Getting pregnant through in vitro fertilization (IVF) can be an emotional rollercoaster. After going through the process of egg retrieval and embryo transfer, the two week wait to find out if implantation occurred feels agonizingly long. Unfortunately, implantation failure is common with IVF. According to research, the implantation rate per embryo transferred in IVF cycles is around 15-25%. This means that most of the time, implantation does not occur after an embryo transfer. However, there are signs and symptoms that can give you an indication of whether implantation was successful or not.
What happens during the implantation window?
The implantation window is defined as the time between 5 to 10 days after the embryo transfer. This is when the embryo will normally implant into the uterine lining if conception occurred. Here is a brief overview of what happens during these crucial days:
- Day 5 – The embryo, now at the blastocyst stage, hatches out of its shell-like zona pellucida structure.
- Day 6 – The blastocyst starts to make contact with the uterine lining and loosely adheres to it.
- Day 7 – The blastocyst continues to adhere more firmly to the uterine lining.
- Day 8 – The blastocyst is completely embedded into the uterine lining, finishing the implantation process.
- Day 9 and 10 – Implantation continues to strengthen as the placenta begins forming.
If implantation is successful, you can expect symptoms like light spotting and cramping during this window as the embryo implants and burrows into the uterine lining. However, the absence of these symptoms does not necessarily mean implantation failed. Every woman and every pregnancy is different.
Signs that implantation did not occur
Here are some of the biggest indicators that implantation likely failed after an IVF transfer:
1. Negative pregnancy test after the implantation window
The most definitive way to determine if implantation occurred is through a pregnancy test. Home urine tests can detect the pregnancy hormone hCG as early as 8-10 days after ovulation or embryo transfer. If you take a pregnancy test after the implantation window and get a negative result, it unfortunately means implantation did not happen.
2. Full bleeding/menstruation
If you experience full flow bleeding or menstruation around the time of your expected period, it means your body is shedding the uterine lining and no implantation took place. This is one of the clearest signs of implantation failure.
3. No pregnancy symptoms
Symptoms like breast tenderness, nausea, fatigue, mood swings and frequent urination often start around the time of a missed period when implantation has occurred. If you do not experience any noticeable pregnancy symptoms around the time your period is due, it may be because implantation did not take place.
4. Lower hCG levels
Your doctor will monitor your hCG levels after IVF to ensure they are rising appropriately. hCG is secreted by the placenta after implantation. Slow-rising or low hCG levels may indicate improper implantation or early pregnancy loss.
5. Spotting that gets heavier
It’s normal to have some light spotting during the implantation window. However, if the spotting progresses to heavier bleeding, it may signify that implantation was disrupted.
Other factors that impact implantation
While the above signs can provide clues about implantation failure, there are other factors that influence the chances of successful implantation after IVF:
The uterine lining must be properly prepared and receptive for the embryo to implant. Conditions like endometriosis, fibroids, polyps and adenomyosis can make the uterus less hospitable for implantation. Lining thickness and pattern are important as well.
Not every embryo is capable of developing normally and implanting after transfer. Issues like abnormal chromosomes, poor morphology or arresting development can impact implantation potential.
There is an optimal 2-3 day window when the endometrium is most receptive to implantation. If the transfer occurs outside this window, reduced implantation rates may occur.
Certain women may have increased immune cells or antiphospholipid antibodies that make the body “reject” the embryo and prevent implantation.
When to test after IVF transfer
Here are the optimal days to take a pregnancy test after IVF based on embryo age:
|Embryo Age at Transfer
|Number of Days After Transfer to Test
|Day 3 (Cleavage stage)
|Day 5 (Blastocyst)
However, some clinics may advise waiting until 14 days after the embryo transfer before taking a definitive pregnancy test, especially if doing a blood test. This allows enough time for detectable hCG levels to build up.
Coping with implantation failure
When implantation fails to occur after IVF, it can feel devastating and emotionally draining. Here are some tips for coping:
Allow yourself to grieve
It’s normal to feel profound sadness, anger, guilt and loss when your IVF cycle fails. Give yourself time and space to fully process these emotions.
Share your feelings with your partner, close friends, family members or a support group. Counseling can help manage difficult emotions.
Take care of yourself
Be gentle with yourself both physically and mentally. Do relaxing activities, eat healthy foods and avoid stressors until you are feeling better.
When you are ready, start thinking about next steps like another transfer, new treatment protocols or other family building options.
The two week wait after IVF can be excruciating, especially when implantation fails to happen. While negative pregnancy tests and menstruation offer definitive answers, lack of pregnancy symptoms and abnormal hCG trends may also signal that implantation was unsuccessful. However, support and time to heal emotionally are essential before deciding on next steps. With an individualized treatment plan, persistence and hope, most couples can eventually achieve their dream of building a family through IVF.