and gently so that the uterus does not contract, then it is doomed right then and there.

    In my practice, I am the only doctor caring for my patients, and therefore, I practice the transfer prior to the IVF cycle. This is called a mock embryo transfer (MET). If the canal is difficult, and I have had my share of very difficult ones, ones that corkscrew, I will practice several times so that when the actual embryo transfer comes about, I am not learning the path of the canal anew, and can prepare for it. Being prepared is the key but does not necessarily insure that the transfer will go well or easily. However, having the same Physician transfer the embryos, that did the MET, is a big big step in the right direction.

    Embryo transfer technique is a learned and practiced technique. Physicians that have done a lot of IVF transfers are certainly better at it than doctors who have just come out of Fellowship training and have done few or no transfers. That is something you certainly can ask. Just as you would want a doctor that has done a certain type of surgery multiple times, you want a doctor that has done actual embryo transfers multiple times, and preferably has practiced on your with an MET prior. A recent study presented at ASRM showed that most infertility Physicians coming out of their Fellowship have an average of four embryo transfers in their training. That is certainly not as good as the thousands I have had.

    So what can you do? Make sure your doctor does an MET prior to the IVF cycle and writes down the nuances of your canal. Make sure that doctor is the one that does the transfer, which is not always the case with big group IVF clinics (they rotate the weekends). Make sure that your doctor has plenty of experience doing embryo transfers. Try to stay relaxed at the time of the transfer so that the pelvic muscles don't tense up and deviate the canal (I give my patients a valium tablet prior) and relax the legs (tightening the thigh muscles tightens the vaginal muscles). Say a prayer and hope for the best.

    ReplyDelete
  5. We just came off a failed first cycle. We are 29 yrs old and have been TTC for over a year. We are diagnosed with MF (husband has obstructive azoo-cryptorchidism) and all of my tests came back normal so I was put on a very low dose of follistim (75 units) According to my RE we had a beautiful cycle. ultrasounds loked normal, HSG normal, blood tests normal...etc.
    At ER we got 19 follies with 17 fertilized by ICSI, 13 matured, and 4 that made it to 5 day blastocysts. RE said endometrium look great and based on cycle advised us to only put back one blast and freeze the remaining 3....2 days before my Beta Test I had heavy period bleeding. I was on endometrin 3 times a day and have been racking my brain for the last month as to why this happened when everything seemed to go so well. We used all of our savings to do this cycle and want to be sure we do our due diligence (husband is a resident with a hefty amount of student loans!) before we dive into another cycle--this time a frozen. Any advise you can offer is very much appreciated. Another thing to note is I had a miscarriage 7 years ago at 7 weeks. No damage whatsoever on HSG..

    ReplyDelete
  6. Hello,

    I wish I could tell you exactly what the bleeding was from, but I'm afraid I can't. It is not likely to be progesterone bleeding because is was heavier, like a period. It was most likely a period bleed. With the Endometrin 3 times per day, that should have been adequate to sustain the endomerium without inducing a period, but obviously it did not in your case.

    One thing you have to realize about single embryo transfer, is that the shift to SET is because of the increased pressure being put on us to reduce the incidence of multiples. In addition, studies have shown that it does take several SET cycles to get the equivalent pregnancy rates as one multi-embryo transfer cycle. Therefore, in doing SET, you have to be prepared to do additional cycles.

    The good news is that you have two things in your favor: you have embryos frozen and you have been pregnant in the past. So, the only barrier at this point is to get a good embryo into your uterus, without stimulating the uterus through a poor transfer technique, and to have an adequate well primed endometrial lining. Then the rest has to be left up to God/Nature but chances are good that you will eventually be successful.

    I would recommend that you continue on to attempt the frozen transfer cycles, but I might recommend that you consider transferring two instead of just one, if you are willing to accept the risk of a twin pregnancy. I might also recommend that you add injectable progesterone to your regimen, but decrease the Endometrin to twice per day (injectable progesterone is the gold standard). Finally, I would recommend that you take aspirin 81 mg per day starting with the start of the cycle, continue the estrogen all the way until the pregnancy test and possibly add Medrol 16 mg per day, decreasing to 8 mg after the transfer until the pregnancy test. That is what I would do next if you were my patient.

    You should probably have a follow-up appointment with your doctor before moving to another cycle so that he/she can review the cycle with you and make any suggestions for future cycles.

    Good Luck

    ReplyDelete
  7. Hello - we just completed an embryo transfer 4 days ago and I have had light pink spotting which changed to bright red spotting starting the evening of the transfer. I spoke to my specialist who thought it was due to some some bleeding on my cervix [which she had touched up prior to transfer] and I went back in to the clinic yesterday morning and they fixed it up and said to wait and see. I am now having darkish red/brownish spotting that seems a bitheavier. I am using progestorone suppostories 4 times a day. I called and they asked me to come back in tomorrow morning and am going to ask them to a) test my hormone levels and possibly switch to injectible progestorone but wanted to see if you had any other advice?

    ReplyDelete
  8. As you have probably read from this blog post, we see spotting very commonly with the use of vaginal progesterone. It is likely that the progesterone causes the cervix to be more "friable", which means bleeds more easily. I usually tell my patients not to worry (because it is so common), unless the bleeding is bright red and flows like a period.

    ReplyDelete
  9. Hi I started bleeding on the night of day 10 of my 3 Embyro transfer that turned into a heavy bleeding; even heavier than my normal period and we are very worried to the fact that this may be implementation bleeding of more than one embyro or if it's just a heavy period. My body is showing the normal signs of my period so I was told to stay rested and positive that everything is ok...so what are your thoughts and please be honset. Thanks

    ReplyDelete
  10. Hi. At bleed that late into the cycle may most likely be due to the onset of a period. The easiest way to make this distinction is for you to have a blood pregnancy test. By this time, if you are pregnant, it can be detected. If then test is negative, then you know that it is your period and you can stop your meds. If it is positive (there should be an actual number), you can repeat it in 48 hrs to determine how the pregnancy is going. You want it to be going up. In that case, we may never know why you are bleeding but will have to wait and see how things go.

    Good Luck

    ReplyDelete
  11. hi Dr,

    i did et one grade one, since i only had 2 good quality ones. This is my first ivf/icsi, my self and DH 33. i started spotting 7th day after et. on 8th day evening it was almost like AF, heavy red bleeding. I was devastated, now i'm trying to be hopeful. My coordinator advised me to do blood test tomorrow. 2 days before scheduled blood test.

    I really hope and pray to God, that there will be a miracle. coz i've heard some women being pregnant even after heavy bleed. i know it's a least possibility but i'm hopeful.

    Appreciate your opinion about this dr

    ReplyDelete
  12. Hi Angel,

    Bleeding does not necessarily mean that the cycle failed. You need to check the pregnancy blood test to know what is going on. As this blog entry points out, bleeding is commonly seen after IVF and still patients will turn out to have successful pregnancies.

    Good Luck

    ReplyDelete
  13. Dr. Ramirez,

    I just turned 38 this month. My husband is 37. I have 2 sons from a previous marriage. Both carried full term and vaginal delivery, both are healthy boys to date. My husband has no previous children. After my 2nd son, I had a tubal ligation done. That was when I was 25.

    On Monday, Jan 24, we transferred 2 grade 4AA cytoblasts. I have not had any bleeding, just mild cramping. I guess I'm looking for what the odds are for us, considering our ages. Or when I can expect some type of symptoms? The blood test is scheduled for Feb 3-which is a lifetime away for me.

    I took the Follistim. But did not need the Luveris, I guess because my estrogen was good. We harvested 28 eggs. Fertilized 15. Froze the remaining 13 eggs, which were all mature, said the doctor, "we are very pleased!".

    They put the 2 grade 4AA's in Monday and on Tuesday they called and said the remaining fertilized did not make it to the 8 cell. That freaked me out, because I was considering those as back up and at least hope for freezing.

    Any insight or thoughts?

    ReplyDelete
  14. Hello,

    I'm not quite clear on your information. In your third paragraph you said that "Fertilized 15, Froze the remaining 13 eggs". So I presume that you now have frozen eggs as a back-up.

    In the next paragraph you state that they transferred "2 grade 4AA" embryos but the next day called and said the remaining fertilized embryos did not make it to the 8 cell stage. I take that to me that you had a post-retrieval day#2 transfer and the embryos transferred were 4 cells, grade AA?

    Based on that information, one question I have is why your clinic transferred embryos on day#2? The standard is to transfer on day #3 or day #5 (blastocysts). I guess that would be one concern.

    In terms of your chances for success, the statitstic depends on your clinics success rate for 38 year olds. Statistics vary greatly between clinics. In my center it is 64% pregnancy rate and 44% delivery rate. You have to ask what your clinic's rate is. I'm a little surprised that they have not given you that information or you did not seek it out prior to starting your IVF cycle. It is very important for patients to gather all the information regarding their clinic before deciding on which clinic to seek care from. In our area, for example, there is a clinic that has a 10% pregnancy rate in under 35 year olds, which is very very low (most are 50% or higher). I feel sorry for the patients that went to that clinic.

    Over all, based on the number of eggs that were harvested, as long as the frozen eggs fertilize okay and culture into good embryos, I think you would have a very good chance of success eventually.

    Good Luck!

    ReplyDelete
  15. Hello Doctor Ramierez and whoever is reading this.
    I have been having IVF and two days ago I had my third attempt at an embryo transfer. Three weeks ago I had a resolving ectopic and at the time of my transfer all was well in that my HcG levels were back down to 2. My specialist has told me that I was ready to get back on that horse so to speak and try again which I did!
    As of yesterday I have been bleeding quite heavily ( not enough to soak a pad in 2 hours or anything ) but it is def heavier than a period and it is bright red blood. I also have slight pains on my left side ( co incidentally this was where I was told my ectopic prob occurred) and have cramps. Should I be concerned this has not taken or is this just implantation bleeding do you think? In hindsight should I have not gone ahead with this procedure til later as could I have damaged my body and further limited chances now of getting pregnant in the future? I am feeling very sad and confused about this.
    Beth

    ReplyDelete
  16. Hello,

    I don't think this is implantation bleeding. Implantation bleeding is not usually heavy like a period but is light and spotting. My worry is that the transfer was done too soon after the ectopic resolved. Not that this bleeding and pain indicate that there is another ectopic, it could be but not necessarily, but that the inflammation caused by any resolving pregnancy, be it a miscarriage or ectopic, can take up to 6 weeks to resolve. This heightened immune response can potentially have an effect on embryo implantation. For that reason, I don't recommend frozen embryo transfer or another fresh IVF cycle until 6weeks post surgery, ectopic, miscarriage or D&C. For me the rule of thumb is to allow one normal cycle and period before starting the next cycle. However, this being said, it does not lessen your chances of getting pregnant in a future cycle.

    Good Luck

    ReplyDelete
  17. Hello Dr. Ramirez, I just want to ask question about IVF, This is my second attemp for ivf treatment. The first time, had 2 embryos tranferred. Quality of the embryos wasn't good but got pregnant, but only for 5 weeks. Then Have had 2 embryos transferred on the 9th Feb this month. The quality are grade 3. Accoding to the clinic it is a better quality. Then started having the brown spots at the 11th day , and on the 12th day I started bleeding and it is like a period bleed. Never have the same problem on the first attemp. Didn't bleed alot like what I am having now, although, on the first attempt, got stomach cramp and pain on the lower back, sad to say pregnancy didnt continue. Not sure what has happend. Anyway, I am due to do the preg. test on the 26 feb and I am still bleeding. I am really worried about what is going on, I have stomach cramp everyday but it only last for few seconds and bloated. 5 days on and I am still bleeding. Called the Clinic and they told me to continue the pessaries and do the test tomorrow. I don't think they are that concern much about it, or they dont want me to build my hope too high. Can you please help me understanding about this. Really appriciate your help. Thanks alot. Best regards!

    ReplyDelete
  18. Hello,

    I am sorry for the delay in getting back to you. I have been away for a few days.

    With the increased bleeding all hope is not lost but chances are certainly decreased for a good pregnancy. The biggest worry I would have with the abdominal symptoms is the small chance of a tubal pregnancy. For that reason, I think you should have the pregnancy test done as soon as possible and your doctor should take it from there. The bHCG levels will give us more information. If it is negative, then the cramping could be coming from a persistent ovarian cyst so make sure to explain all this to your doc and they should take a look with the ultrasound to make sure everything is okay.

    Good luck,

    ReplyDelete
  19. Hello Dr. Ramirez, Many thanks for the reply! Done Preg. Test this morning and it is negative. I feel really gutted! crying like a river this morning.
    Many thanks for your explanation. All the best!

    ReplyDelete
  20. Hi, I just had my day 3 embryo transfer on February 25. Doctor transferred 3 embryos on which 2 were grade 1 and one was grade 2. Today is February 27, but I don't see any pain or any symptom. Does that mean that the embryos did not implant? In addition,yesterday my husband was is bad mood, and abused me a lot. can it harm my embryos?Please help

    ReplyDelete
  21. Hello,

    The lack of symptoms does not mean that you are not pregnant. Some people don't have any early signs. You have to have a pregnancy test (blood) to confirm whether implantation occurred or not. You are far enough now for it to show so I would recommend that you contact your doctor and have one done.

    In terms of your "husband's abuse", I cannot tell you if the abuse will affect your pregnancy since you have not given any specific details. Certainly, any trauma to the abdomen or pelvic region can put a pregnancy in jeapardy. If that is the case, you need to report him as soon as possible. Check and see if there is a Women's Crisis center in your area or call your local police department. No matter what the reason, physical abuse by a spouse should not be tolerated!

    Good Luck

    ReplyDelete
  22. Hello. I had my embryo transfer 2 days ago. It was a 5-day transfer of 2 embryos. During the transfer, the RE discovered that I have a polyp right on the outside of my cervix. The day of the transfer I had some bleeding and was told that was to be expected. The day after transfer, the spotting mostly stopped (maybe just a little brown spotting). Then today, 2 days after transfer, I had some dark red, then light red bleeding. I have passed a clot also. I have continued to have dark red/brown spotting throughout the day. Could this be from the polyp? Thank you.

