Friday, February 5, 2010

Post IVF Transfer Pain: Implantation Pain or Ectopic?



Question:

My wife says that she was experiencing sharp pain yesterday (10 days after FET) on the area near right side of her stomach. She experienced the pain only yesterday and that was during a 3 mile walk. Today she says she feels some pressure near the right ovaries.

I'm concerned. Could you please let me know your suggestions? Thank you.

Answer:

Thank you for your question. This could be normal, but the main concern would be an implantation that occurs in the tubes called an ectopic pregnancy. I wouldn't jump to this conclusion but it is a possibility. This could also be what we typically call "implantation" pain. Please see my overview of what happens after the IVF transfer including pain and bleeding here: "After Your IVF Procedure".

Let me go into more detail regarding both possibilities.

All patients with infertility are at increased risk for an ectopic, even with IVF. The incidence is low but it occurs. At 10 days post transfer I usually have done my pregnancy test. This can give a better idea of how the pregnancy is doing and whether or not an ultrasound will show anything. Generally, the BHCG level has to be over 3000 to see a pregnancy in the uterus and if it is not there with that level, then an ectopic pregnancy as to be assumed. At only 10 days post transfer, it is unlikely to be an ectopic, however. These usually do not become symptomatic until 6-8 weeks of the pregnancy. At this point, it is probably not anything serious.

Pregnancy can also induce other kinds of pains and discomforts. We call them implantation pain or growing pain. Sometimes women tell us that they "feel" a sharp pain within a week or two post transfer. I cannot discount that sometimes the women who complain of this pain (and I have IUI patients who tell me the same) do have a positive pregnancy test. Another possibility on the right side, of course, would be appendicitis. You can still get other illnesses despite trying for pregnancy. However, appendicitis, is progressive and does not come and go. Once the pain started it would progressively get worst. That doesn't fit your wife's scenario. Without further evaluation it is hard to know what is going on. You should probably bring this up with your doctor.

As a side note, if your wife is actively trying to get pregnant using IVF or FET, then I would not recommend a 3 mile walk right now. She should limit her activity to more sedate activities. A short normal walk would be fine, but power walks are not recommended as are heavy exercises like aerobics, karate, gymnastics, running, etc.

Good luck with your cycle and I hope that this will be a success!

Sincerely,

Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF program
http://www.montereybayivf.com/
Monterey, California, U.S.A.

93 comments:

  1. Hi I had an ivf transfer 7 days ago and 4 days after I started getting pain in the lower part of my stomach especially when I get ip or go down steps today I also woke up with a very big headache what can this be this is my third ivf the other two where not sucessful.

    ReplyDelete
  2. Hello,

    I think I covered this question in the posting above. Probably the best advice I can give in addition to the aforementioned information is to contact your doctor and be seen. It may be nothing but probably a doctor's visit is in order. Without an examination and further evaluation, I certainly could not tell you more than that.

    ReplyDelete
  3. Can you tell me if pregnancy symptoms following a HCG shot (Novarel) get progressively worse over the two weeks or do they come on right away and slowly go away? I felt significant breast tenderness after the first couple of days, but then it went away after 3-4 days. Now I'm nearing my period and the breast pain is back but worse. Could this be that I'm pregnant, or is it most likely related to typical PMS "sore boobs" combined with the HCG shot?
    Also, can you tell me when I can do a home pregnancy test without a false positive?

    ReplyDelete
    Replies
    1. hello
      MY WIFE HAD FIRST WAS CHEMICLE.NOW DID SECOND TRANFER DONE 9 DAY DID HOME TEST COME FALSE POSITIVE. SHE WAITING TO DO BLOOD WORK SHE PANNC

      Delete
    2. It is probably too early for a home test o show positive. She needs to do a blood pregnancy test which should detect a pregnancy by this point.

      Delete
  4. Hello,

    HCG injections usually do not produce pregnancy symptoms. Sometimes supplemental progesterone can produce symptoms such as breast tenderness.

    In terms of your symptoms occurring near the time of your expected period, those are not definitive for anything in particular so no conclusions or suspicions can be made. A home pregnancy test should turn positive after 10-12 days after embryo transfer in an IVF cycle or 14 days after an insemination cycle.

    ReplyDelete
  5. Hello, I had a day 5 transfer and today is my 5th day after dat. I left some sharp pain in my right side few days ago, my breast were heavy but down now. My body goes hot at night. Am just worried as these is my first ivf but has a daughter on the natural way she is 3 years. What time should I test positive and when will implantation take place. Am so worried as a travelled from Nigeria to Dubai for these procedure. I cry all night for these dream to be a reality. Please help me and say something

    ReplyDelete
  6. Hello May 25th,

    After a D#5 transfer, implantation should occur within 3 days, so if it has been 5 days, you would be pregnant. You probably could have a blood pregnancy test done now, if you wish. I generally like to wait until 7 days post transfer just to be sure, in case there has been a late implantation.

