Knocked Up Podcast - Managing The Two Week Wait
We speak to a team of experts, and a patient who has just had her embryo transfer, on how to best prepare, and get through this time.
Managing The Two Week Wait
For those accessing assisted reproductive technology, The Two Week Wait is a time of heightened anxiety. We speak to a team of experts, and a patient who has just had her embryo transfer, on how to best prepare, and get through this time.
Our experts include Mandi Azoulay, Integrative Chinese Medicine Practitioner and Wendy Fedele, Clinical Dietitian
Hosted by Dr Raelia Lew and Jordi Morrison
Dr Raelia Lew is a RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Find us on Instagram - @knockeduppodcast
Have a question about women's health? Is there a specific topic you'd like us to cover? Email podcast@womenshealthmelbourne.com.au. We keep all requests anonymous.
TRANSCRIPT
Jordi Morrison: Jess, you've just had an embryo transfer, and now we're going into the two week wait. Tell me how you feel about that.
Jess: I'm excited. A little impatient already. Like, I just wanna know already. But I've got, like, I'm still working, so I'll be okay, like, for the next two weeks to keep myself busy. And hopefully, I don't symptom spot, which will be hard because I know my body all too well. And I'm just all, like, really excited.
Jordi Morrison: So Women's Health Melbourne is an innovative, holistic fertility and women's health practice. We are world leaders in IVF and egg freezing and provide our patients with every opportunity to achieve their goals. Our handpicked expert team provides the ultimate care experience for our patients. Reach us at womenshealthmelbourne.com.au and follow us @womenshealthmelbourne and @doctorraelialew. Hello and welcome to Knocked Up, the podcast about fertility and women's health. You are joined as always by me, Jordi Morrison, and Dr Raelia Lew, CREI fertility specialist. Today, Raelia, we're talking about the two week wait, and we are joined by yourself as always.
Dr Raelia Lew: Hi. How are you doing, Jordi?
Jordi Morrison: I'm good. A bit excited about this episode. We have a few special guests.
Dr Raelia Lew: It's a big collab.
Jordi Morrison: Yes. We just heard from your patient, Jess, straight after finishing her embryo transfer. And later on, we'll hear from the perspective of some of our expert team from both Women's Health Melbourne and Life Fertility Clinic Melbourne. But first, Raelia, tell us, what is the two week wait and why is this a time when people might be feeling anxious?
Dr Raelia Lew: The two week wait is the luteal phase, the time from ovulation to whether we get a period or we find out we're pregnant. In an assisted reproductive medicine context, often we refer to the two week wait as from the time someone has an IUI or an embryo transfer, and we're waiting to find out if we've been successful. Two week wait is a bit of a miscalculated term for a blastocyst embryo transfer because we actually put a blastocyst embryo back in the womb about five days after ovulation or sometimes in a stimulated IVF cycle if you're having a fresh embryo transfer after an egg collection, which is the surgical equivalent of an ovulation where the egg is collected instead of released. And when we wait for pregnancy test in that context, it's actually more like a ten day wait.
Jordi Morrison: Well, ten days sounds better than two weeks already. So what we're hoping for during this time is implantation?
Dr Raelia Lew: Yeah. Implantation should occur in really literally the hours to days after an embryo reaches the womb. And it's not something that happens in a moment. It's something that is a continued process that occurs from when an embryo reaches the receptive lining of the uterus to when it attaches implants and forms the beginnings of what will become the placenta, which is a very special organ in pregnancy, a connection between the growing baby and the mother through which an exchange of blood gases and nutrients happens throughout the pregnancy.
Jordi Morrison: We've brought in a few experts today to to join us on this episode. From your perspective, what are some of the challenges of the two week wait?
Dr Raelia Lew: It can be a really exciting time, but also a really nerve wracking time. And it's really important to contextualise it that not every embryo transfer or assisted reproductive treatment and certainly not every time someone has sex when they're fertile is gonna result in a pregnancy. So there's a lot of build up, a lot of anticipation. And sometimes there's a feeling of disappointment or grief when a period comes if you're not pregnant. So it can be really hard, especially in someone who's been trying to get pregnant for a really long time and has experienced that moment of optimism, anxiety, and sometimes disappointment in a recurrent context. I think it's really important to understand the background chance of natural pregnancy, which is if there's nothing wrong with you and you're young, only about a one in five chance per month having sex to get pregnant. And in terms of assisted reproductive treatments, if you're very young and you've got a beautiful embryo with nothing wrong with it, its chance of making a baby statistically is more like one in two. It's still not a hundred percent. And if you're someone who's a bit older, maybe you're in your, you know, thirties, it might be more like one in three embryos make a baby. If you're in your forties, it's gonna be more like one in five embryos or one in six embryos will make a baby in your early forties. And in between, it it's a transient gradient. So if you're, say, 35, it's about a one in four chance of a embryo making a baby. So the lived reality of a lot of people having assisted reproductive treatment is they might have had multiple treatment attempts before they're successful. And that is a very normal experience. It doesn't make it an easy experience.
Jordi Morrison: Do you have any do's or don'ts for that period of the of the two week wait?