    ReplyDelete
  23. Hello

    I cannnot tell you exactly where the bleeding is from. It could be from the cervical polyp, although polyps usually don't bleed without something inciting the bleeding like an exam or intercourse. It is unlikely that the embryo transfer is still the cause of bleeding from the polyp because it has been too long. The only other possibility is that the bleeding is from the uterus.

    ReplyDelete
  24. Hello Dr Ramirez,

    yesterday i had a frozen embryo transfer and just 31 hours later i noticed red blood when i went to the toilet. (it was on my pants). This morning its just turned to brown spotting. Should i be worried. The embryo was a perfect 9 cell.

    ReplyDelete
  25. Hello,

    I don't think you need to be worried at this time. I cannot tell you exactly what the bleeding was from, but if it is now brown spotting then that is a sign of old blood and the cause of the bleeding is resolving. It cannot be used as any measure of whether or not implantation may occur.

    Good Luck

    ReplyDelete
  26. Hello, I had my transfer on wednesday morning 03/16/2011 and had some brown spotting this evening and feel very crampy and bloated. I am taking Progesterone vaginally, should I be worried and contact my doctor? is there anything that can be done to stop the spotting?

    ReplyDelete
  27. Hello,

    I don't think you need to worry about this spotting of old blood (brown) nor need to contact your doctor. As mentioned in this blog, progesterone vaginally often causes spotting. Nothing can be done about it at this time, and nothing needs to be done about it.

    Good Luck

    ReplyDelete
  28. dear Doctor Ramierez
    i am 30 and had fresh embryo transfer on 22/3 during transfering the Doc. discovered i have cervical stenosis and took 25 mins to finished transfer the next had 1500IU luteal injuction.no medicine or pessary. 30/3 today i started bleeding very heavy like normal period also has clot i called nurse she said wait for the blood test which 2/4. i'm desperated and depressed, my heart broken
    could u explain what has happened? what do i do for my next cycle?

    ReplyDelete
  29. Hello,

    I'm afraid that I cannot tell you what is going on or what went wrong. You'll first need to do a blood pregnancy test and since it has been 9 days since your transfer you could have it done today or tomorrow and it should show positive if you are pregnant. The blood pregnancy test is very sensitive. If it is negative then the bleeding is probably your period.

    It is too bad about the embryo transfer problem. The embryo transfer is the most IMPORTANT step in the IVF process because even if you have absolutely perfect embryos, if they are not placed into the endometrial cavity properly the cycle will fail. The actual embryo transfer SHOULD NOT be the first time that your doctor attempts a transfer. Most IVF docs, including myself, will do a "mock embryo transfer" ahead of the actual IVF cycle to make sure that we know the direction of the canal, any obstructions or difficulties and the length of the canal. This is a type of practice run. That way any difficulties can be identified and remedied prior to the actual embryo transfer. I does not sound like one was done with you, which is a shame.

    For the next cycle, if you stay with the same doctor/clinic, I would insist that the doctor do a mock embryo transfer. If there is stenosis, the doctor can take measures to increase the cervical os, such as cervical dilation.

    Good Luck.

    ReplyDelete
  30. Dr, I am 6dp a 5dt of one grade 2 blast and a grade 2 morula. I had some cramping for a few days and alight spotting on day 5. On day 6 i began bleeding heavily like a period. I was on 400mg of progesterone spread through the day both orally and vaginally. I called my RE and he upped the dose to 400mg twice a day. I had my original IVF done overseas. He wants to see me tomorrow to see what is going on as its too early for my period to start. I had a negative today as I tested for the HCG shot. Is 6dpt too early to get a pregnancey positive? I hope they find out what the bleeding is.

    ReplyDelete
  31. Hello,

    6 days post embryo transfer of a blastocyst would be right on the brink of begin able to detect, but could be detectable. Implantation would just have occurred either one day prior or on that day. So, I would say that I would not draw a pregnancy test for 1-2 more days to confirm.

    Good Luck

    ReplyDelete
  32. Dr Ramirez

    I had posted on April 6 regarding early bleeding. It started on 5dpt, it got heavier and on 9dpt it was a negative blood test. Can a period start that soon after transfer? I was very shocked. My progesterone level when I took the blood test was 9. Why do they say wait 14 days if your period can come in 5? what questions should I ask? Thanks, Lisa

    ReplyDelete
  33. Hello Dr Ramirez,
    I am on day 13th post my 5d-IVF(4et, 3 perfect grade). I got pink spotting few days ago only when I wiped though. and today i had little pink/red which turned into brownish spotting (not a whole day thing but only when i went to the bathroom). I'm scared because my symptoms kind of not there anymore, my breasts are not sore but my nipples are sore to the touch only. My blood test in not until thursday the 14th 2011 and I don't know if I should call the docs office or this is normal and i shouldn't worry about it. What is happening to me, please anything helps.

    ReplyDelete
  34. Hello Anonymous from April 6th,

    I think that the bleeding that occurred 5 days post transfer was possibly the onset of the period. You don't mention if progesterone or estrogen supplementation was usd. Taking these supplements would delay the bleeding, but without supplementation, the period would occur. Since 5 days post transfer is 10 days post ovulation (retrieval), a period could occur at that time. It is a shorter luteal phase but within the normal limits.

    ReplyDelete
  35. Hello Anonymous 13th dpt,

    As explained in the text of this blog, it is no uncommon for some light bleeding or spotting to occur with IVF cycles. We think this may be due to progesterone supplementation, especially if suppositories are used, but we don't know for sure. Pregnancy symptoms are definitely not reliable enough to draw any conclusions. They are highly variable. At this point, there is nothing that can be done or should be done. Just wait for the pregnancy test. I had a patient of mine call me with the exact same problem. My advice to her was the same. The only bleeding that might be worrisome is if it is bright red blood that is moderate to heavy like a normal period. Even then it may not herald doom.

    I don't usually like to use anecdotes to as a means for advice, but I thought this story would be interesting to share. My wife had bright red bleeding like a period after her IVF cycle, and at that time, I was sure she had lost her pregnancy (we already had the positive bHCG). I rushed her to my office and did an ultrasound (because we were already 6.5 weeks pregnant) and found that the pregnancy was still intact. This then went on to be a normal pregnancy and we delivered a beautiful baby girl who will turn 14 years old this year. maybe it was possible that she originally had twins and one was lost (we transferred 4 embryos), but we will never know. In any case, as you can see, bleeding does not necessarily mean that all is lost. Things can still turn out okay.

    ReplyDelete
  36. Dear Dr.

    In response to your answer, When I started bleeding on 5dpt i was taking 400mg of progesterone 2 by mouth 2 suppository. When I started bleeding they upped it to 800mg. I was taking no estrogen. Do you think the bleeding started because i was not taking ENOUGH progesterone? I am pretty shocked it came that early as it feels like the embryos did not even have a chance. My progesterone level on 9dpt blood test was 9. Is this normal level? thanks, Lisa

    ReplyDelete
  37. Hello Dr. Ramirez
    im 31 and had fresh embryo transfer on 01\04\11.and this is my first ivf treatment and transfer 2 embryo 1 was a good quality and the secant was 2 gread.i have got pain in the left and right (overy).i use progesterone and have prestamol evry day .also i am on the bed from first of April.Yestarday on 11th i started pleeding it was light red but i had alot of pain same like perioed pain .today i have heavy and red bleeding with dark brown clots but not that mach pain .my pregnancy test is on the 14\04\11
    but i dont know with clots and heavy bleeding my result will be positive or not? last night i didnt sleep becouse i was worry about it.
    please help me i dont want to see my negative result i was waiting for 8years to have a child please replay for me this is normal and shouldn't i worry about it????

    ReplyDelete
  38. Hello 5dpt,

    Again, I cannot be certain as to the cause of your bleeding. There is no way to know for sure. But as to the progesterone level, it is too low. We usually strive for a progesterone of at least 20 ng/ml. Oral progesterone has been shown in past studies to be totally inadequate and ineffective for luteal phase support. Most of it is lost in passing through the liver and not enough of it gets to the endometrium. The best ways to provide progesterone is via injetion, cream or vaginal suppository.

    ReplyDelete
  39. Hello 31 yo anonymous,

    By now you would be able to know whether or not you are pregnant. I usually will do the first pregnancy test at 8 days post transfer. So, if you are having bleeding, I would recommend that you have a blood pregnancy test to find out what is going on. At this point there is no other way to know. Although I understand that worrying is human nature, and after IVF it is more so, it accomplishes very little in reality. Go seek out the pregnancy results so that you can know whether you are pregnant or if you need to move forward to another cycle.

    Good Luck

    ReplyDelete
  40. dear DR. Edward Ramirez
    i wote a letter to you at 31/3, after i did my prenancy blood test not suprisely it was faild, the next day nurse called and said the doctor would have a general anaesthetic for you next FET,which is in June.
    i'm going the see the doctor in 3/5, do i insist to have a cervical dilation or just do what he said.
    i'm a bit worry to have a general anaesthetic, will it be better if i had cervical dilation before ET than general anaesthetic?
    MEI FROM AUSTRALIA

    ReplyDelete
  41. hello.iim 26 its my 1 ivf now is my day 10 and i start to bleed,but my period should be next week.my bleeding is not to heavy and is red-brown.i don't know what to think im taking 300mg progesterone.should i start worry?thanks

    ReplyDelete
  42. Hi im 44yrs old and have 2 kids a 12yr old and a 2/12 yr old both born naturally. My new husband fatehr to the 2/12 yer old desperately wants another so this is our 2rd attempt at IVF. the first time 1 embie was transfered day 5 but got period before preg test and the last time we had pg testing done on the embies (because of age) and nothing was vialble to transfer. I had given up but we know another couple older that just had sucess so my husband pleaded for another go. This time we transfered 2 4 celled embies day 3 but none left to freeze so this is our last attempt. I have been getting period like pains since day 4 and on day 6 had really bad cramps that woke me up and i thought it was over but no bleeding. Today though cramps have returned not at bad but have noticed when the crinone vaginal cream comes out its a bit brown in colour so am wondering if this is a normal sign or could it be a period just begining? I am due for my preg blood test on fiday and dont hold much hope but curious as to what you think. thankyou

    ReplyDelete
  43. Hello 44 yo anonymous,

    As you have probably read from this blog post, bleeding is very common after IVF. There is no way to know exactly where the bleeding is coming from unless there is an obvious source seen on ultrasound (like a retroplacental bleed). I think that some, if not the majority, of the bleeding is coming from the vaginal progesterone, which can make the cervix more friable and therefore have more tendency to bleed. In general, I can draw no conclusions from bleeding prior to a pregnancy test. You'll just have to wait and see. But if the bleeding is not bright red blood like a menses and no strong cramping, I think hope is not yet lost.

    Good Luck.

    ReplyDelete
  44. Hello 26 yo anonymous,

    Sorry this post is out of order. As I mentioned in the post just after yours and prior to this response, until we do the pregnancy test, there is no way to know exactly what is going on or predict the outcome. In general, I tell my patients not to worry unless the bleeding is bright red blood and heavy like a period with cramping. Since your does not fit that description, there is hope.

    Good Luck.

    ReplyDelete
  45. Fron 44yr old anonymous
    thankyou for getting back to me un fortunately i think its all over as i am def cramping and now am getting heavy spotting mostly brown but also bright red as well. I am gutted as this was it for us and it just kills me to think that we are now too old. I wish everyone else lots of luck x

    ReplyDelete
  46. Hello Mei from Australia,

    I looked at your post from March 31 and saw that the doctor had difficulty doing the embryo transfer because of cervical dilation.

    My recommendation would be to have him do a cervical dilation (gently) prior to the embryo transer and this can be done mechanically with dilators (he doesn't need to dilate it too much) or medically with prostaglandin gel or suppositories. He can look up the protocols.

    Good Luck.

    ReplyDelete
  47. Hello 44yo anonymous,

    I am sorry to hear that things are not looking good but until you have the actual pregnancy test, you cannot know for sure.

    Also, keep in mind that although you may have ended your quest for a genetic child (using your own eggs), you always have the options to use donor eggs, which will have a much much higher chance of pregnancy. Your age is not significant in that regard with this option. What you have to decide is how strong you want another child vs how strong is it for you to have this child be yours genetically (remember it will be your husband's child geneticaly and yours biologically). The differences in pregnancy rates are 33% per attempt with only 11% delivering with your eggs versus 76% pregnancies with 61% delivering with donor eggs. The oldest donor I have done was 55 years old. So, how badly do you or your husband want another child so that your child can have a sibling? Something for you to think about.

    Good Luck

    ReplyDelete
  48. We have thought about that but as we have 2 children i dont know if i could have someone else child? Also the egg donor do they have any rights to the child? I know that my husband has done it as he has accepted my daughter but he knew that from the begining this is a little different and i would always worry that the egg donor mother would come back? that may be silly but im not sure what rights they actually have
    Also i think there is a 12mth waiting list and the cut off is age 45 so i sont think i would even be eligable. Im in Australia Melbourne
    thanks

    ReplyDelete
  49. Hello Again,

    You have defined egg donation as "someone elses child" but in reality it will be your child. It may not be genetically yours (but most people don't check their genetic heritage), but you will get pregnant, nurture the child in your body, watch it grow, deliver it and hold it in your arms immediately after delivery. Would you not then consider it "your" child at that point? In addition, it will be your husband's genetic AND biologic child.

    I don't know what the laws are in Aurstralia so I can't repond to those issues. However, if you can't do a donor egg cycle in Australia because of legal reasons (some countries don't allow it) or timing reasons, then maybe you might want to seek out the services elsewhere (like here in the U.S.) We can a lot of people from other countries to do donor IVF cycles here in the U.S. We also don't have a cut-off age.

    Something to think about.

    ReplyDelete
  50. Hi again sorry to keep pestering you but i have a query and would love you opinion and medical advice. I have done a alot of reading and have heard that a combination of Melitonin and Dhea can in some cases improve egg quality??? Would like to know what you think or know professionally re this. Also as Dhea is banned in Australia would like to know how to get it?
    Thanks again for all your advise

    ReplyDelete
  51. Hello,

    I don't think there is an substantial evidence that either of these medications improve egg quality, and they are not accepted as standard treatments. I do not use them or recommend them. At this point in time, there is no technology available to improve egg quality.