    I'm a little worried that you have put so much emotional energy in this IVF cycle. You need to keep in mind that IVF is not 100% sure. It helps increase the chances of pregnancy but the last two steps of the process are still natural steps, meaning they have to occur on their own. We don't have the technology to make them happen. These are the steps of hatching and extrusion of the embryo so that it can attach to the uterine wall and growth of the lining over the uterus (implantation. So, if the cycle does not work, it does not mean that you can't get pregnant. It just means that it may take more than one try. Keep that in mind and just be patient. Since you have been pregnant before, you have a very good chance of getting pregnant again.

    Good Luck

    ReplyDelete
  7. Hi...I am 9 days past my 3 day transfer. 2 embies, both 8 cells grade a. I am now having sharp pains every now and then in the left side, very bottom of stomach...near previous c-section cut...is this a nerve or could it be implantation?
    Thank you,

    AC Miller

    ReplyDelete
    Replies
    1. Hello AC Miller,

      By 9 days out from transfer, you should be able to do a pregnancy test to see if you are pregnant. That would be the first step to determine what this pain is from. Most people do not have pain from implantation.

      Good Luck

      Delete
  8. Thank you... I'm still praying I'm pregnant... :) I was told not to take a test b/c results may not be accurate and to wait for clinics' blood test, which is Monday...just nervous and anxious. :(

    ReplyDelete
    Replies
    1. Hello AC Miller,

      Sorry for the delay in my response. I hope that you had good news with your blood test. If not, do not give up hope. You just have to keep trying until you are successful.

      Good Luck

      Delete
  9. hi Dr.
    my wife is in day 10 after ivf, and has apain in her stomach and headach. some time she said she will be period and some time normal no pain what we do ?

    ReplyDelete
    Replies
    1. Hello June 23rd,

      The first step is to have a blood pregnancy test done to see if she is pregnant. That is important because what is done next depends on that result.

      Good Luck

      Delete
  10. Hi, I am now on my day four after a Day 5 blastocyte embryo transfer of which one of the two had started hatching. I have been experiencing sharp pains in my breast since yesterday and could barely sleep last night due to bloating and tummy aches could these be side effects of the progesterone?

    ReplyDelete
    Replies
    1. Yes. These could be side effects from the progesterone supplementation.

      Delete
  11. Hi Dr.
    I am 9 days post 3 days ET. Last night I had a sharp pain in the lower abdomen for about half an hour. I am worried I might lost my emberyo.

    ReplyDelete
    Replies
    1. By now, implantation should have already occurred and you can check to see if you are pregnant by blood pregnancy test. It is possible that the symptoms are due to pregnancy, as much as, it could be due to being not pregnant. Without doing a pregnancy test, you cannot determine which it is.

      Good Luck

      Delete
  12. Hi i had 5 day transfer yesterday and today have pain on righ side-sharp stabbing pain. Not sure what this means.

    ReplyDelete
    Replies
    1. Sorry for the late response.

      I can't determine what your pain was from, but it was most likely from the remaining corpus luteum cysts, formed from the previous follicles. It should not be anything to worry about unless it gets worst.

      Good Luck

      Delete
  13. I am 9dp5dt, I did a home pregnancy test and it's positive. Is it too early to test?

    ReplyDelete
    Replies
    1. Hello,

      No it is not too early to test. D5 embryos will usually implant by 3-4 days.

      Good Luck

      Delete
  14. Hi Dr
    my wife is 5days post day 3 transfer.she complains of vaginal cramping and lower abdiminal pain.any thoughts?

    ReplyDelete
    Replies
    1. It is most likely due to the ovaries which have probably re-filled with fluid and cause tenderness. It is too soon for an ectopic or pregnancy to be present.

      Delete
  15. Hello, I had a transfer about 2 weeks ago. On Saturday I felt really bloated and it was very uncomfortable. But on Monday is when pain came into place. I've had pain right under my breats going through my back and stomach oain also. I'm worried can you please help? Also last night I had no position in bed it was very painfull.

    ReplyDelete
    Replies
    1. Hello,

      You're asking me to give you a diagnosis without any testing or an examination, which is not possible. I would advise that you have a pregnancy test to see if your are pregnant and consult your doctor regarding these symptoms.

