After embryo transfer: day-by-day symptoms, confirmed and debunked

Whether it’s your first embryo transfer or your third, the “two-week wait” can feel like a lifetime. Your mind races: Is that cramping a good sign? Is no cramping a bad one? Should I feel something by now?

We spoke with Dr. Jennifer Nichols, DO, FACOOG, at IVFMD – an award-winning group of six fertility clinics, covering Miami and South Florida – and part of The Prelude Network®, the largest and fastest-growing network of fertility clinics across the U.S. and Canada. Read up for Dr. Nichols’ own really amazing fertility story and super-focused patient care approach. 

In her own words, 

“I am a busy mother of three boys. When building my own family, I experienced pregnancy losses and diminished ovarian reserve. I truly believe that my journey furthered my understanding and commitment to providing exceptional care to my patients.”

Here at TRB, she takes us through the day-by-day breakdown of what to expect after an embryo transfer, which symptoms are typical (and which are myths), and how to stay sane in the process.

What happens after an embryo transfer?

Let’s start with the basics – what’s happening in your body right after an embryo is transferred? According to Dr. Nichols, the timeline can look something like this:

Day 1-3: Attachment begins

The embryo begins to attach to the uterine lining during these first few days. You might not feel anything yet, or you may experience mild cramping, similar to menstrual cramps. Rest is good, but strict bed rest? Not necessary. As Dr. Nichols puts it, “That’s a common myth. We want our patients to rest and relax, yes – but also to keep moving a little.”

Day 4-5: Implantation in progress

You may start to feel twinges or light cramping as implantation continues. For some, this is when light spotting occurs, known as implantation bleeding. Not everyone will experience this – not having symptoms doesn’t mean it didn’t work.

Day 6: Placenta and fetal development begins

Around this time, trophectoderm cells – which will form the placenta and fetus – begin to develop and differentiate. Dr. Nichols notes, “Hormonal changes can kick up a notch here, too. My patients often notice:

• Breast tenderness
• Fatigue
• Bloating
• Increased urination
• Gastrointestinal (GI) changes (like constipation or diarrhea)

“These are all related to higher levels of estrogen and progesterone, either naturally or through the medications we use in a frozen embryo transfer (FET) cycle.”

Day 7: hCG enters the bloodstream

By this point, if implantation has occurred, hCG (human chorionic gonadotropin) – the pregnancy hormone – starts entering your bloodstream. This is one of the earliest indicators that your body may be responding to the embryo transfer.

Day 9-10: Possible positive pregnancy test

Around this time, your hCG levels may be high enough to register on a pregnancy test. “But hold off”, Dr. Nichols urges “testing too early can lead to false negatives or even unnecessary worry. Most clinics recommend waiting until Day 10 or later post-transfer, and ideally confirming with a blood test.”

Common symptoms after embryo transfer – day by day

From her extensive in-clinic experience, Dr. Nichols outlines some of the most common symptoms reported by patients:

• Mild cramping or twinges (Days 1–5)
  
• Light spotting or bleeding (Days 5–7)
  
• Breast tenderness and bloating (around Day 6+)
  
• Fatigue and mood swings
  
• Nausea or morning sickness (though this is less common and typically happens later)

It’s worth noting that not everyone experiences symptoms, and some people won’t feel anything at all until after a confirmed pregnancy. “Although symptoms can feel reassuring,” says Dr. Nichols, “the absence of symptoms is not a sign that implantation failed.”

Frozen vs. fresh embryo transfer symptoms

Wondering if your symptoms – or lack thereof – are linked to the type of transfer you had? There can be differences.

• In a fresh transfer, some people experience more cramping or ovarian discomfort, especially if they’ve recently ovulated.
  
• In a frozen embryo transfer (FET), many are on hormone replacement therapy, which can come with side effects like bruising or pain at progesterone injection sites, skin irritation from estrogen patches, and vaginal irritation from progesterone suppositories.
  

“But ultimately”, Dr. Nichols says, “it depends on the individual. Your body’s response is as unique as your fertility journey.”

Myths about post-transfer symptoms – debunked

Over to Dr. Nichols, to clear up a few of the big ones: 

• “The embryo can fall out.”
  Nope. Once placed in the uterus, an embryo will either implant or it won’t – it will not fall out, even if you go for a walk or stand up right after.
  
• “You have to be on strict bed rest.”
  False. While taking it easy is recommended, total bed rest can actually increase stress and anxiety. We want you to be comfortable, but also mobile.
• “You should feel pregnancy symptoms right away.”
  Some do, some don’t. Hormonal shifts can cause pregnancy-like symptoms, but they’re not a reliable indicator.

What is the most critical day after embryo transfer?

“There’s not one single day,” says Dr. Nichols, “but implantation typically happens between Days 6 to 10. This window is when we hope the embryo successfully attaches and hCG begins to rise.”

It’s also the window where people feel the most uncertainty. Cramping, no cramping, spotting, no spotting – it’s all in play. And none of it can definitively tell you whether you’re pregnant.

No symptoms – should I worry?

Short answer: no.

Not having symptoms is completely normal. Every transfer – and person – is different. Dr. Nichols reassures that symptoms aren’t a prerequisite for a positive result.

What should you keep an eye on? Any severe pain, heavy bleeding, or symptoms that feel out of the ordinary should be reported to your clinic.

Managing the anxiety of the “two-week wait”

You’re not alone. The two-week wait can be one of the most emotionally intense parts of the fertility process. Some of our favorite resources:

• How to Stay Sane During the Two-Week Wait – The Prelude Blog

Or, specifically for IUI

• Day-by-Day Breakdown: What Happens After IUI – The Ribbon Box

Putting together a tool kit? It can help to:

• Track symptoms, but not obsessively
  
• Stay connected with a trusted partner, friend, or therapist
  
• Limit googling – easier said than done, but worth it
  
• Focus on comfort rituals – think cozy meals, gentle walks, Netflix marathons
  

Need more personalized support? Your care team at a Prelude Network® clinic, like IVFMD, is there for you. As Dr. Nichols puts it:

“I am dedicated to ensuring each patient is educated about the process and receives personalized care. My focused approach is apparent as soon as patients walk through the door, and they know that my entire team has their best interest as our primary goal.

My hope is that patients will never leave my office saying they don’t understand what is going on or what to expect.”

Final thoughts

Whether you’re tracking every twinge or trying to stay distracted, this phase is hard – but it’s also hopeful.

Your body is doing its part. And if you have questions, your clinic is just a phone call away. For award-winning care, compassionate guidance, and expert fertility science, The Prelude Network® is here for every step.