    I also have no idea how to obtain medications in Australia. Sorry.

    Good Luck.

    ReplyDelete
  52. Dear Doctor,

    I had embryo transfer yesterday. About 2-3 hours after transfer, i found a little bright bleeding. Then It stopped. For what I have read above, I am afraid that my cycle will be failed. Could you tell me if I have any hope ?
    Thank you

    ReplyDelete
  53. Hello,

    Certainly traumatic embryo transfers that cause bleeding at the time of transfer is detrimental and can lead to a failed cycle. That is because blood is toxic to the embryos. Preventing this is the reason why the transfer technique is so important and why pregnancy rates can vary between dcotors and clinics.

    However, in your case, we cannot know where the bleeding was from. Sometimes it can be from the outside of the cervix that is touched by the speculum when it is being placed or by any irrigation prior to the transfer on the outside surface of the cervix. These two sources would not affect the embryo and therefore not affect your chances of success. At ths point, I would not give up hope based on this one finding. It would only be speculation.

    Good Luck.

    ReplyDelete
  54. Dear Doctor -
    I had two failed ivfs using my eggs in 2008. My eggs were of poor quality so we decided to use a donor for this round. I had a 5day transfer of 2 good quality embryos using donor eggs (AB and BB) on 5/15. This morning I woke up with the period like feeling in my stomach and then later today I had some brownish discharge in my underwear and when I wiped. I called my Dr. And he said it may just be old blood coming through. I am daily progesterone shots, estrogen shot every Tues/Fri, and a daily prog/estrog suppository. I haven't seenp any bright
    red bleeding yet, but I'm afraid my period is trying to break through. I've taken to
    lying down and drinking more water. During my last two failed ivfs, I ended getting my period before my scheduledmblood test. Since I never had a hCG injection, would it be too early to take a home pregnancy test?

    ReplyDelete
  55. Hi Dr. Edward Ramirez,

    Im 35years old and just had embryos transfer on 3/5. After 2 weeks i started to have brown discharge and continued till this day. My doctor has advice me to go for urine pregnancy test on 20/5 which i have done and it was negative. When i told them about the results he suggested me to tried after two days time which i did and it still negative. So when i informed the doctor about the result i got, he asked me to stop the Utrogestan 100mg. Last few days, my body started to develop some rashes all over my body? Could it be the effects of the Progesterone and the Ultrogestan that i took during the treatment? Tomorrow will be my 3weeks and i have not done any blood test yet. Is there any possibility that i could be pregnant?

    Appreciate your advise.

    Thank you.

    SK from Malaysia

    ReplyDelete
  56. Hello,

    I usually do my first blood pregnancy test at 8 days. You could certainly do this to see if you are pregnant. It would be too early for a urine pregnancy test unless the bHCG level is higher than normal (i.e. in the case of a twin gestation). So, you could try and see but don't assume that you are not pregnant if it comes out normal.

    Like I've explained in this blog, the amount of bleeding you have had at this point is not worrisome. It is very common with IVF when progesterone suppositories are used. You cannot draw a conclusion from it or the cramping. The only bleeding that I worry about, which still is not a definite sign, is when the blood is bright red and heavy like a period. I've even had cases with this scenario that went on to have a healthy pregnancy and child!

    Good luck.

    ReplyDelete
  57. Hello Embryo transfer on 3/5,

    The urine pregnancy test was done at 18 and 20 days after embryo transfer. I think that if you were pregnant, even a urine pregnancy test would have been positive. I don't know why a blood pregnancy test was not done since it is more accurate. In any case, the delay in starting your period is because you are on progesterone and until you stop it, the period won't come down. I think it unlikely that you are pregnant at this time. Sorry.

    Good Luck

    ReplyDelete
  58. Hi I had my fresh embryo transfer on 23rd may 11 and i started pink color bleeding today.I was in progoston vaginaly but today my doc adviced me to take progoston injection, and after taking injection my bledding is very less, i had cramping also pls advise do i have to worry about my pregrency or everything is fine

    ReplyDelete
  59. Hello Usha,

    As mentioned in my blog post, bleeding after embryo transfer is especially common with vaginal progesterone. It may just be an effect of the progesterone that causes the cervical tissues to bleed more easily. I would not worry at this time. Just wait for the pregnancy test to draw any conclusions.

    Good Luck

    ReplyDelete
  60. Thanks for positive reply, hope result will also come +Ve.

    ReplyDelete
  61. Dear Doc, I am 39 and on my 13day after ET of 2 embroys of grade 2 and 3 on day 2. I started bleeding on day 11, was slightly pink but with bad cramps, felt like am in labour with the breaks and by mid day had heavy bleeding with tiny clots this has continued till today. When I called the nurse she said I should still go for my PregTest (Urine) test on Thursday.

    I am on progesterone suppositories twice a day and folic acid.

    Is this the end of it? Could it be implantaion or enlargement of the uterus? I have been devastated since Sunday and cant stop crying although my husband is trying to make me brave by saying it could be uterus enlargement. Would you please explain what could be happening? Is it advisible to do a home pregnancy test, would it be accurate?

    Cheerme

    ReplyDelete
  62. Hello,

    I can't say for sure what this bleeding is from because, as I said earlier in this post, bleeding occurs quite frequently after IVF. But, you should be far enough along to do a blood pregnancy test so I am wondering why your doctor just doesn't order it? It would solve the question. Blood pregnancy tests will be positive as early as 8 days post transfer. A urine pregnancy test (home test) would be positive as soon as 14 days post transfer (sometimes sooner).

    ReplyDelete
  63. Dear Dr Ramirez,

    I am 34 yrs old and had a 4AA embryo transferred on May 18th 2011 (at 5 days). I am currently on progesterone 200 mg twice a day, lovenox 20mg, low-dose aspirin and dexamethasone 1 mg/day. I also had two infusions of IvIg (one at beginning of cycle and one right after transfer). On day 9 post-transfer, I started spotting which turned into light red bleeding by day 12 post-transfer. On that day, my beta was 105. The bleeding was heavier on the next day and some tissue passed. My beta on day 14 was 432. I am wondering how this is possible? I have since discontinued the lovenox and aspirin and the bleeding has pretty much stopped. Could this be an ectopic or blighted ovum? My 3rd beta was today, but don’t have the level yet. Any ideas you have would be most appreciated. Thanks so much!

    ReplyDelete
  64. hi dr. i am day 13 after having 2 8 cell embryos transfered on day 3. i started having brown spotting yesterday and today red blood when i wee, not like a period. today was the day to do a test and it came out negative. do u think there's any chance that the test is wrong

    ReplyDelete
  65. Hello 34 yo,

    First, congratulations on your pregnancy.

    I cannot be sure what the bleeding is coming from. It could be from the progesterone, it could be the loss of an extra implantation (such as twin) or it could be from an abnormal pregnancy such as an ectopic or blighted ovum. It could also mean that the pregnancy is not progressing well and that a miscarriage might occur. Finally, it also could mean nothing and the pregnancy will proceed well regardless.

    When my wife and I had our IVF cycle, she had a similar heavy bleed after positive pregnancy tests, that was more than a period. I was sure that she had lost the pregnancy and had resigned myself to that. We were far enough along that an ultrasound could be done so I did it and to my surprise there was still a viable pregnancy. This pregnancy resulted in my daughter who will turn 14 in July. It is possible that we had a twin and one was lost but I could never really determine what the bleeding was from.

    Just like us, all you can do at this point is wait and see how things turn out.

    Good Luck.

    ReplyDelete
  66. Hello SarahLee,

    If the test that you did was a blood pregnancy test, and you are now 13 days after the transfer, it is unlikely that the test is wrong. Sorry. But nonetheless, I would repeat the test to confirm. Stranger things have happened.

    Good Luck.

    ReplyDelete
  67. Today I had my blood test and it come negative, very depressing and not able to understand why this happened, everything was going gud but my bad luck

    ReplyDelete
  68. hi it was a urine test i done. am losing blood now but still not like a period

    ReplyDelete
  69. Thanks so much Dr Ramirez. My third beta was 1307 so I am still hopeful.

    Sincerely,
    34 y old

    ReplyDelete
  70. Hi Doctor, I'm 31... my embryo transfer was June 25th morning and I have appointment Dr appointment on June 30th for blood test. Is that normal to have this fast blood test? I just don't want to hear false result. After my transfer, I still don't feel nothing is that normal?

    ReplyDelete
  71. Hi,

    5 days post transfer is a little early. I presume you had a blastocyst (D#5) transfer because it would be way too early for a D#3 transfer. It is possible to return positive after blastocyst at this early date but to be on the safe side, I would probably wait a couple of days. If it is negative, that would not be reliable because it is early and you would need to repeat the test in two days.

    Most women will not feel any symptoms this early.

    ReplyDelete
  72. Hi Doctor,

    I was diagosed with PCOS in January and started Melfmorin. My doctor decided ivf will be best for me and my husband who have been trying naturally for 2 years. I just did my first cycle in which I found out failed 2 pays ago. My question is with my condition is there anything I can do To help my chances for it to work in the future. I had 5 day transfer 2 embryos. Throughout my cycle I had no complications. So I'm very confused with why it didn't work. Can you please help with some advice I should do definelty.

    Thank you

    ReplyDelete
  73. Hi Dr, I had 5 days morula embies transfer on June 26/11. My Dr said the embies are fair, so I got 3 embies transfer. What's your opinion?

    ReplyDelete
  74. Please Dr let me know what you think.... I have sharp pain these 3 days my right side pelvis area. I got my ET on June 26 and my blood test is 7/7.

    ReplyDelete
  75. Hello Anonymous with PCOS,

    IVF is certainly a good option for you and despite the failure of the first cycle, I would urge you not to worry. IVF is no a perfect technology and 40% or more patients have to try it more than once. The last two steps of the process required for you to become pregnant are natural steps that we do not have the technology to make happen. Because of this, failures can occur despite the best embryos. You just need to keep trying and it will eventually work. Most patients are pregnant by three attempts.

    Good Luck

    ReplyDelete
  76. Hello Day 5 Morula transfer,

    The biggest concern I would have is that the embryos were only Morulas at day#5. They should have been at the blastocyst stage, so they are not as developed as they should be. This could be because the embryos were not that good, or there was a culture problem. But, the bottom line is that you never know until you know, so you have to wait and see what the pregnancy test shows.

    Good Luck

    ReplyDelete
  77. Hello Sharp pains,

    I can't give you a definite answer to your question because that is not possible via the internet. However, one consideration for the source is a residual cyst from your IVF stimulation. The follicles that you formed re-fill with fluid and so the ovaries can hurt. That is the most likely cause of the pain.

    Good Luck

    ReplyDelete
  78. Hi Dr, I just got my HCG test result and it came out negative. I have to wait until Saturday to talk to my Dr. So my question is why I didn't have any abnormal symptoms like other people. Therefore my husband and I were very positive of having a pregnency because of no abnormal symptoms.

    ReplyDelete
  79. Hi, i had et on the 27/6 with a 5cell average to good quality. On day 11 i had a very light spotting then stopped. I woke up today and its bright red and enough to use up 1 sanitary towel, although its worse when i go to the toilet. I have had some cramping but none now but still bleeding but not as heavy as anormal period of mine. Ive been told to rest and upped the cyclogest and drink plenty of water. Is this the end? is there anything else i can do?

    ReplyDelete
  80. Hello July 7th,

    Most patients will not have any symptoms, positive or negative/good or bad, in the very earliest stages of pregnancy so no conclusions can be drawn either way. Even patients with cramping and/or bleeding cannot make any conclusions. Many of these pregnancies do just fine. If the pregnancy test is negative, as in your situation, you would not have any type of symptoms.

    Good Luck.

    ReplyDelete
  81. Hello July 9th,

    It sounds like you have started your period. I presume that your doctor explained the meaning of the cell number and grade of your embryo. It was not very good, but does not automatically eliminate any possibility of pregnancy. However, with a not so good embryo and the symptoms of a period coming on, it is most likely a failed cycle. At this point there is nothing that can be done. It is all a natural process from here.

    Good Luck

    ReplyDelete
  82. Dr Ramirez,
    I am currently 6 days post transfer of a 5 day old Blastocyst. I am taking both oestrogen and progesterone and am not due to have my beta tested until 24/7. Today i started to bleed - enough to have to wear a pad. The blood is bight red, thin and mucousy.Clumps of crinone are also passing out. Is this the end? It is so early. My clinic have suggested bloods tomorrow and then if need be a progesterone injection - wont this all be too late?
    Thank you
    AmyK

    ReplyDelete
  83. Hi Dr.This is my 3rd IVF,They got 17 eggs from me,and 5 were good,they were 7af-7bf-10bf-9bf-7af,all 5 were transferd on july 22nd,my test date is the 27th july, i have no pain or bleeding,is that ok,and about my numbers ,are they good embryos numbers, and is it (5) too much to transfer at once,what maybe the out come of transfering (5)embryos.

    ReplyDelete
  84. hi doctor
    i had embryo transfer on july 08.from yesterday i am having slight bleeding-brown and red both.my pregnancy test is on july 23.am i still pregnant.i don't have any preganancy symptoms.please advise me.thanks

    ReplyDelete
  85. Hello July 20th anonymous,

    The embryos look good if this was a CD#3 transfer. In terms of the number transferred, in the U.S. we do not transfer 5 good embryos unless you are over 40 years old. Under 40, the most that is recommended is 3 and under 35, the most recommended is 2. This is to reduce the chances of a super-multiple pregnancy such as triplets, etc.

    In terms of outcome, other than the increased risk of a multiple pregnancy (twins or more), I cannot predict what will happen.

    Good Luck.

    ReplyDelete
  86. Hello July 21 Anonymous,

    I cannot answer your question because I don't have that special ability. You are now 13 days out from your transfer. By now implantation should already have occurred. I check the first pregnancy test at 8 days from transfer. So, based on that, there is a possibility that you could be pregnant. I would request that your doctor do a pregnancy test right away. There is no reasonable reason to wait until the 27th.

    Good Luck.

    ReplyDelete
  87. Hello July 13 Anonymous,

    The bleeding may not necessarily mean the end. We see bleeding often with IVF cycles and especially with Crinone. The blood test will tell better what is going on.