      Good Luck

      Delete
  16. Hello,

    I'm writing you from Serbia. I am 4 days after my 3daysFET (8 cells, I think). Ass. Hatching was done, too.
    Please tell me when should I expect implantation and why do I have light cramps, since I had no hormonal stimulation.
    Thank you in advance.
    Best,
    Jelena

    ReplyDelete
    Replies
    1. It takes approximately 4 days after a D#3 transfer for implantation to occur. The embryo still needs to develop into a blastocyst (two days), then hatch out of its shell and attach to the uterine lining, then the lining needs to grow around the embryo (2 days). There is no way to know exactly what is going on in terms of the cramping but it is not worrisome and can be normal.

      Delete
  17. I have just had my day 5 transfer and feel cramping and my overies keep have a pluse feeling? i'm omn day 4 today and want to do a test but have been told to wait until day 11. Could the test be done sooner?

    ReplyDelete
    Replies
    1. By D#4 I presume you are referring to four days post transfer? That would be too soon to check for a pregnancy test. Implantation would just be occurring. However, I don't think you need to wait until D#11. The pregnancy should be detectable by 5-6 days of a D#5 transfer.

      In terms of your ovaries "pulsing", the ovarian follicles will refill with fluid and become tender as they were prior to retrieval. Most patients will feel their ovaries at this point.

      Good Luck

      Delete
  18. Thank you but if the test shows negative is it still possible to be positive at a later date as day 11?

    ReplyDelete
    Replies
    1. It is possible, as all things are possible and I have had such a case where late implantation occurred, but that is not typically the case.

      Delete
  19. Hello, I had a 3 day transfer 4 days ago. I am on endometrin and estrace (that I started today.). I am having some inner vaginal (cervix?) sharp pains. I had the same type of pains with our chemical pregnancy last fall. Could this be related to implantation, or does it just go with the endometrin?

    ReplyDelete
    Replies
    1. Hello,

      I'm afraid I can't answer this question for you. Certainly some patients have described such pelvic or cervical pains and they are labled "implantation" pain but usually it is more of a mild cramping type pain. No one knows for sure what these are as there is no way to evaluate them or make a diagnosis. It is not necessarily related to Endometrin but I do know that vaginal progesterones can lead to some mild cramping, possible from effects on the cervix. These are not worrisome findings.

      Good Luck

      Delete
  20. MY WIFE 9DAY TRANFER DO HOME TEST FALSE POSITIVE. WAITING FOR DO BLOOD WORK WHAT CAN SHE DO

    ReplyDelete
    Replies
    1. The only option is to do a blood pregnancy test, which can be done at any time now and, if pregnant, should turn up positive at this point.

      Delete
  21. hi i had 2x 5D transfer done 4 days ago (was told they had started hatching), this is my 2nd ivf as a surrogate , im experiencing little sharp pains mainly lower left side of abdomen and backache and my tummy feels tender internally if that makes sense (sorry) just trying to be as honest as posible, could this be all good signs? how soon can i do a pregnancy test im now fast approaching day 5 and these are the only symptoms im getting so far can i say please it is noticable but nothing to the point as i think i need see my GP
    sorry to go on so long could you please give me a feed back to put my mind at ease
    many thanks and good luck to everyone else too!

    ReplyDelete
    Replies
    1. Hi. It is too early to detect a pregnancy, and too early to be having pregnancy symptoms. Some people relate these types of syptoms to "implantation pain" but that is usually more of a cramping pain than sharp. I'm afraid I can't tell you what the source of the pain is. It does not necessarily indicate that pregnancy is occurring.

      Delete
  22. im on day 5 after day 5 transfer (hatching blastocyst) but experiencing sharp pains in my lower left side of my belly and backache could you tell me is this normal please?
    many thanks

    ReplyDelete
    Replies
    1. More than likely the pain is due to swelling of your ovaries. After the retrieval of eggs, the follicles refill with fluid. Other possibilities, such as ovarian hyperstimulation syndrome, could also cause this type of pain. I would strongly suggest that you see your doctor. It would be too early for an ectopic pregnancy to be causing symptoms.

      Delete
  23. Iam 40 & had the following performed. Removal of polyps in uterus.3dt Dec 6th. 3 transfer..8 cells all grade A. After transfer I have had mild cramps in mid section & very limited cramping in lower section. No spotting, lower back pain, breasts feels tight & itchy..they r not sore. Dec 9th felt one sharp pain as tho the embryos came loose in the uterus. As of Dec 10 Iam feeling aching pressure on my ovary..the same feeling I would get when my cycle is starting. I don't think this ivf cycle worked given my symptoms. How long does it take to implant for 3d transfer; when can I take a hpt; & do my symptoms indicate an unsuccessful cycle?

    ReplyDelete
    Replies
    1. Hello. It is most likely that these pains are from the refiling of the ovaries and not due to implantation or a pregnancy. It takes 7 days after transfer of a day#3 embryo for implantation to occur and so the earliest the pregnancy test will show positive will be day#8 post transfer. A home test will not show a positive for a while longer since the level needs to be higher for it to detect it.

      Delete
  24. This comment has been removed by a blog administrator.

    ReplyDelete
  25. I am 11 days past transfer. I have been through 4 fresh, 1 frozen and one iui. I can't bring myself to test yet. For the past several days I have had a pain near right side of belly button and another pain inside above my cervix. It just feels uncomfortable, but my civic had never hurt like this in pay cycles. I have no idea why I would have a pain above my cervix. Also I have mild nk cells and my Doctor put me on hydrocortisone 10 mg for only 20 days, starting day 3. Shouldnt I be taking it longer? I ran out of pills yesterday and my Doctor is out of office for Christmas. I have some prednisone 10 mg from past cycles and am considering taking it until I reach him.

    ReplyDelete
  26. today is my 20 day post 3 embryos transfer on day 3. my pregnancy tes came back positive and my HCG yesterday was 553.
    First HCG test 59, second 134 and my 3rd one 553.
    are these good numbers?

    ReplyDelete
    Replies
    1. CONGRATULATIONS! These are excellent numbers and a good rising pattern.

      Delete
  27. Hi can you please tell me how long it will take for implantation after a 2day transfer and on what day can a pregnancy test be done?

    ReplyDelete
    Replies
    1. Hi. From the day#2 stage, it will take 6 days for implantation to occur. A pregnancy blood test can be done at 8 days at the earliest to detect a pregnancy. A urine test will take longer.

      Delete
    2. This is my first time doing ivf I am 3 day past 5 day embryo transfer I have heartburn in my stomach some side. Abb pain e pelvic cramp but my progesterone level is 17.1 and some hot fleshes but breast hurts constetly

      Delete
    3. Hello Arianna, I'm not sure you meant to do this, but you put a reply to my reply with symptoms and information but no question. Did you mean for it just to be a comment or did you have a question?

      Delete
  28. Dr. Ramirez, HELLO from Bulgaria,

    My name is Ellie and I am 43 years old. Today my first DE ivf cycle ended in BFN. My doctor, who is considered the best in the country, blames for my failure the thin uterine lining which actually reached 8 mm this particular cycle. Here is my medication protocol from cycle day #1:
    1. Estrogen (Estrofem 2X2 mg + 2 Climara patches twice a week) ;
    2. Vaginal Viagra 2X100 for 5 days;
    My natural ovulation (which has been very regular so far) was suppressed due to the high estrogen intake and on cycle day #10 my uterine lining reached 8 mm. The previous 2 cycles were cancelled due to even thinner lining – 7 mm or less.

    I was given Pregnyl / Ovitralle shot on cycle day #12. From cycle day #14 I was on:
    1. Progesterone both vaginal (Utrogestan 3X200 mg) and oral (Dufaston 2X10 mg);
    2. Estrogen (Estrofem 2 mg + 1 Climara patch weekly)
    3. Medrol 2X4 mg;
    4. Baby aspirin;

    Half of my 3 day frozen embryos were thawed and let to develop and grow for another 2 days until they reached blastocyst stage. On cycle day #19, I was transferred 3 blastocyst. Along with the 4 above listed drugs, I was on Clexane shots every night.
    I have another 3 frozen DE embryos left.

    Dr. Ramirez, I would like to ask for your professional viewpoint on how to increase my chances next time by improving the thickness of my uterine lining?

    Here is some more data: My second IVF, which was 3 years ago, was successful but ended in miscarriage 2 months later. My endometrial lining then was 13.5 mm. I had curettage and then 2 hystaroscopy operative inspections followed by 2 unsuccessful IVF treatments. My uterine lining became critical one year ago by becoming 7 mm or even less. I have a very healthy lifestyle, regularly take a lot of supplements and vitamins and even though I still look over 10 years younger, I am perfectly aware of the approaching menopause.

    Shall be looking forward to your replay.

    Ellie







    ReplyDelete
    Replies
    1. Hello Ellie,

      What a pleasure to receive your question from
      Bulgaria. I think you are the first from your area. Knowing the beauty of Bulgaria women (from photographs), I am sure you look much younger than your age. Unfortunately, your eggs don't know that.

      Endometrial thickness is absolutely critical in a frozen embryo transfer. I would NOT do a transfer unless the lining is appropriate. One thing you can try, that I have used in my patients with a decreased lining, is to add estrogen tablets vaginally. I use oral estogen, such as Estrace 2mg, and have my patents insert them vaginally. Studies have shown that vaginal absorption of estrogen and progesterone and delivery to the endometrial lining is superior to other methods.

      In addition, I would recommend that you take low dose aspirin 81 mg each day and heparin 2000 units twice per day (or lovenox 35 mg once per day) beginning at the start of the cycle. Both these will increase micro blood flow to the endometrium and implantation site.