    If the pregnancy test is positive, the addition of progesterone at this point won't prevent a miscarriage if that is what is fated, but the extra progesterone does not hurt.

    Good Luck.

    ReplyDelete
  88. Ramirez -

    Thank you so much for the knowledge and understanding regarding bleeding after an embryo transfer. Last night my wife (6 days post day 5 transfer) started to spot a very faint pink when she wiped, then about an hour later she spotted a light red spot on her pad about the size of a dime. It was not a deep red color, more of a watery light color such as a watercolored red. We were very alarmed by this. That evening and this morning she did not show any signs of the red color and is only spotting the very faint pink.

    Should we be alarmed by the red watery spot or could that also be from the progesterone suppositories? (she uses 100mgs 3x a day). She occasionally spots brown or pink prior to her periods, but never this light red spot.

    Thank you for your input.

    ReplyDelete
  89. Hi Dr.
    i had my embryo tansfer on july 08.then on july 13 i started spotting .i had my pregnancy test on july 23 and waiting for the result.i don,t have any pregnancy symtoms.i am confused.i feel dizziness all the time.

    ReplyDelete
  90. Hello July 25th writers,

    At this point, the bleeding could be from the vaginal progesterone. In general, I don't worry unless the bleeding is heavier than a normal period. There is no way to know what is actually going on right now but all is not lost yet. Just wait patiently for your pregnancy test.

    For the other July 25th writer, I do pregnancy tests 8 days after the transfer. There is no reason to have to wait until July 23rd. If you want to know what is going on, then ask your doctor to do a test today!

    Good Luck to you both.

    ReplyDelete
  91. Hi doctor
    its almost more than a week i am spotting .it's brown colour but sometimes red.i am still waiting for my test result which i did on 23 july .why i am still spotting because of progesterone.please help.for how many days the spotting goes

    ReplyDelete
  92. Hello July 26th anonymous,

    I can't tell you why your are spotting, but vaginal progesterone surely could be the reason. Since you had your blood test on the 23rd of July, why don't you have the result? It only takes 20 minutes to run with the new machines!

    If your test is negative, that would explain that you are probably preparing to have a period. If it is positive, then it may be the progesterone or just early pregnancy spotting. I generally don't have my patients worry about bleeding in early pregnancy unless it is heavy like a period and bright red. Anything less is probably insignificant.

    Good Luck

    ReplyDelete
  93. Dr. Ramirez -

    Here is an update to my July 25th 2011 12:27pm post:

    We just received word from our doctor that we have a POSTITIVE HCG level of 119! This is 9 days Post 5 Day Transfer. What do you think of these early HCG numbers? FYI we transfered two embyros... one was a 3AA and the other was a 3BC. Any thoughts, Dr?

    Dr. Ramirez is correct... spotting can still result in a positive test result! Keep the faith alive!

    ReplyDelete
  94. Hello July 27 Anonymous,

    CONGRATULATIONS!!!!

    You can't really draw any conclusions from your bHCG number but is is a good high and strong number. You'll have to wait until the ultrasound to see how many implanted.

    Good Luck.

    ReplyDelete
  95. Dr. Ramirez -

    Thank you for your reply back! We are very excited for what the future holds. We wanted to give you a quick update and know your thoughts on our latest HCG number. As you recall, our first HCG number was 119 and two days later it was 221.5. What do you think? I've heard the number should double and this did not quite do so. Is this a concern?

    Thanks again

    ReplyDelete
  96. Hi Dr Ramirez I had 2 5days frozen embryo transferred On 7/14/11 got my beta on 7/28 at 493 all was going ok until today 18 days post transfer that I went to the bathroom to pee and noticed a bit of blood on the toilet paper and then a spot of blood on the toilet, 30 minutes later I went again and felt something coming and I wiped and I saw Luke a blood cloth similar to when I had my period in the past I freackout I called the on call Dr and I have to go have my levels Check tomorrow 8am I am so scared I am miscarrying can you please advise what can it be I had never had any bleeding I did get preggo the first time but miscarried at 21w3d due to incompetent drs then I had had 3 frozen embryo transfer with this one and this one implanted buy now I'm bleeding and had that blood cloth discharched please please tell me it is not a miscarriage !!!! I am on progesterone shots 2 ml a night estrace pills 3 by mouth and 2 vaginally and also I'm doing vibrios patches, baby aspirins foli acid and pre natal vitamins please respond to my message soon awaiting good news... Mik

    ReplyDelete
  97. You cannot make a determination as to the success of a pregnancy based on the bHCG. In general it is supposed to double, but in reality a 80% rise is the minimal requirement. So if your 119 bHCG increased by 80%, it should be 214.2. The number you have is a more than adequate rise. Don't scrutinize every little detail of your pregnancy. If you do that, you'll drive yourself nuts.

    Good Luck.

    ReplyDelete
  98. Hello July 31st anonymous,

    If you look above your post, you will see a patients who had bleeding but her pregnancy is proceeding successfully. Early bleeding does not necessarily mean something bad. It is quite common. Your doctor is correct to check your bHCG levels, then an ultrasound will eventually be warranted. Until then, this finding is neither good nor bad. You just have to wait and see.

    Good Luck

    ReplyDelete
  99. Thank you Dr.This is regarding to july 20th the 4:58 am message to you,i have learn alot and still cannot understand alot of things.i had my blood test on july 27th,and the HCG level was 59.
    I had to go back for another blood test on the july 29th,and the HCG drop to 49,i went back for another blood test on 8-1-11 and it went up to 81.
    They now stop me from useing the Progesterone gel,and to come back for another blood test on 8-4-11,,,i have light back pain on and off and lower cramps on and off,my breast is heavey and blue veins showing,,,today the 8-2-11 i felt like i wanted to vomit,but it did not happend, Now that they stop me off the progesterone gel.
    What do you think all this mean,AM i still pregnant,what if the numbers go back down or up,am so confused,your feed back helps me alot,thank you Dr.

    ReplyDelete
  100. Hello Again,

    First congratulations on getting pregnant. That is a big step and showed that the IVF cycle worked. Remember, IVF can only give you the opportunity to become pregnant, not make you pregnant, because the last two steps are natural steps in IVF. At the very least, now you know that it can work.

    In terms of the bHCG levels, we can't interpret a lot based on levels, but the drop 48 hrs after the first test is a little concerning. Since the third test was an increase, all we can do at this point is hope and wait. It is possible that maybe there was more than one implantation and that one of the embryos has ceased, therefore accounting for the drop. The would be the best case scenario. The worst case scenario is obvious of course. If you were in my clinic, I would continue following your bHCG levels every 48 hrs to see how it is trending. I would NOT stop the progesterone. It is way too early and could impair the progress of the pregnancy.

    Good Luck.

    ReplyDelete
  101. Thank you for that imformation Dr.i do have a blood test 8-4-11 and i will let you no what the outcome was.i dont no why they stop me from taking the progesterone,but i will ask about that later ,maybe because the numbers was 59 and then drop to 49,then back up to 81,but i will see what happen later with the blood results.

    ReplyDelete
  102. Hello Doc. I am 35 years old lady who is surrogate for her sister. I had 3 embryos transplant on Aug.7. On Aug. 16th I found brown discharge, so went to the doc and got the blood test for HCG and Progesterone. My HCG is <1 and progesterone is 6.44. I am having difficult time to believe that I am not p[regnant. For the peace of my mind the nurse told me that we can do another blood test in a week or two. Is this the end of my pregnancy or should I hope for some miracle. Thank you!!

    ReplyDelete
  103. Thank you for posting your comment on my blog, but this is really a question you should ask your doctor. In general, however, by 9 days from embryo transfer the blood pregnancy test should be positive if a pregnancy occurred. Rather than wait one week to find out, it is my policy to repeat the test in 48 hrs, so I would request that you have it done on the 18th.

    It is always hard for patients to accept that an IVF cycle failed, especially since most people see it as the ultimate and perfect high tech way to become pregnant. However, it does not always work. Pregnancy rates are at a maximum of 70-80% if the eggs are from a woman under 35 years old. In my practice, approximately 60% will achieve pregnancy on their first try and the rest in up to three tries. We never reach a 100%, however. This is mainly because IVF accomplishes 7 of the 9 steps your body goes through to achieve pregnancy. The last two steps are still dependent on natural factors which we do not have the technology to make happen. Sometimes the body doesn't do exactly what it is supposed to do even if the most beautiful embryos are transferred.

    Good Luck

    ReplyDelete
  104. Hello Dr
    this is an update from july 21.my preganancy test negative.i am 41 yrsold.what is am hormone replacement therapy.one of clinics told me to do before embryo adoption.this time i am planning for embryo adoption in india.what do you suggest.i am so depressed and confused now.
    please help
    thanks
    sheela

    ReplyDelete
  105. Hello Aug 23 Anonymous,

    I presume that by "embryo adoption" you are referring to a frozen embryo transfer by donor embryo, which is different than using donor eggs. In frozen embryo transfers or all embryo only transfers, the uterine lining needs to be prepared to accept the embryo. This is done with estrogen. This may be what your doctor is referring to as "hormone replacement." Otherwise, I am not sure what your doctor is referring to as hormone replacement therapy is NOT required prior to a donor cycle.

    Be sure that "donor embryos" is what you want. By embryos that means that the eggs are from an egg donor and it has been fertilized by sperm from a sperm donor. If you want your husband to be the genetic parent of the child, then your husband needs to provide the sperm, in which case it is a donor EGG cycle, NOT donor EMBRYO cycle.

    Good Luck

    ReplyDelete
  106. Hello Dr
    my husbands semens test showsd 20% abnormalites.so we decided to go for donor embryo.Is HRT safe.it seems my hormone level is very low.is there any thing to increase my sstrogen high.
    thanks

    ReplyDelete
  107. Hello,

    The 20% abnormalities is not an issue because the minimum required for normal sperm is 30% normal. He has 80% normal which is better than the minimum required.

    Since you will be using donor IVF, most clinics will precede the IVF cycle with a low dose birth control pill (the month prior). That will be sufficient hormone replacement. In order to increase estrogen, you either have to increase estrogen production in the ovary, through the use of fertility medications or give estrogen as a medication.

    Good Luck

    ReplyDelete
  108. Hi Doctor,

    I am 36 yo. I am currently on my 11 day post embryo transfer. 3 good quality embryos were transferred after 4 days. I am amazed on how patient you are answering the different queries. Im having my blood pregnancy test in 3 days. I started bleeding 5 days post embryo transfer and it continued until the 9th day. Bleeding is like my period but no cramps. Now bleeding is gone. I am still using Crinone suppositories 2x a day. I am still hopeful that a positive pregnancy will occur. Hoping for your positive thoughts.

    ReplyDelete
  109. Hi,

    You've got them, and my prayers as well. With each of my patients I say a little prayer at the time of transfer. I will pray for you:

    Dear Lord, bless this couple with fruit of the womb and grant them their wish for a child to share their loving household. We ask this through Jesus Christ, your Son. AMEN.

    Good Luck.

    ReplyDelete
  110. Thanks for the prayers Doctor Ramirez. You have been a blessing to a lot of anxious people here. Thanks again.

    ReplyDelete
  111. Dear Doctor I have read most of the posts above and all I can say is that you are an wonderful human being for giving so much of your time, both professionally and in human kindness, loving support to anonymous people. Thank you.

    I am on my 2ww, day 11. My clinic has scheduled my blood test for day 14 as they want to be 100% certain. I stated cramping from day 5 after day 3 transfer with 2 excellent embroys, but as of yesterday I stared bleeding using the ladies room, today it was more slippery brown with period like cramps. I told my docter but she advised that I rest and double my pregestrone dosage for the next 2 days.

    Have I lost all hope is there some chance that things may still be ok?

    Any little advise would be words of inspiration. I thank you in advance.

    Love Kat

    ReplyDelete
  112. Hi doctor
    I am 31 and my wife's age is 27. We did had a Frozen embryo transfer(3) on Aug 7th. First blood HCG test(16th Aug) was positive but the level was only 24. On 18th Aug it was 46. On 27th Aug it was 1916. On 29th it was 2824. At this point our doctor assumed it would be ectopic and asked us to discontinue Vaginal and Injectible progesterone as the level was low. On September 1st we did another test to see the level was only 3824. On the same day evening my wife had a bleeding which was red like periods. Sep 2nd we did Vaginal ultrasound for the first time and there was a heartbeat in the uterus. The doctor asked sorry to us to stop the medicine but she was still wondering on the low level of hcg. So we started our medication again from Sep 2nd. Sep 3rd another blood test was done but at different blood test center as recomended by doctor. Still the results are yet to come. Today again we had a bleeding which was little heavy and not spotting. This is worrying for us as we are on injection we shouldnt be getting the bleeding. Our doctor has scheduled a visit for September 6th. We are totally confused.

    This is our first IVF after 2 failed IUIs. Reason for going to frozen was because my wife got Ovarian Hyperstimulation after the egg retrieval. Only God as to save us from this situation.

    ReplyDelete
  113. Hi
    I am male 31 years old. My wife is 27 years. We had two failed IUIs. Then we switched over to IVF. My wife's one ovary was removed because of Polycyst 6 years back. She has only one ovary.
    My sperm count is good but the motility factor is not. So we were trying thru IVF. I am not sure about the quantities we used for IVF but the bottles I remember is 3:2 for brovelle/menopur.The doctor preferred a Blastocyst transfer so we waited for 5 days. When we went to the clinic for the transfer we were informed the egg didnt grow to the blastocyst and we need to wait for one more day.Just to mention our trigger was through HCG. So we returned back and on the same day my wife ovary got twisted because of the OHSS. Thankfully we got admitted on the right time so doctor was able to recover her ovary. So the doctor cancelled the transfer and freezed the embryos. They didnt give much detail about the quality of the embryos and just that they mentiond 3 embryos got frozen out of the 6.
    So our Embryo transfer was delayed by 2 months and then we did our transfer on Aug 7th. All the 3 embryos were transfered. HCG results on Aug 16th revealed a count of 24 and on 18th it was 46. Doctor was not confident with the test results and she suspected Ectopic. We did another test on Aug 27 to see the count was 1916. Aug 29th it was 2800 which the doctor felt it was way below normal so the doctor asked us to discontinue both the Estradiol inj(3 days once-.2cc), Progesterone inj(daily 1 cc) and Vaginal progesterone tablet. On Sep 1st we had another HCG test and the level was only 3800. The same day we had a bleeding with small blood clots. Next day we had a doctor visit and vaginal ultrasound was done to see a heartbeat. Doctor was shocked and she said it was miracle as the HCG counts were low. She asked us to continue the medications again from Sep 2nd and planned next visit one week later. But unfortunately my wife had a heavy bleeding(less cramps) with some clots of blood on Sep 4th and when we went to ER . The doctor said foetus has died and in Ultrasound they couldnt see anything other than some scratches. So they administered a vaginal tablet(8) for miscarriage. We were advised to have a doctor visit on Tuesday as this is a labour day weekend. But after the tablet the Vaginal bleeding got reduced which makes me to ask the question to you so do we need to go for D&C? The other question would be is the miscarriage was because of stopping the progesterone medication. Please guide us.