      Age is going to be your biggest factor, but since you have been pregnant before, you know you can get pregnant. What you are trying to overcome is the poor quality eggs that have occurred because of their age. Once you find he perfect egg and form the perfect embryo, you will get pregnant. You'll just have to keep trying.

      Good Luck

      Delete
    2. Hello Dr. Ramirez again from Bulgaria,

      Thank you so much for the quick response, considering the 10 hours difference between East Europe and the West Coast of America! I was really surprised to see your reply this morning.

      The fertility drugs that we use in Europe are of different names/ brands.
      I cannot find “estrace” here because the only available brand is ESTROFEM oral tablets 2 mg, which I will start using virginally instead of orally, following your advice.
      “Lovenox” is also unknown medication here or it is known as CLEXANE shots 40 mg, on which I was 10 days after the DE transfer.
      I do take low dose of aspirin (baby aspirin) on a daily basis. I think that ivf protocols in Europe and the States are pretty similar, just the medication brands are different.

      Dr. Ramirez, what is “appropriate lining” according to your standards? For my doctor this is at least 8 mm of a good three-layered pattern. That is why the previous two cycles were canceled. Shall I insist on reaching at least 9 mm for the next transfer? What do you think of my Blastocysts score: 3BC? Because it was a “shared eggs” donor cycle, my doctor mentioned that my co-recipient was pregnant. I didn’t like this “shared eggs” option because I know that the quality of the retrieved donor eggs may differ considerably…

      Dr. Ramirez, thank you once again for your reply! Have a nice Sunday!

      Ellie

      Delete
    3. Hello again,

      You are correct that the names of medications differ all over the world. I had a patient from Italy that I had to help find the proper medications and that was quite a task. Even the Pharmacists had a hard time, but we found them by comparing the chemical names. Estrace tabs is basically Ethinyl estradiol tablets. I thing that Clexane is the same as Lovenox.

      You are correct that even in "shared" donor cycles, the egg quality can vary. The Blastocyst grades given were not great. Finally, the textbooks show that the minimum endometrial linig required for implantation is 7 mms with a triple pattern, but I use 9 mms as my minimum.

      Good Luck

      Delete
  29. Hello Dr Ramirez.
    Thank you so much for helping so many people all across the world through this online forum. Im a 37 yr old who has just had IVF and four 3-day embryos transferred done a day ago. This afternoon approx 24 hrs after ET, I experienced excruciating lower abdominal pain that was probably set off by a bumpy car ride to a mall not too far from where I live. The pain was so bad that I found it difficult to breathe or even walk. The pain was constant, went on for hours and was accompanied by a low grade fever of 37.6. A few hrs later I passed what appeared to be a mucus plug and some clear watery discharge. The pain has now lessened after an NSAID use and the fever resolved. I have absolutely lost all hope for this cycle esp after seeing the watery discharge which I presume 3 day old embryos could not have withstood. What could have caused this reaction to ET?? Prior to my EC id taken Augmentin tab prophylaxis and prior to ET I was in perfect health. No pain or fever.
    Leona.

    ReplyDelete
    Replies
    1. The symptoms that you had would be worrisome to me and if you have not reported it and seen your doctor by now, I would strongly recommend it. Embryo transfers rarely cause any type of symptom if done correctly but whenever something is placed into a sterile cavity, such a the uterus, infection can occur if proper sterile technique is not used. I would not expect such symptoms from the transfer itself, but could not tell you what may be going on without a proper evaluation and examinaton.

      Delete
  30. Thank you for the concern Dr Ramirez.
    The pain symptoms I mentioned above continued to reduce with time so I didnt go to the clinic or hospital. Instead I "googled" up my symptoms and now I think I had a mild form of early OHSS. My abdomen became swollen right up to the sternum and moving and breathing were difficult for the first few days. Im much better now. No longer swollen or in much pain. Still not very hopeful about this cycle. Time will tell. God Bless!
    Leona.

    ReplyDelete
    Replies
    1. OHSS can be a very serious problem and is a side effect of ovarian stimulation. Severe OHSS, if not treated promptly and appropriately, can lead to death. I don't think you're at risk for that but it sounds like you might have had moderate OHSS at the very least since you had breathing difficulties. You absolutely should have contacted your doctor!