    ReplyDelete
  114. Dr. Ramirez,

    I am taking estrogen, folic acid and vaginal crinone.
    I stopped my medication 3 days ago! (for no good reason) I started bleeding one day later. The bleeding is just like my period.
    Did this happen because I stopped my medication? Did I ruin my chances of being pregnant?

    Thanks

    ReplyDelete
  115. Hello Victor,

    I am very sorry to hear about the loss, but keep in mind that the good thing is now we know that your wife can get pregnant. That is a big step. It is now just a matter of time before she has a successful one. In most cases, early miscarriage occurs because the fetus was abnormal and the body realizes this and stops the pregnancy. Hopefully, it was not because your doctor stopped the supplemental medications, but there is no way to know for sure.

    The medications given to your wife was to induce a miscarriage, and again, I am not sure why she was given this considering that she was already in the process of natural miscarriage on her own. Since they could not see anything on ultrasound, that should have confirmed that the miscarriage was completed. No other treatment was required. A D&C is not required at this time unless she begins having heavy bleeding again, in which case, we would worry that there is some retained tissue. I would recommend waiting.

    Good Luck.

    ReplyDelete
  116. Hello Sept 5 anonymous,

    Since you haven't really explained to me why you were taking that medication, I'm afraid I can't explain why you had the bleeding.

    Sorry.

    ReplyDelete
  117. Hello Kat,

    I am sorry for the out of order reply. Unfortunately, I went through the questions in reverse order (the order I get them via email, most recent to later).

    The bleeding you had would not be considered frank bleeding. I only worry if the bleeding is like a period and red, and accompanied by strong cramping. Anything less than that is not worrisome and fairly common. I don't think you need to worry at this point.

    Good Luck.

    ReplyDelete
  118. Thanks a lot for your reply doctor. I salute the service that you are doing. I feel so unlucky that I am in Los angeles instead of Monterey.
    I have some more questions doctor. I think you have read my earlier post regarding our pregnancy loss. My first question would be whether our HCG levels were normal or abnormal and how do they calculate pregnancy week for a frozen embryo transfer.
    Second question is since my wife uses Metformin I would like to know whether we need to stop Metformin the moment we get the HCG test positive. I have seen in an article that Metformin do cause spontaneous abortion.
    Third question would be I don't see any person on normal pregnancy using a progesterone suppository. Why do they advice it for a IVF or IUI patients alone?
    Fourth question and final one as of now :) would be how long your international patients stay in ur place for a IUI or IVF treatment. Thank you.

    ReplyDelete
  119. Hello Dr,
    i had 3 embryo transfer,on the 11 day i started bleeding that lasted for 8 day.am not sure if am still pregnant.

    ReplyDelete
  120. Hello Victor,

    Los Angeles is only a 1 hr flight or 6 hr drive from me. I have patients coming to me from Los Angeles, so if you want to come see me, you certainly can. In fact, I have had patients from all over the US and other countries. We have a program set up to make travel IVF easier.

    The only thing you can determine with HCG levels is the trend. You cannot interpret anything else, unlike other types of blood tests. Basically, HCG levels should rise a minimum of 80% every 48 hrs.

    LMP for a frozen cycle is a designated date and that is usually the day that the cycle is started. Using a pregnancy wheel, you could also calculate LMP by putting in the embryo transfer date as the probable date of conception. Gestational dating and age is not an exact thing. For that reason we call it an "estimated" date of confinement or due date.

    In terms of Metformin, if your wife takes it because she is a diabetic, then she would continue it. It is safe in pregnancy (category B). If she is taking it due to PCOD, then I usually will stop it when the pregnancy test is positive, mainly because she is no longer trying for pregnancy at that point.

    Progesterone hormone is required for implantation and sustenance of the pregnancy. In normal pregnancies, the body naturally produces this hormone so supplementation is not required. In artificial cycles like IVF, we add the progesterone to make sure there is adequate amounts and not rely solely on the natural progesterone. Inadequate progesterone is a cause of lack of implantation and miscarriage.

    Usually the minimum amount of time that a patient needs to be here for a fresh IVF cycle is 10 days.

    Good Luck

    ReplyDelete
  121. Hello Anonymous from Sept 9.

    You didn't ask a question. In this blog I have explained the possible causes of bleeding after embryo transfer. The exact causes cannot be known. In addition, bleeding doesn't necessarily mean that a miscarriage is occurring, because some will end up as continuing pregnancies, but it is a possibility as well. You will just have to wait and see what the outcome is.

    Good Luck,

    ReplyDelete
  122. Hello

    I had a 3 day embryo transfer on the 10th September and it was a top quality grade 1 embryo. I am on day 9 after ET and I started to bleed lightly yesterday and today it has become much heavier. I dont have any stomach cramps but it is heavy bleeding similar to a period. Do you think its all over? My clinic have said I can not do a test till Saturday the 24th September.

    I am loosing hope.

    ReplyDelete
  123. Dr. Ramirez,

    I performed IVF over the summer and transfered the 2 eggs on 08/25.
    About 1 week after transfer I had a normal heavy period.
    Although, my urine test at home was positive a week later.

    I went to the docotor and had a positive blood test with an hcg of 40.
    Two days later I had another blood test with an hcg of 134.

    About 4 days later I had another blood test that showed an hcg of 60.

    My doctor says I had a miscarriage.
    From your experience does the decrease in hcg mean no pregnancy?

    Thanks for all that you do!
    Amy

    ReplyDelete
  124. Hello Sept 19,

    I don't think "it is over" until I know for sure and that won't be until a pregnancy test is done. I know that is scheduled for tomorrow, but there is no reason why it can't be done sooner . . . like today.

    Good Luck.

    ReplyDelete
  125. Hello Sept 19th at 6:02 pm,

    The drop of bHCG is an indication that the pregnancy is no longer growing. That is called a chemical pregnancy and is a form of miscarriage.

    Sorry.

    ReplyDelete
  126. Hello Dr,

    i had 3 embryo transfer,on the 24 Aug,2011.on the 11th days of the transfer i had implantation bleeding for 9 days.i did blood test on the 7 sept which came out negative.
    again i did home pregnancy test on the 17 sept which shows positive and later start to have cramping for 3 days which make me to visit the clinic on the 24 sept.i did scan and the Dr said she saw something like baby scan or the remain of the blood that she is not sure i should repeat the scan next week.
    pls advice what to do cause i don't want to lose hope

    ReplyDelete
  127. Hello Sept 26th,

    This is very strange. If you had achieved pregnancy from your embryo transfer, then it should have been clearly positive by the 11th of September. The fact that the blood test was negative, means that a pregnancy was not achieved. Blood tests can detect a pregnancy as soon as 7 days after embryo transfer.

    I'm not sure why you did a home pregnancy test on the 17th but that fact that it was positive was strange and I certainly cannot explain it. It would be very unusual. Did your doctor confirm this with a blood pregnancy test? Is that why she decided to do an ultrasound? Is she continuing to check blood pregnancy tests to see what the level is and how it is progressing?

    I'm afraid that I can't give you any specific advice because I am not sure what is going on. I would have to review your medical records to be sure.

    Good Luck.

    ReplyDelete
  128. Hello We did IVF bc my husband had a vasectomy 17 yrs ago in 1994. We had two kids from a previous marriage and I had two kids as well. We found out that I needed a hysterectomy so we decided that we'd do IVF so that we could have a child together. I had a transfer of 4 embryos on Sept 18th and on the evening of the 29th I got light spotting but then it turned to bright red blood like a light period. It had a lot of clots too. I have fibroids as well. I did a test on today and it was negative. I may be delayed but not denyed! I am concerned bc I bleed heavy on my period and I have a lot of pain as well do to my fibroids so I don't believe this bleeding is a period. My concern is that I have no pain as I normally would. (I would normally take prescription meds for the pain but not during IVF cycle. I have morning sickness everyday for four days now and I have an odor with my period in which I do not have? My doc told me that he had only had one patient in 25 yrs practice who had a negative blood test but was actually pregnant. I may very well be the second lol. I'm staying positive as a Christian I have faith and getting depressed is not a sign of faith. I just can't explain the nausea and I know my body. I just wanted your opinion. Thanks!

    ReplyDelete
  129. If the pregnancy test was a blood pregnancy test and it was negative, then it is highly unlikely that you are pregnant. However, there are always exceptions to the rule so a simple answer would be to repeat the test.

    Good Luck.

    ReplyDelete
  130. Dr. Ramirez,
    Wondering what your thoughts are on the following situation:
    1. I have had multiple IVF failures over the last 2.5 years.
    2. I have never gotten pregnant and never started my period early after a transfer. I always went back for my blood/pregnancy test 14 days after the transfer only to get a negative test and my period soon after.
    3. I just had a frozen embryo transfer on 09/27 and am scheduled to go back for a pregnancy test on 10/11/11.
    4. On Friday, 10/7/11 I started a light period, which is not typical for my regular periods. It was light on Friday(barely needed a tampon). I didn't have cramping or numbness in my thighs that I normally feel with a period. I went to bed w/o a tampon and woke up fine on saturday(10/8/11). I have had on and off spots throughout Saturday. I am nervous. The bleeding is like small blood clots in a mucus texture.
    5. I took a pregnancy test today. It was negative. I am on vaginal progesterone.
    Bottom line: is there any chance I am pregnant or do you think starting g this type of bleeding 11 days after a FET is definitely a period?
    Also, I had three embryos transferred.
    Thoughts? Thanks.

    ReplyDelete
  131. Hello,

    The amount of bleeding is not an indicator of whether or not you are pregnant. As you've probably read on this topic in my blog, bleeding is very common in the early pregnancy, especially with IVF. The only definitive way to know if you are pregnant is to do a blood pregnancy test. Home tests are not necessarily conclusive because the levels have to read a certain threshold before they turn positive. You are only 13 days post transfer so it is possible that the levels may be to low as yet, but a blood pregnancy would be able to detect even the lowest levels. Instead of waiting until the 11th for the test, I would recommend that you call and see if you can do one today or tomorrow. I usually do my initial test at 8 days post transfer.

    Good Luck

    ReplyDelete
  132. Dr. Ramirez,
    Thank you so much for taking the time to reply. I have never bogged before, so I didn't really think I would hear something back. So, thank you for your time.
    I took another pregnancy test today. It was negative. I still have some noticeable bleeding today....but very very faint. I called the dr on call at my clinic this afternoon. It was a new fellow that was on call. He told me that it is highly likely that I am not pregnant with two negative pregnancy tests. However, he said that if the bleeding were my period, he would have expected it to be very heavy due to the fact that they had built my lining up prior tot he transfer. He too recommended I get a blood test tomorrow. My last and final question, however, is this.....if it isn't implantation bleeding.....what is it? Thanks again for your response. In the meantime, I am going to spend the next 24 hours praying. I keep thinking this will have to be a miracle if I'm pregnant, but clearly others have had bleeding and had a positive result. Thanks again

    ReplyDelete
  133. Hello again

    I agree that it is unlikely for you to be pregnant after two urine tests, but as mentioned previously, only the blood test is definitive. I cannot be sure what the bleeding is. It could be the onset of your menses or bleeding from the cervix due to progesterone or other possibilities. I am not able to make such a diagnosis on this venue. I know that by the time you read this reply, you will have done your test.

    Good Luck

    ReplyDelete
  134. I just failed my first IVF. I DO NOT have fertility issues, I had my tubes tied back in 12/2009 after I had my 2nd child....19 days later she passed away of SIDS. My husband and I decided that IVF would probably be easier then having the surgery to untie my tubes. The entire procedure went well until the transfer. I was on the OHSS protocol due to PCOS. I was on the hormone treatment for 15 days had my ER on Oct 3rd and we had 19 eggs, which dwindled down to 16 on day 2, so they froze half. On day 3 we had all 8 seeming to be high quality, they left them alone for day 4 and on day 5 we had a blastocyst...6 of the 8 survived and they had implanted 1 that was full blast and another that was Morula quality. During the transfer the "on call doctor" did not know anything about my case. She inserted a catheter and "couldn't get it through" as she did not know I had scarred tissue from my prior c-sections. She removed the original cath and tried a bigger one, but when she did that it pinched twice and I actually flinched. I honestly feel this doctor botched the procedure. I have 8 frozen embryos left, and I am a little nervous on continuing....do you have any advice or medical dialect to better my side of things when I discuss my concerns with my regular doctor. Thank you in advance for your help!! Eileen

    ReplyDelete
  135. Hello,

    I just failed my first ivf transfer. I have no fertility issues but had my tubes tied in 12/2009 after having my 2nd child. We have decided to try again because my daughter passed away of SIDS 19 days later. I feel the doctor botched the transfer. I was on the OHSS protocol because of PCOS. I had the ER on Oct 3rd and had 19 embryos, day 2 16 survived...1 was not viable and 2 didn't survive. They froze half, day 3 all 8 still survived. They decided to go to the day 5 blastocysts. When we went in for the transfer there were 6 left so we decided to implant 2, 1 full blast and 1 morula. When the doctor did the implant, she seemed to be unsure of what she was doing. It was not my usual doctor, but an on call physician. She did not know anything about my history, so when she originally inserted the catheter she could not get it through the scarred tissue from my past c-sections. She removed the original cath and used a bigger catheter. It actually caused pain, not severe a double pinch and I flinched. Then did a flush of my cervix to make sure the embryos didn't drag when removing the catheter. They had me lie down for 10 minutes then sent me home for 24hrs bed rest. They did a beta at day 9 and it was negative. I have a appointment with my doctor this coming week to review and discuss the next steps, which in my case would be FET. I was wondering your opinion of my assumption that it was actually a medical mistake, instead of the typical it just didn't attach. And if you have any suggestions on the dialect to use when talking to the doctor to see if they can fix their errors. I feel the doctor should have known my history, especially when I had a MET done with my original doctor, and they supposedly review each case the week of transfers to be familiar with each patient.

    ReplyDelete
  136. hallo doc
    i have spotting on day 8th of transfer .only light
    i am worried.
    i have also early pregnancy test today .it is also light postiv.but should i do

    ReplyDelete
  137. Hello Oct 23rd Anonymous,

    The doctor that I trained under once told me, that the embryo transfer is the most important step in this process. You can have the absolute best embryos but if you don't get them into the uterus properly, it will fail. That is what you experienced.

    Studies have documented that pregnancy rates vary even between doctors in the same group. This is mainly because of the embryo transfer technique. Did you know that new Reproductive Endocrinologists coming out of training have on average only having done 3-4 embryo transfers in their training? This is also a problem when you go to a large multi-doctor IVF center. Becuase they are often run like an assembly line, patients often will see different doctors with every step. The critical step is the transfer and this should be done by a doctor that knows you and has done a mock embryo transfer prior so that all the nuances of your endometrial canal are understood in advance.

    You are correct that the most likely reason for the failure was from the difficult embryo transfer. At this point you have two choices: (1) you can talk to the doctor that you have been working with and get a promise that he/she will do the transfer and not hand off to some unknown doc, or (2) you could move to a smaller clinic where you know that only one doctor will be taking care of you.

    Good Luck!

    ReplyDelete
  138. Hello Oct 25th Anonymous,

    As you have probably read in this blog, bleeding at this point is not necessarily indicative of anything. I usually will not worry unless the bleeding is heavy, but even then, I have had patients with successful pregnancies. My advice is to no worry unnecessarily at this point. All you can do is wait and see.

    Good Luck.

    ReplyDelete
  139. Hello Doc,
    Thanks for all of the information.
    This is my 1st IVF cos we realised that DH is azoospermic, we did ICSI with donor sperm when TESE didn't produce any sperm. We got 25 eggs,21 were mature,12 were fertilized and 9 made it to blastocyst. We transferred 2 beautiful hatching blastocyst on 29th Oct. Started vaginal progesterone 400mg daily on d day of the EC-24th Oct.I had a little pinkish spotting on the following day when I wiped after peeing, also little cramps sometimes. Now am 10dpt and am cramping like period pains and also spotting light brown.
    Question: what probably caused the spotting on the day following the transfer, I thought it was implantation bleeding since the blastocyst transferred was hatching already, so means implantation should be immediately. But wondering what is causing the bleeding 10dpt if implantation has already occurred. Or what's the probable cause of the 2 bleeding. My clinic told me to come fore a urine test on 14th Nov, asked why not blood, doc said urine at that time would be conclusive, blood tests are usually done on cases with issues. I took a HPT yesterday 9dpt which shows negative, but I believe it may be too early to be picked up by HPT. Thinking of going for a blood HCG on Sat, which would be 14dpt which would be certain result. But am worried about this spotting, not heavy,brownish red but it hasn't stopped for some hours now. Do I need to increase my progesterone suppository? Called my doc she said I should rest and shouldn't worry since its not heavy.
    Looking forward to your response.
    Thanks.
    Dammy

    ReplyDelete
  140. Hello Dammy,

    Sorry for the delay in getting back. I had a computer crash and had to get it fixed.

    I can't give you an explanation for the bleeding. It could be many causes. I think that your questions should be asked directly to your clinic because they are not things that I can adequately answer for you, such as why a urine vs blood and where your progesterone is adequate. I think you have to go with your doctor's advice since you are putting your trust in him or her.

    Good luck,

    ReplyDelete
  141. Hi Doc

    I went in for my embryo transfer this morning (doing DE for 1st time, shared cycle) and it was cancelled due to bleeding in the uterus and now my period has started. I do have frozen blasts to work with for a FET hopefully next month, but was very upset nonetheless. My periods have always been irregular all my life, but this is ridiculous. I took the last birth control bill on 10/26 to start synchronizing with the donor and other receipent, and started the 10 units of Lupron every day for 14 days. On 10/30, I started the Vivelle Dot 0.1 patches and was increased to 4 patches (taking them every other day, 1 then 2 then 3 then up to 4 a day). On 11/11 I had a ultrasound and labs and both were normal. I started the progesterone oil injections that day at 1 cc (50mg) and increased it to 2 cc on 11/14. Donor had her retrieval on 11/12 and everything was fine with that. I am wondering if the protocol was incorrect, as I should have NOT gotten a period, especially as the embryo transfer was beginning. Do you have any suggestions I can speak to my RE with about what to do? They have prescribed Provera for me to start taking to regulate my cycle, and will find out when to start that. Thanks for posting, as I think that is wonderful you are giving advice to us on these difficult topics.

    ReplyDelete
  142. Hello,

    I am presuming that you continued the estrogen after starting the progesterone or did you stop? If you were on both estrogen and progesterone, there should not have been any bleeding, unless there were some other source such as a polyp or uterine fibroid. I presume you had a hysteroscopy or hysterosonogram before the cycle to confirm that the cavity was free and clear? Overall the protocol seems fine (there are many ways to accomplish the same thing) unless you stopped the estrogen patches. If you did that, then it would explain why there was endometrial shedding at that time (bleeding). It would be best for you to go over this cycle with your RE.

    Good Luck.

    ReplyDelete
  143. I was on the estrogen (vivelle dot patches) thru when I had the transfer and was on it with the progesterone shots. I did have an HSG that showed everything was free and clear. I read on other forums that the estrogen did not completely shut down some other women's cycle, so my doctor will be adjusting it for this upcoming frozen cycle. I start the Provera this Thursday for 5 days and hope to have another transfer before Christmas. Thanks Doc.

    ReplyDelete
  144. Hello,
    I did a day 3 transfer on November 16th with 2 - 8cell embryos grades 2&3 (1 being best 5 being worst)
    I am also on progesterone (50ml) once per day. I took a pregnancy test last night for the heck of it (only 6days past day 3t) and got a negative.

    I am having period like symptoms, I am bloated..cramping EXACTLY like when my period is about to start. Nothing at all different then if I were to start my period.

    With the negative test and period symptoms ...do you think I could still be pregnant??

    Also we found out none of our other eggs made it to freeze, which has me worried about the two in me if they can/will implant. Please help!!

    ReplyDelete
  145. Hi Doctor Ramirez,

    I need thank you for this post. I am in the second IVF. I am 29 years old. In this cycle, my physician used Femara, and I got 10 ovocites. He placed two embryos of 5 days and not used estrogen, only progesterone vaginal (Utrogestran - 300 mg per day). I am in the D10 after IVF and I will do the serum HCG test today. I was with the brown spotting since yesterday (like the same way of the first negative IVF) and because of this I was getting really sad. You give me hope. Thank you. (Sorry for my english, I am brazilian.)

    ReplyDelete
  146. Hello Dr. Ramirez,
    I appreciate you taking the time to answer all these questions. I have read through them and learned quite a bit.
    I am 32yo, my husband is 35yo. We have no explanation of why we have been unable to conceive but have been trying for four years. We did three IUIs and now one IVF. We were able to harvest 20 eggs, 14 fertilized but by day three they were all fairly fragmented. They transferred a 5cell, a 6cell and a 7 cell. They were unable to freeze the rest. Eight days post transfer my beta was 11 and I had a small amount of cramping and bleeding. My 10-day beta (11/25) was 48 and I had a large amount of cramping and bleeding. The nurse just said to take one extra dose of crinone and stay quiet for a couple days. I definetely feel that all is lost as I've bled heavily with lots of tissue and clots.
    When I asked if I should call with any other concerns through the weekend they said no, just keep taking the crinone once a day and rest--repeat a beta on Monday. I do have some doubts with the clinic I've used and had a couple questions for you.
    I imagine our factor based on our embryos is either egg or sperm...and since the sperm have all looked good I'm guessing egg. Would you recommend trying egg donor with the next cycle as opposed to trying another fresh IVF cycle?
    Also, with this heavy of cramping and bleeding is it appropriate to continue bedrest and crinone? I'm obviously very tempted to stop it all and move on.
    Any thoughts you have to provide are greatly appreciated.
    -cs-

    ReplyDelete
  147. Hi Doc,

    Please help im so worried, i had a 5 day Blast embryo transfer 7 days ago. Last night i was struck down with very severe menstrual like cramps and also light brown, redish bleeding, its not heavy but its still enough to have to wear a panty liner. Im so worried does this mean i have lost the embryo?...i also noticed it started to happen right after i pulled out the crinone tube and found blood and sort brown bits of blood or maybe my embryo? please help im so upset right now :(

    ReplyDelete
  148. Sorry Doc i also wanted to mention that when i was struck with the severe cramps last night that i put a heat pack on my tummy for about 5 mins, but i have since read that if i was still pregnant that would be harmful to the embryo, is this true? i didnt have it on for long at all :(

    ReplyDelete
  149. Hello Jenn,

    I am sorry for the delay in getting back to you. Probably by now, you have had a blood pregnancy test so you know the answer to your question. If you have not yet had a pregnancy test, it has certainly been long enough and you should have one done. The period symptoms are not necessarily related to starting a period. Sometimes an early pregnancy can cause some light cramping and the progesterone can give the symptoms of feeling like a period is starting.

    Good Luck.

    ReplyDelete
  150. Hello Nov 26 Anonymous,

    My recommendation would be to double up on the Crinone and wait and see how things turn out. All is not lost yet. It is only ended when it ends. If the bHCG's start dropping, then you know that it is ended.

    In terms of the egg quality, it certainly can be egg or sperm OR lab. At your age, I am surprised at the poor embryo quality and lab would be my first concern. Remeber, pregnancy rates are highly dependent on the laboratory quality. Before I would recommend moving to donor eggs, I would try at least two more tries with your own eggs. Whether you continue in your current clinic or move to a different one, is up to you. You could always come to California. It is cheaper than using Donor eggs and I can attest that my lab is very very good with our cumulative under 35 pregnancy rates running at 75% and 59% continuing.

    Good Luck.

    ReplyDelete
  151. Hello Again Nov 26 Anonymous,

    I also meant to mention that you need to keep in mind that you have ACHIEVED a pregnancy, which is all that IVF can do for you. Whether the pregnancy ends or continues is totally dependent on the pregnancy itself. It is not a consequence of IVF. IVF ONLY gives one the opportunity to become pregnant, because after the embryos are trensfered, it is a natural process again that is in God's hands. You've now shown that it can work! If this one fails, then all you need to look forward to is the cycle where you have the perfect embryo to make a baby. That is a BIG accomplishment. You no longer need to worry that you won't ever become pregnant. Now, it is all just a matter of time.

    Good Luck.

    ReplyDelete
  152. Hello Nov 27 Anonymous,

    Slight bleeding and cramping do not necessarily mean that all is lost. It could be the result of an early pregnancy and the bleeding could also be from the Crinone, as I've explained in this blog. Do not worry at this point. By now you should be ready for a pregnancy test, so I hope all goes well.

    Good Luck

    ReplyDelete
  153. Hello again Nov 27 Anonymous,

    Hot pad on your tummy will not affect the pregnancy so there is no need to worry.

    ReplyDelete
  154. Hi doc i just had my 2nd cycle on IVF the first one didnt work i had my egg transfer 4 days ago i am using crinone vaginal gel i am having a cramps and pain in my lower back its like a period pain,what is this mean?am i having my period?i am really worried cos we havent got frozen embryo left and i told my husband this will be the last cos we havent got any budget for another cycle pls help me i want to know if the pain is normal or abnormal so atlis we wnt put our hopes up anymore thanks doc

    ReplyDelete
  155. Dear Dr.

    Thank you for being so patient and answering all these questions, I hope you don't mind answering one for me? I'm the UK and the standard here for progesterone support in IVF seems to be suppositories, injectible progesterone is extremely difficult to get hold of. I've recently failed an IVF cycle where up until 9 days past 5 day transfer I had a lot of what I thought were side effects from the progesterone suppositories (it drove me mad as the side effects of progesterone are the same as early pregnancy symptoms pretty much) then on the 9th day everything went away, although I still continued taking the progesterone as prescribed.Later that evening I began to bleed.On the 11th Day I tested negative and stopped the progesterone but by this time I'd been bleeding heavily for two days anyway.I think perhaps I may not have been absorbing the progesterone properly because it doesn't seem to have done anything to delay or prevent my bleeding at all, it started on the exact day as it would have done had I had a natural cycle. Also, the "side effects" I felt were the same as those I have with a natural cycle which also stop abrubptly and then bleeding begins a day or two later. Sorry for the length of the post, but the progesterone not seeming to have worked is troubling me as I know pregnancy is impossible without progesterone support. Have you had patients who've experienced this and what did you do for them?

    ReplyDelete
  156. Hi,

    The symptoms you are having are non-specific. It may not mean anything, but sometimes patients will have sypmtoms which have been designated as "implantation" pain. Also, It may just be a reaction of your uterus to the progesterone or pregnancy. It is difficult to know for sure. I advise my patients not to worry about it. All you can do is wait and see what the pregnancy test shows.

    And don't ever give up! I had a patient that did several IVF's in her 40's and then in her 50's decided to try again and now she has a beautiful daughter!

    Good Luck

    ReplyDelete
  157. Hello Dec 7th Anonymous,

    As you can see from this point, variying types of bleeding occur after embryo transfer and before the pregnancy test is done. In some cases, it can be due to the onset of a period, but usually, if there is adequate progesterone support, the bleed will not occur until the progesterone is withdrawn.

    From your description, it does sound like you had the spontaneous onset of your period, which would indicate that the progesterone supplementation was inadequate. Without knowing how much you were prescribed, I can't give you specific recommendations on how to increase, but with vaginal support only, I have my patients taking it three times per day (Endometrin 100mg).