      Delete
  31. Dear Dr. Ramirez,
    I would like to ask an opinion about my situation. I have had so far 5 transfer -2 fresh and 3 frozen - (actually the 6th frozen transfer is going on right now)in 2 ICSI. In all the cases blastocysts were transferred (usually very good or top quality 5AA, 5AB). Transfer of single blastocyst has been done always. I have never even seen a positive pregnancy test. One common feeling in all the times after transfer is that, 3-4 days after the transfer it starts a mild but CONSTANT abdominal pain, similar to menstrual pain that goes on every day/night until the period comes usually just before the 2 weeks end. What does it mean? I am really desperate that even in this sixt transfer things are going just the same as usual! Thanks a lot for your help, Perla

    ReplyDelete
    Replies
    1. I'm sorry for your plight. The pain you are having may not necessarily be related to the IVF transfer (because you should not have pain from that), but may be a sign that your period is about to start (some people will have premenstrual cramping before the onset of bleeding in anormal period).

      It is unusual that you have failed so many cycles when good blastocysts are being transferred. I can't help but think that something else is going on that you are not being covered for, OR the transfer technique is at fault.

      Delete
  32. Hi Dr. Ramirez,
    I, too would like your expert opinion about post IVF transfer pain. I am now 10 days post transfer of 2 blastocytes (one was a BB grade and the other was DD). I have been placed on estradiol BID, progesterone BID and endometrin TID - all vaginal suppositories. I have been feeling the expected side effects - nausea, dizziness, constipation, headaches, fatigue, mild abdominal cramping, bloating -possible abdominal distension, spotting on day 7 only, on/off bilateral ovarian pain and lower lumbar pain. For the past 2 days, the pain has escalated to a grade 2 where the pain reminds me of the pain I had prior to egg retrieval with crowding of embryos. I have also had basal temperature increase, weight gain and shortness of breath, probably due to weight gain. No edema in extremities or diarrhea. Can you confirm if I have a mild case of OHSS or I have signs of implantation? I'm due for my lab test this Friday, 6/7/13. Any info would be greatly appreciated. Thanks. - BE

    ReplyDelete
    Replies
    1. Hello,

      With the symptoms you are having, it is possible that you have a mild to moderate case of OHSS but that requires an examination to determine.

      Delete
  33. Dear Dr. Ramirez,

    I am a 33 old woman with so far many implantation failures, without apparent reason. In this cycle, I have transferred a frozen "top-quality" blastocyst in a natural cycle. I am taking progesterone, heparin, and hcg injections every 3 days to support the luteal phase.
    on day 8 after transfer, the doctor told me to do the blood test to dose HCG and the value was 216. However, there were only 38 hours between the last Pregnyl shot (1500) and the blood test. I am afraid that the HCG values is totally influenced by the Pregnyl still circulating into my body. The doctor said that the value is good and I don't have to worry, but I am really scared to be very disappointed when I will have to repeat the blood test after 1 week. Could you please give me your valuable opinion on the possible effect of Pregnyl injection on that hcg value?
    Thank you for helping so many people around the world!

    Best regards,
    Mina

    ReplyDelete
    Replies
    1. The hormone test for pregnancy is beta HCG and subunit of HCG. The pregnyl (HCG) should not cross react with the test, but not being a biochemist, I can't be absolutely sure. By 8 days post transfer of a Blastocyst, a pregnancy should be detectable.

      Good Luck

      Delete
  34. This comment has been removed by the author.

    ReplyDelete
  35. good morning doctor,,my 2 fallopian tubes has been removed deu to ectopic,,,,i did ivf 5 times all failled,,,,now i am on my 6days of transfer of 2 eby,,i 8cel and 2nd 2cel,,i was getting hot almost every night,,and on 3rd day of post transfered i had a very sharp pains;;i am using vaginal progetrone..i am lost and i dont know what to do,,my breasts was fulled and painful,,since about 2 days i cant sleep....thank you for been there ..

    ReplyDelete
    Replies
    1. Many of the hormones that are give with IVF can cause the type of symptoms that you are having, but without an examination and further testing, I can't tell you exactly what is going on.

      Delete
  36. Dear Doctor,

    I am from Singapore and am 4dp3dt of two 8 cell embryos. Two days ago, I had severe constipation and had strong straining as a result. I don't know if this is a silly question but will this have any impact on my embryos and its implantation? Also, I had mild OHSS after egg retrieval last Friday and it has slowly subsided. I understand that hcg can cause OHSS to reoccur. Does this mean that in the next few days if I don't develop OHSS symptoms, my cycle would have failed? Thank you for taking precious time off to answer my queries. God bless you always.

    ReplyDelete
    Replies
    1. Neither the straining at bowel movement nor the lack of OHSS symptoms will lead to failure. In many cases of OHSS, the pregnancy will make the symptoms worst or prolong the OHSS, but that does not necessarily mean that if you don't develop OHSS that you are not pregnancy.