    Injectable progesterone should be readily available, if not in the pharmacies, then by mail order. Also, pharmacies can formulate injectable progesterone in oil. However, the oil they tend to use is usually too thick and causes the injection to hurt more. The pharmacy I use has formulated it with oleate, which is thinner and so a smaller needle can be used for the injection. The pharmacy I use is called MDR Pharmacy out of Los Angeles. You can look up their website.

    Good Luck

    ReplyDelete
  158. I had a 5 day transfer and the doctor said that these two eggs were only 12 hours away from the blastocyst stage.

    Also on day 6 I went for a blood test and it looks that my estogen was below normal so now I am taking estrogen pills.

    Please tell me if my eggs were to lazy to reach the blastocist stage is a bad sign and also if a lower that normal estrogen is also a sign that things don't work well.

    ReplyDelete
  159. Dear Dr.
    I am 35 and my husband is 38. He has low sperm count aswell as morphology and motlity. So we did ICSI.

    On first cycle i produced Six eggs on 150 Gonal. 3 fertilised normally
    on day 3 RE said they were all "very good quality", so took to day five. On day five, only one had progressed to early blast stage and was put inside me. I was on 400mg of cyclogest twice a day. On day nine i bleeded. My period came. It was failed cycle.

    Second cycle (now) we changed clinics. We found my AMH was only 4:95. Dr gave me double dose of 300 menopur and then 375 after six days. I produced 9 eggs, 8 were mature and 5 fertilised. By day 3, 3 of the eggs were "beautiful 8 cells" and again clinic took to day five. On day of transfer, again only one was morula and others arrested. The morula was put back inside me dec 8th. I am 400mg twice daily of cyclogest pessarie and a 1ml injection of progstine every other day. (as last time i bled too early)

    I am currently 9dpet. On day of egg transfer to day five i had cramping, sore boobs, nausea, tired. Then after day five, all symptoms have just dissapeared, just mild soreness of boobs and mild nausea.

    My questions are:
    - why are our embryos very good and beautiful at day 3 and then arresting from day 3-5? Is this a sperm issue do you think? Husband had a karotype done, it was normal.
    - do you have experience in morula's making it to pregnancy?
    - do you think we should go for a day three transfer next time?
    - why did all symptoms dissapear ater five days of egg transfer?

    I thank you for your patience and giving us opportunity to ask an expert questions in our time of need.

    Best wishes,

    Shyam

    ReplyDelete
  160. hi, i've just done my 2 week wait after having 2 frozen embryos implanted. i done a hpt and it came up positive. i was just wanderin, if only 1 of the embryos catch's wot happens to the other. do you have a bleed? i'm asking cause i wanted to know if i had a chance of twins.

    ReplyDelete
  161. Hello Shyam,

    I am very concerned about the lack of development of your embryos to blastocyst. Of course it could be due to an inherent embryo problem, which is influenced by your age, but the other worry (one that I think might be more important) is the quality of the lab. That is whether the lab has a good track record of culturing to blast. For a short while, I too tried taking more of my patients to blast, but like you saw a large number of very good looking embryos not develop. Since then, I have heard several lectures stating that is quite common, probably because of lab conditions, culture media, etc. So now, I use mainly day#3 embryos and only culture when I have 8 or more 8cgrade1 embryos. Due to the limited number of embryos you have at day#3, I would suggest that you transfer at that time in future IVF cycles.

    Sometimes, although they are dividing slowly, it can progress within the uterus and lead to a pregnancy.

    I cannot explain the change in symptoms. They are too variable to determine exactly what is occurring. Sometimes patients will have the same symptoms as you and be pregnant, whereas other will not. I wonder if there is a psychological component, but there is not way to determine for sure.

    Good Luck

    ReplyDelete
  162. Hello Sarahlee,

    If only one of the two embryos implant, then the second embryo would have stopped growing and wilted away or be absorbed. It will not cause a bleed.

    Congratulations,

    ReplyDelete
  163. Hi Dr,
    I had a failed ICSI cyle, my cycle started on the usual 27 day. I have now started bleeding again, on day 16. I have been bleeding for 7 days. Should I be concerned or is it normal to have really irregular cycles after an IVF/ICSI cycle due to the hormones used during these cycles?
    Thanks
    Catherine

    ReplyDelete
  164. Dear Dr Ramirez,

    I was wondering if u could please offer some advice.

    I am a 28 yr old (diagnosed with 'slight' PCOS on US) married to 31 year old(diagnosed with teratozospermia; 3% normal)

    in april 2011 we had icsi which led to a chemical pregnancy. no frozen eggs.

    since then we have had another go(oct 2011) collected 31 eggs, 24 mature, 12 fertilized, 8 viable embryos(5days).

    i had 2 excellent blastocysts transferred on 14th jan -(2months after collection due to OHSS), i was on progynova and cyclogest pessaries. i passed some dark brown/black blood yesterday morning eg 6dpt (half a pad got dirty), later i noticed v dark clots on wiping, but pads remained clean. after speaking to the clinic i have started taking oral progesterone as well, and am taking complete bedrest. serum beta hcg is to b tested on the 24th of jan (3days away). no bleeding today.

    please would u explain y the blood was so dark?it was never red or heavy like a proper period. do i still have hope with this transfer? i would b very grateful for ur advice. please help me.

    ReplyDelete
  165. Hello Jan 19,

    It is not normal to have an irregular cycle or abnormal bleeding after an IVF cycle. If you are pregnant, then sometimes that can occur, but if you are not pregnant, then you should return to your normal cycle.

    Good Luck

    ReplyDelete
  166. Hello Jan 21,

    It is obvious to me that you are in a foreign country and the protocols are certainly different from the U.S. For instance, studies have shown that oral progesterone is ineffective because most is lost in the liver. In addition the medications you have used, cyclogest and progynova, are medications that are not used in the U.S. The recommended method for progesterone supplementation in IVF is either by injection or vaginally.

    Since I do not use these particular medications, I cannot give a wholely reliable or secure answer to you. However, I will give an answer that is in general. Since you have been on the progesterone pessaries (cyclogest), it has been shown that vaignal progesterone can lead to friability of the cervix and cause some spotting or bleeding. This is a very common finding and has no influence on your outcome.

    Good Luck

    ReplyDelete
  167. Dear Dr Ramirez,

    I am very grateful for your reply. Thank you very much :) Unfortunately for us, the serum beta hcg was only 5.5... which i'm sure isnt great news(10dpt). we're hoping to try again next month.

    I think its really wonderful how u manage to give time to this blog. May God bless u with his infinite blessings for your hard work and generosity.

    Jan 21

    ReplyDelete
  168. Dear Jan 24,

    I would not give up yet. 5.5 is a positive so I would recommend that you repeat the test in 48 hrs. If it continues going up then continue to check it every 48 hrs. I have had patient that started at a lw number, and even negative, with the first test that went on to have a normal and successful pregnancy. Of course, more of them had a chemical pregnancy but you don't know until you follow the tests.

    At a minimum, you had a positive so that means it will just be a matter of time before you have a perfect one.

    Good Luck.

    ReplyDelete
  169. My wife had three 5 day expanded blasts transfered on Jan. 13th 6dpt she started bleeding. They did a beta and it was 25.5. The bleeding continued for 5 days. They weren't sure what caused the bleeding so they continued betas. They were as follows. 6dpt-25.5 8dpt-69, 10dpt-116, 12dpt-140. We are wondering if it's viable with only a 20% increase? They said 50% chance it is viable, and that the reason for the slow down in hcg could be due to the fact that one or two of the embryos could have implanted and then she lost one or two when she had her bleed and maybe one embryo still remains.

    This is our second IVF/ICIS-fresh transfer and both have had early bleeding. We also did two FETs and she was on PIO shotS and there was no bleeding. Our concern is that they didn't monitor the progesterone. When we asked for those levels on 6dpt they were only 6.2. They had her on 8% crinone once a day, which I guess can't be measured in the blood stream. They added the PIO at our request. We are 29 years old and they say our embryos are some of the best they've seen.

    ReplyDelete
  170. I am 11DPT and was told our Beta was negative. I did everything correctly and my lining and labs have all been great. I have had crammping the first week after the transfer which I assumed were signs of implantation. I have spotted a couple of times. I'm on vaginal estrace and IM progesterone. I am having hard time believing that I'm not pregnant. I have even been having some onset of fatigue during day which have been my previous signs of pregnancy. Is there any possibility that they could be wrong or just too early for beta to rise???

    ReplyDelete
  171. Dear Dr Ramirez,
    I was hoping you could give me some advice, I'm a 26 year woman and this is my first IVF cycle. I live in the UK I am now 7 days past a 5 day transfer ( 2 embryo's transferred) yesterday I experienced some cramping in my stomach and lower back and had some slight spotting, only when I wiped. I was very upset by this and phone my consultant on call he increased my progesterone to x 3 daily ( was x2 daily 400mg ) after the call I decided to take a pregnancy test and it came back negative I was extremely upset by this, I'm hoping that maybe I tested to soon? And if there is still hope? I'm due to take my " planned" pregnancy test this coming Friday. I would be grateful if you could help me with my dilemma.

    ReplyDelete
  172. Hello Jan 28,

    By 11 days post transfer the bHCG should have been positive. I usually do my first pregnancy test at 8-9 days. Even if there is late implantation and the first test is negative, the second one is positive. Sorry.

    ReplyDelete
  173. Dear Dr. Ramirez,

    I have a fibro and did the embrolization procedure 5 or 6 years ago. I will be turning 35 by May, weight 105 lbs, and 5'1" height. I have done two times of the stimulation method, one insimulation, and I am now on my 10th day post of IVF transfer. I have been having some minor cramping and today I see very light brown discharge. I snuck a home pregnancy test on day 7 after the IVF and it shows negative. I am worry my blood test tomorrow would be negative. If so, I don't plan on giving up yet but will have some disappointment. My question are what's the successful rate or chances for patient with similar situation? Is pregnancy possible for my situation? What can I do to increase my chances and how can prevent miscarriage if the IVF shows positive?
    Thanks for spending the time responding all our questions and you advices.

    ReplyDelete
  174. Helo Dr, Im 26 yr old and have good ovary and eggs.
    My 1st & 2nd IVF attempt end up with ectopic. It bleeding within 14days. I have frozen embryo with 4cell and 5cell. Do you think i should 3rd attempt with frozen cycle or fresh cycle?

    ReplyDelete
  175. Dr. Ramirez,
    I'm at a loss. I'm 34 years old and have a 3 year old daughter that was conceived through my first IVF attempt. We are now trying for baby #2 and have had three transfers (1 fresh and two frozen) that have not been succesful. I develop blood clots. What would you recommend my next step to be?

    ReplyDelete
  176. Hello Feb 7,

    The symptoms you have had are not predictive of anything. It can go either way. Therefore, there is no statistic that I can quote. I can't give you recommendations regarding your IVF cycle without review of your medical records. Since IVF is not a perfect technology, you have to keep trying. You will eventually be successful.

    ReplyDelete
    Replies
    1. Hi Dr R! I've learnt a lot through reading all your responses! I'm 27 years old, day 6 post 5 day blastocyst transfer and this morning I had some brown spotting but only slight - after going for a walk/light jog (I was running 30-50km week prior to transfer as I'm in a running club) but I've stopped almost all exercise to ensure my best chances. I see that this can be normal but I did a urine test after lunch today and it was negative (devestated!) but my blood test is not until next Thursday (14 days after tf). Could this be too early for a urine test? The reason I need IVF is due to my pituitary gland not functioning correctly and I don't get a period at all (previous anorexia as a teenager which was severe) I have a normal body weight now and have done so for 7 years. I am on progesterone 400mg/day plus oestridol three times a day. Is there still hope?!!

      Delete
  177. Dear Doctor,
    I had 3 failed IVF/ICCSI for the past 3-4 years. I am 39 now, I have done a donor egg IVF/ICCSI transfer on 04th of February 2012, and bleeding started on 09th night, started with a brown clot and then red bleeding also came, we immediately rushed to hospital and doctor scanned and taken progesterone injection and 1 proluton depot injection also, he asked me to stop asprin tab and continue with progesterone tab and estradiol valerate tablets. Even after the injections the bleeding was continued and like my periods and still coming( now its not heavy but some leaks , yesterday it was like almost black clour blood with some clots, I am sure it is 100% gone, But my doubt is why should I again continue the medicines until my B-hcg result comes? My hormone levels were very good and my uterus lining was also excellent and why early bleeding has come even after all medicinal support? Is it my body rejecting the embryos? This time 04 embryo’s were transferred? Even after the bleeding is there any chance to survive even one embryo in the womb? Doctor please advise me!

    ReplyDelete
  178. Hello JL,

    There is certainly a possibility for frozen embryo transfers to result in a successful pregnancy, but the embryos you have frozen are not very good. In my clinic, and most clinics, we do not freeze CD#3 embryos that are less than 6 cells. If it does not cost too much, then I think I would recommend the frozen transfer cycle first, just in case it works. But, considering the poor quality of the embryos, you probably will need to do another fresh cycle.

    By the way, ectopic pregnancies with IVF is a rather rare occurrence. I am suprised that it occurred to you twice. If that diagnosis is correct, you might want to have your tubes sealed off before attempting IVF again.

    Good Luck

    ReplyDelete
  179. Hello February 13th,

    It's hard for me to make recommendations without a full review of your medical records. There can be any number of reasons why you would have failed.

    Sorry that I can't advise you more.

    Good Luck

    ReplyDelete
  180. Hello February 15th 03:17,

    It could be too early for a urine pregnancy test. You need to do the blood test and that can be done at any time now. If you're worried, ask your doctor for the test sooner.

    There is ALWAYS hope.

    Good Luck

    ReplyDelete
  181. Hello Feb 15th 06:58,

    I cannot answer some of your questions but until you have a blood pregnancy test, you cannot know what the fate of this pregnancy is. Yes, it could be that the bleeding is your period, but I have seen enough cases where bleeding occurred, including in my wife's IVF cycle, to think that bleeding does not necessarily mean that the pregnancy is lost. God will make a way when thre seems to be no way. If not in this cycle, then in another.

    Good Luck

    ReplyDelete
  182. Hi Dr. Ramirez. I'm 44 and on day 10 after using donor eggs for IVF. We transferred x2 8 cell embryos. Had cramping day 3. Had what has felt like menstrual cramps pretty consistently from day 5 on along with just the usual premenstrual type symptoms. Had light spotting (dark brown) but very very faint last night. Wondering what your thoughts are? I have my blood test on Monday morning. Thank you for your time.

    ReplyDelete
  183. Dr Ramirez, ThankQ for your advice & suggestion.
    Yes my diagnosis is confirm Ectopic. 1st on Left side & 2nd on Right Side. Thankyou Dr. From JL

    ReplyDelete
  184. Hello Feb 18,

    The symptoms you have are non-specific and very common. They can indicate that the cycle will go either way: positive or negative. There is not way to know. The only way to know is to wait for the blood pregnancy test. For now, I would recommend that you keep up your hopes, with some reservation since IVF is not a perfect technology.

    Good Luck

    ReplyDelete
  185. Hello Dr. Ramirez,
    This is my first time writing. I have had 2 Frozen embrios transfered on Jan 25 2012. After 10 days my test came out positive with 200 hcg, I went back 3 days later and it was at 500. I'm now 6 weeks according to the ultrasound done on Feb 15 the sack look fine according to the clinic. But today Feb 20 I was laying down and I feel blood rushing down my leg. I got up and endeed I was bleeded and it was red with cloths, I had to change pads almost every 3 hours, it's now night time and the bleeding has slow down about 60 percent but it's still bright red, I was having very light cramping. I have been taken endometrium suppositories 3 per day, 1 estradiol per day, and one progesterone injection 1 ml. per day. Please help me and give me your opinion. Thank you so much Dr. Ramirez.

    ReplyDelete
  186. Hello, I am 9 days post FET and had my first beta today which was 9. I then noticed a small amount of brown spotting this morning when I wiped. Is it still possible for my numbers to go up?

    ReplyDelete
  187. Hello Feb 20th,

    Sorry for the delay in my response. The amount of bleeding you have had is worrisone. I would be worried that you have undergone a miscarriage, however, that is not definite. The best way to proceed is to see you doctor right away, if you haven't already, and have another ultrasound done to see the status of the pregnancy. Was there fetal heart motion at your first ultrsound? Heart motion should be visible by now.

    My wife similarly, had a fairly heavy bleed in about the same time after her IVF. I was convinced that she had a miscarriage. I did an immediate ultrasound and found that the pregnancy was still there and doing well. Long story short, my daughter was born just fine and is a healthy soon to be 15 year old.

    Only God knows what's going to happen. Keep up your faith and hope for the best.

    Good Luck

    ReplyDelete
  188. Hello Dr Ramirez,

    I am 38 years old, have both tubes occluded and because of that my only hope to become pregnant is IVF. Also I have a cyst on my right ovari( around 35mm). I was on dipherelin(1 per day) and Menopure(3 per day) stimulation and during that time my ovarian cyst stayed the same size. from this cycle I had 4 follicules and 4 eggs and all 4 were fertillized by ICSI.0n 13th of January I had ET and it was done with three 3day embrios.I was on Utrogestan 3x200mg vaginaly. On 3rd day after ET I had a very strong stabing pain in my lower abdomen and in my back. After that everything was ok, I had light cramping and tenderness in my breast. On day 10 after ET small pinkish bleeding appeared on my towell. I was told by my doctor to start taking utrogestan orraly and 4x200mg. But next day bleeding was heavier and looked like period. And eventauly it was period and my HCG was 4. Unfortunately it ended like this. Could You tell me what, by Your oppinion, went wrong? Thank You for Your time!

    ReplyDelete
  189. Hello Dr Ramirez,
    I am 38 years old and the reason for me going to IVF program is that both my tubes are occluded. Also for 9 months I have ovarian cyst on my right ovary (around 35mm). I’ve started cycle with contraceptives and then with diphereline (1 per day) and menopure (3 per day). I have produced 4 eggs (only on my left ovary, right did not react to stimulation) and they were all successfully fertilized with ICSI procedure. On 13th of February I had ET with 3day embryos (3 were transferred). On the second day post ET I had sharp, stubbing pain in my lower abdomen and my back and it lasted around 10 min. After that everything was ok, I had light cramps and tenderness in my breasts. Two times I had shivering and feeling cold and it lasted for about two hours but I had normal body temperature. On my 10th day after transfer I’ve notices small amount of pinkish blood on my towel. I called my doctor and he advised me to take Progesterone orally (until that day I was taking progesterone vaginaly 3x200mg, from the day of aspiration) and to take it 4x200mg. Next morning bleeding was red and heavier and looked like period. And, unfortunately it was period. My HCG was 4. Could You please tell me, by Your opinion, what went wrong? Did my symptoms have any meaning? Did they point that I should take some other drugs? I am asking all these questions so I’d now for next time. Thank You for Your time.
    Sincerely,
    Eya

    ReplyDelete
  190. Hello Dr.,
    I had 1 baby from 1st marriage with 2 abortions. Now its my second marriage and I am 37 and my husband is 35 , his ex also got pregnant earlier but got the MTP. Now we have tried 3 IUI's , its the 1st IVF cycle, I just got the little white and brownish discharge on the tissue paper while cleaning on the day after ET, also got little itching in the vagina, so I am really worried as I am on Progrestretone injections and medicines and also there were 2 good quality embroyos were transferred. Please suggest when sould I check the pregnancy test as its my 4th day today after ET

    ReplyDelete
  191. Dear doctor,

    Thank you very much for your kindness and patience when answering the questions. While reading through the blog I have learnt a lot.
    I believe that I just had a failed Ivf cycle. Really sad now feeling that I will never have a baby ... I am 39 years old and husband is 41 years. This is our first cycle. We are in Sweden.
    Feburary 29, at day 3, two 10 cells embryos had been transferred. The clinic did not tell me what grade of the embryos are. They mentioned that they were normal but not perfect because they could not see nuclues. After transferring, I went to work because my clinic told me it was ok to have daily work in office. I was suffering from the ovulation stimulation for the first 2 days. Then I had very strong pain in my belly one evening I think it was 4 days after ET. Then, In the following days, I felt very tired and all the other early pregancy symptoms. Day 11, the symptoms suddenly disappeared. At the night I started bleeding lightly. The second day, I did home urine testing on day 12 after EF there was a faint test line. Now bleeding is much heavier and with cramps sometimes. I am going to do another test tomorrow but I think it will be nothing...
    What I am asking now what could probably went wrong?
    1. Embryo quality? What does it mean 10 cell embryo with invisible nuclear? What grade it could be?
    2. Do I need to stay in bed after ET for 48 hours?
    3. Is it normal to have such strong pain after ET?
    4. Do you think it is possible that implantation did happen but some how I lost it? The reason why I am suspecting this case is because of the faint positive line in the tester.
    5. I will start another IVF cycle. Minimally how many days are needed in between ivf cycles.
    6. For the second cycle what I should be more careful comparing to the first one?

    Thanks a lot again.
    3. Is it normal to have such strong cramps after EF?
    4.

    ReplyDelete
  192. Hello Feb 29th,

    Brown spotting is old blood and is not necessarily indicative of anything. It is a common occurrence with IVF. If you are using vaginal progesterone, it could be the cause. In general, I don't worry about bleeding unless it is as much as a period. By now, hopefully you have good news.

    Good Luck

    ReplyDelete
  193. Hello March 1,

    I cannot tell you what went wrong. That is not possible. It is not related to the spotting that you had. At your age, you are at high risk for abnormal eggs leading to abnormal embryos. The most common reason for IVF failure or loss in your age group is due to abnormal embryos. With a bHCG of 4, we would call that a positive, and would be evidence that implantation took place. In that case, the pregnancy stopped because it was abnormal.

    You need to bear in mind that you are trying to overcome the disadvantage of age, which means more debilitated eggs. IVF increases your chances by getting lots of eggs out but it cannot change the quality of eggs. So, you need to be prepared for it to fail, for miscarriages to occur and for it to take several tries. The only other recommendation I can make is to have your doctor increase your stimulation so that you can get more eggs to work with. If you have more eggs, you have a higher chance of finding a good one.

    Good Luck

    ReplyDelete
  194. Hello Mar 2nd,

    The earliest you can check a pregnancy test is 7 days after your transfer. Sooner than that would be too soon.

    Good Luck

    ReplyDelete
  195. Hello Clare73,

    1. "Embryo quality" is actually a description of the embryo. We do not have the technology to know the true quality of the embryo which is located internally in sub-microscopic structures such as the chromosomes. Because of this, we give it a "grade" based on how it looks. There are several grading systems, which would be too extensive to put here. If an embryo has no nucleus, it is completely abnormal. It should not have been transferred. Embryos have to have a nucleus. It is what houses the chromosomes of the embryo. An "anucleic" embryo is a nonviable embryo.
    2. Studies have shown that staying in bed does not necessarily increase pregnancy rates. Keep in mind that when a couple is trying for a baby naturally, the woman does not stay in bed. However, that being said, I do caution my patients to only do light activity which includes no lifting, runing, exercise, intercourse, etc. After the transfer of a D#3 embryo, it will take another 4 days for implantation to occur.
    3. I am not sure of the cause of the pain and it is not a usual symptoms after ET.
    4. Given the light positive test and pregnancy symptoms, it is possible that implantation occurred. I usually do the pregnancy test at 8 days after the transfer and at that time, we can detect an early pregnancy. In your case, if it were positive, it would have been called a "chemical pregnancy" because it did not continue to develop.
    5. In general, you should wait at least one month before starting another IVF cycle.
    6. There is nothing that you necessarily need to be "careful" about, as I explained earlier. Keep in mind, however, that IVF is not a perfect technology and is still dependent on some natural processes such as the inherent quality of your eggs. At your age, the number of normal eggs are limited and the goal is to get enough eggs out with the hope that one good egg will be present in the group. For that reason, you need to be prepared for failing, miscarriages and having to try multiple times. If you are persistent, IVF still will give you the best chances for pregnancy and you will eventually become pregnant.

    Good Luck

    ReplyDelete
  196. Dr. Ramirez
    I am 25 years old and my husband is 28 years old.  I have no health problems and no fertility issues that we have encounted thus far in our journey with infertility.  My husband however has been diagnoised with severe male infertility due to very low sperm count and low motility.  We were told that due to such low sperm count, IVF would be out only hope for conception.  We recently started our first IVF cycle.  Our Dr. had told us that due to my young age and good bill of health our chances for success were very high.  He had me do 2 weeks and birth control then start Lupron injection.  For stimulation we did 3 bravelle and 1 menopur injections up until our tigger shot.  Our trigger shot was 4 units of HCG.  At out ER out Dr. was able to retrieve 11 eggs.  Of the 11 eggs only 9 were mature enough to have ICSI performed.  Out of those 9 only 2 matured into blastocysts.  We were very suprised and disapointed in how low our embryo count was.  We did a 5 day transfer and chose to transfer both blastocysts but walked away from the transfer feeling pretty negative.  During the transfer I wasnt able to see the catheter or the embryo being placed into my uterus.  Post transfer our Dr. had me insert 1 crinone insert at nighttime. The morning of 5dpt I woke up to very heavy bleeding which has proven to be my menstrual cycle (more than a 10 days early).  7dpt I took a blood HCG which resulted in a negative.  We are feeling pretty confused and let down from our experience with our first IVF cycle and I have so many questions and concerns.
    1.  Could the cause of my early menstration be due to low progesterone?  And could low progesterone be the cause of a failed cycle?
    2.  Does our low embryo count seem to be cause for concern in future cycles?  Could more stimulation meds fix this or could this be due poor egg quality? What could be the cause of such low maturity rate resulting in no embryos left over to freeze?
    3. Is there any thing that we could have or need to be doing differently in our next IVF cycle? Are the question or concerns that we should be discussing with our IVF Dr? Should we feel cheated like we didn't get as good of results as was expected?
    Thank you so much for such a great blog and such great insight!

    ReplyDelete
  197. Dear Dr. Ramirez,

    I had my ET on Mar 1st 2012. It was a clevage stage transfer on Day 2.
    I did not bleed at all. No implantation bleeding. So , is this something to worry?
    Kindly suggest

    Regards
    Soma

    ReplyDelete
  198. Hello SKM,

    1. It is possible that the onset of the period was due to inadequate progesterone. If adequate progesterone is given, usually the period will not start because the progesterone will prevent it. In addition, Crinone is specified to use in the morning because the activity through the day causes the dissolution of the cream and absorption. That may have led to inadequate progesterone levels as well.
    2. In fact, your numbers were pretty good and what would have been expected. You don't mention how many follicles you had, but a retrieval of 11 eggs is a good number with more than 50% being mature. Again, you don't mention the number fertilized but we expect a minimum of 60% to fertilize. Going to blastocyst will always result in less embryos, and is one of the reasons to do it. Because of this, I generally will not go to Blastocyst unless I have a good number of good CD#3 embryos (I require 8). So, in fact, having two good blastocysts, would have been expected. Part of the reason I don't put all my embryos to blastocyst is because the technology is still not perfect and even some good embryos will not develop to blastocyst. Doctors usually will go to blastocyst to reduce the number of embryos to choose from for the transfer. The majority of my patients still trasnfer at D#3 but I limit the number transferred.
    3. First of all, the number of eggs retrieved is influenced by the strength of your stimulation. You had a very low stimulation protocol. Again, without looking at your medical records I cannot determine if this was adequate or not, but your doctor might want to increase the doses. Second, keep in mind that IVF is not perfect and does not have 100% pregnancy rates. That is because the last two steps to become pregnant are still dependent on natural processes. Just like trying naturally, it can take several attempts. IVF just helps the natural process to increase the chances. It does not make you pregnant.

    Good Luck

    ReplyDelete
  199. Hello,
    I am on day 9 after double embryo day 3 transfer (1 at 9 cell and 1 at 8 cell) good quality. I did a urine test last nite and got a faint positive. Did the test as I was experiencing cramps and pains in my tummy. Today I have gotten up and have a very small amount of brown discharge and I'm so worried. I have had a successful ivf 5 years ago with my son (2nd attempt) I am now on attempt 10!!!! Please can you advise?

    ReplyDelete

LinkWithin

Related Posts with Thumbnails