      Delete
  37. Hello doctor..i had just passed with IVF preocedure with ICSI and IMSI..going with 9th day of FET wid 3 embroyes thaw with 8 cell 1 grade..this is my 2nd ivf cycle..
    Today i exprienced sharp pain in my lower right side of my belly for sometime,feeling cramping and backache..i am too much worried after this pain..i want to knw is this is happening because of implantation or something else..i have big hope with this 2nd cycle..having a sleepless nights please help me and give me a feedback to relax my mind
    Thank u soo muchh..
    MARIA

    ReplyDelete
    Replies
    1. There is no way for me to know what the cause of this pain is via the internet.

      Delete
  38. I had a 3day transfer of 2 embryo and today is day 5. am having a sharp pain on the left side of my stomach. please advise

    ReplyDelete
    Replies
    1. Hi,

      There is no way for me to diagnose what is going on with you. It is way too early for a pregnancy to have occurred as that takes at least 7 days post D#3 transfer. If I had to guess (which I have to), it is mostly likely your ovaries which refill with the fluid and become tender. I would recommend that you see your doctor or call and report the symptoms. There are other things that can happen to cause such pain such as OHSS and ovarian torsion.

      Good Luck

      Delete
  39. Hi,
    I just had a failed ivf cycle in aug.I gained 8 lbs and was trying to loose weight before I cycle again in nov so am walking 3to 5 miles day...I am 36. Is it ok to exercise between cycles. Also how do I know if I am ready to cycle again. I also feel some pressure in my uterus and some occasional cramps from my ovaries..

    ReplyDelete
    Replies
    1. Hi,

      It is definitely fine to exercise between and during an IVF cycle. Your question about knowing if your ready to cycle does not have an answer. There is no "ready" in terms of an IVF cycle other than meeting the requirements your doctor sets, such as pre-IVF counseling, evaluation and preparation. I have no way of knowing what the uterine pressure and ovarian cramps are using the internet. Sorry.

      Delete
  40. Hi,
    I am 18 days past my 3 day transfer of a compacted embryo & an 8 cell embryo.
    I have done 3 positive home pregnancy tests & was having some slight period cramping which stopped about 3 days ago.
    Im slightly concerned now as in the evenings I seem to be getting a sharper pain, slightly higher up than the period type cramps were & always on the left side.
    Should I be worried about an ectopic pregnancy? I have no other symptoms.....
    Thanks

    ReplyDelete
    Replies
    1. Hi. I hope that you have already seen your doctor regarding this. A simple blood pregnancy test will help in determining if you are at risk of an ectopic pregnancy. However, ectopic pregnancies usually don't cause symptoms until much later in the pregnancy (around 6 weeks gestational age).

      Delete
  41. Hi
    I am trying to conceive. After having sex ,how long do I have to wait before I insert Progesterone Vaginal Tablets into my vagina?

    ReplyDelete
    Replies
    1. The timing of progesterone is dependent on ovulation, NOT when you have sex. It should be given 2-4 days after ovulation.

      Delete
  42. Hi,
    I had a 5-day FET done on the afternoon of the 20th (2.5 days ago). I had some fairly severe stomach cramping (came in what felt like contractions) with diarrhea for about two hours tonight. Will this affect implantation? We transferred an early blast, so I'd expect to be in the implantation window now. Worried all the stomach pain and diarrhea caused uterus to contract.

    Thanks.

    ReplyDelete
    Replies
    1. You've asked a difficult question. One of my patients recently had the same thing. The symptoms most likely are intestinal but will those contractions/cramping cause the uterus to contract and possibly risk the chances of implantation? That is a question I can't answer and I don't think anyone knows. We do know that if the uterus contracts at the time of embryo transfer, that leads to a drop in pregnancy rates. But, I would hypothesize that once implantation occurs i.e. the embryo has been engulfed by the endometrial lining, then I doubt that intestinal contractions can have any affect.

      Delete
  43. im beth im on 2nd day blastocyst transfer my right ovary hurts so much i cant sleep. i worry what is this
    thanks

    ReplyDelete
    Replies
    1. Hello Beth,

      The ovaries stay swollen after being stimulated by fertility drugs and so that could lead to pain. If the pain becomes severe and debilitating, you need to see your doctor or emergency room immediately because this could be an ovarian torsion (whereby the ovary twists on itself thereby cutting off the blood supply).

      Good Luck

      Delete
  44. Hi Doc,
    I'm 43 years old and this is thd first time we ventured the IVF. 7 days back, I had a 3day ET but the fertilized egg had not divided. The doctor put it in hoping the natural ambience in my uterus should do the work. Are there any slow starters. Pls can you explain the pros n cons.
    And secondly, I've been having a nagging low fever ranging from 37.4C to at times 38.3C accompanied by headache. There's a sharp pain from the left hip going all the way down to to the lower left abdomen. I was adviced to get an Urine test, culture and blood test done. The reports showed an UTI but the culture showed no growth of bacteria. But the blood count is high indicating infection. I'm on a 5 day course of Cefuroxime axetil antibiotic since the last three days, Panadol for at least 3 times a day, Progesterone suppsitories for 2 times a day and Folic Acid, Jusprin 83mg once a day. On my own I take Vitamin C chewable tab.
    Please can you share your insight as for my condition as I feel, phyically n emotionally drained. Today is the 7th day after transfer. Is it safe to take an ultra sound to scan the reasons of the left side pain and back aches too.
    Would appreciate ur prompt response and help to understand my situation better. Thanking you in advance.

    ReplyDelete
    Replies
    1. Hello. Let me take your questions in sequence:

      1. If there has been no embryo development by D#3, then we call that arrested development and the embyo is likely non-viable. Are there delayed embryos? Yes, that can happen but even these embryos tend to not lead to pregnancies.
      2. UTI can cause a low grade fever and signs of an infection. You are being treated appropriately for this.
      3. In terms of being "physically and emotionally drained", I can't give you any specifics as there are many potential causes for this. IVF by itself can cause these symptoms because it is an arduous process. An infection can cause this as well.
      4. In terms of pain in the left side, you need to discuss this with your doctor and, if appropriate, an ultrasound surely can be done. The symptoms might be normal resulting from the ovarian stimulation, but without seeing you and doing an evaluation, I can't tell you what is going on.

      Good Luck

      Delete
  45. Dear Dr. Ramirez,

    I already love you for the help you are providing we ladies who are trying to convince.
    I am Anita from Mumbai, India.
    I had a fresh ivf cycle. 2 of 5 days blastocysts were transferred on 29th dec 2013. There were grades 5AA and 5AB. We did an IMSI due to male infertility issues. I had no signs of infertility or any medical issues at all. Infact my lining was around 13 mm during transfer and good E2 crossing 1100. What are my chances and what is the earliest I can do a home pregnancy test.

    Thanks and Regards,
    Anita

    ReplyDelete
    Replies
    1. Hello Anita,

      Thank you for your question. I can't tell you what your chances are because that is clinic and Physician specific. It is also age specific and you have not given your age.

      With blastocyst transfers, I will do a blood pregnancy test as early as 6 days post transfer. I don't rely on hpt's so I can't tell you when the earliest time is that you can check. They are made for people to check once they missed their period (14 days post ovulation).

      Good Luck

      Delete
  46. Hi sir,
    I am Manvi from India, 27 years old
    Below is the history of my pregnancies:
    I have been trying to concieve since more than 5 years. Initially in 2007 I was pregnant naturally but due to some personal reasons, had to get aborted through pills as it was only 35 days.
    After 2 years concieved again but that was ectopic pregnancy in the right tube, which was treated with Methotexrate but the tube was not removed.
    2 years later I concieved again i.e in November 2011 -->i.e. under medication, tablets for follicle formation, follicle study and rupture injections..In the 4th cycle of this medication, I had concieved , there was fluid in POD as per doctor.but in the 3rd month, baby's heartbeat was suddenly gone..and hence underwent D&C.
    Since then have been trying naturally but no success.
    In the year 2013 according to my history doctor suggested iui..
    First 2 iuis-->Clomid and Fertamid,follicles present were 4 in the 1st and 2 in the second, ET was 7 and 7.4 on the day of ovulation.
    3rd iui was done with combination of injectibles and clomid--ET was 8, 4 follicles were present
    4th iui was done only with injectibles , 3 follicles and ET 8.4.
    All follicles were 1.8 x 2.1 on average but still there was no success. The doctors are saying its unexplained infertility.
    Hence, doctor suggested to go for ivf i.e in January 2014. 12 eggs were retrieved in which 4 best contunued to grow to the blastocyst stage. On egg retrieval day ET was 8.5 and triple lined.
    I had a day 5 transfer i.e. on 22nd Jan 2014, as per the doctor embryos are too good but lining was 8.4mm which was intermediate.
    Please advice.

    ReplyDelete
    Replies
    1. Hello. I'm not sure what you are asking by "please advice". What is the specific question that you have? It sounds like the cycle in January has proceeded well so you'll have to wait and see how things turn out. Good Luck

      Delete
  47. Hello I am 7 days post 2 early blastocyte transfer. I am now experiencing Lowe pelvic pain. Is this normal, what could be causing this pain

    ReplyDelete
    Replies
    1. This could be normal. At this point, you should have had a pregnancy test. Good luck

      Delete
  48. Dear doc,
    Please tell me is there is some effect of mifepristone after ET in the ivf cycle.

    ReplyDelete
    Replies
    1. It should not be given. It stops pregnancy and is also known as the "abortion" pill because it can be used to induce a miscarriage/abortion if given in less than 7 weeks gestational age pregnancies.

      Delete

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