Dr Raelia Lew: From a medical perspective, the do's, I suppose, are to follow your medication regimen if you're in a treatment cycle of something like IVF after an embryo transfer. So you'll be asked to most likely use some luteal phase support, usually in the form of progesterone. So making sure that you do use that medication to optimise implantation. Try and reduce stress as much as you can. Often, I would say distraction is a good tactic. So planning some nice activities during that time to, protect yourself in a mental health capacity. And, of course, it's really important to look after your your general health as well as it is for everyone at all times, not just when you're trying to get pregnant. At the end of the day, the outcome will be what it will be. I don't tell people what to do in terms of testing for pregnancy early. These days, there's lots of commercial urine pregnancy tests available, and some people literally test every day, and they're looking for a very faint line and whether it's getting less faint, stronger over time. I I guess, tip is that the medications of IVF, some of the medications we use such as an HCG trigger can cause a false positive test and can sometimes be something that causes a bit of anxiety. In terms of right or wrong, look, there's no right or wrong, but it is really important at the end of a two week wait to do a blood test after an embryo transfer. And that's because not every pregnancy behaves the same way. Sometimes a negative urine test can be a false negative. Sometimes you can have a complication of IVF like an ectopic pregnancy. And it's really important even if you have a really low hCG level initially that we know about it so that we can look after you really well and have that index of of concern. At the end of the day, we hope to be there to support you. And regardless of your outcome, if you do need support, please reach out at Women's Health Melbourne. We have a a great network at our disposal, a great team to help look after you whether your news be positive or negative.
Jordi Morrison: I've got a few questions from previous patients about the two week wait and what they can and can't do in it. So, Raelia, can you have sex during the two week wait?
Dr Raelia Lew: You certainly can. No reason not to. And please use Luvs products lubes, which will help make it better for everyone.
Jordi Morrison: What about drinking alcohol?
Dr Raelia Lew: Not recommended. It's true that the majority of negative effects of alcohol are most serious when you're already pregnant. But I'd say alcohol is one of these molecules that really easily crosses from maternal circulation into the uterus, the womb, and ultimately when you have a placenta, it can cross the placenta. And it's a neurotoxin. So from a baby's point of view, it can injure the developing brain. So from the earliest stages of having an embryo in your body, my recommendation is no alcohol.
Jordi Morrison: What about eating things like soft cheeses, smoked meats?
Dr Raelia Lew: There's a lot of foods that should be avoided in pregnancy mainly because of bacterial infections like listeria and toxoplasmosis. On our Women's Health Melbourne website, there's a video about early pregnancy education that I encourage anyone who is, in the early phases of pregnancy to have a watch of because it's great with my colleague, doctor Sippy Ben Harim, explaining all the do's and don'ts. Until you are pregnant and and you've got a positive pregnancy test, enjoy your sushi, enjoy your deli meats, enjoy your soft rind cheeses. Hopefully, you won't be having them for a while. Until your positive test, you can eat anything you like.
Jordi Morrison: With the positive test, when that's done ten days after the embryo transfer?
Dr Raelia Lew: Yeah. And is that a blood test?
Jordi Morrison: It is a blood test. And most often, regardless of the level, you might be asked to repeat that blood test to see a pattern of rise. In a healthy normal pregnancy, we're reassured by seeing an hCG level double every forty eight hours or so. And if we see that pattern, then we're happy that things are going in the right direction.
Jordi Morrison: Joining me now is Mandi Azoulay, doctor of Chinese medicine at Women's Health Melbourne. Mandi, I can think of some obvious ways that you might be able to support patients with acupuncture and stress relief. But tell us, as an integrative Chinese medicine practitioner, how do you see your role during this time?
Mandi Azoulay: I go on a journey with my patients. People often come to me for preconception care, or they may start coming for acupuncture in the lead up to their IVF cycle. I see myself as their integrative Chinese medicine practitioner, but also as their friend, as their confidant, as someone who understands the the journey that they're on when it's quite a private journey and secret and a lot of their friends and family don't know about it. Often their partner doesn't know how to support them, they're just as nervous, and they try to be brave and not let their partner know how nervous they are. So it's a very private time in a in a consult with me where a woman can tell me whatever she's feeling. Is she feeling scared? Is she feeling worried? Is she feeling excited? And we talk about the feelings if she wants to talk about them. If she doesn't wanna talk, it's a very safe space where she can have acupuncture. And we dim the lights, I cover her with towels and blankets. It's very warm, there's relaxing music playing, and it's a time when she can focus on her breathing and connect with her body. What we know is that when you breathe slowly and you take deep breaths, deep abdominal breathing, it sends very good messages, positive messages to your nervous system that all is calm in your body. So even if the rest of the day and the rest of the week, you're a nervous wreck, during this time, even if you're not properly meditating, it is a time to really focus on your breath, which can have a positive effect.
Jordi Morrison: We associate acupuncture probably mostly with your role even though there is so much more to it. How does acupuncture itself support someone during their two week wait?
Mandi Azoulay: I see acupuncture supporting you during your two week wait in two main, roles. The first role is we know that from a Chinese medicine perspective, it brings blood flow to your uterus. And by bringing blood flow to your uterus, you're increasing your antioxidants and all the nourishing ingredients that are gonna supply the embryo, with the energy to implant and have a very healthy implantation, and hopefully be, you know, form a very healthy pregnancy. The other main effect is for stress management, and there is lots of research that shows that women who have acupuncture, during IVF, it significantly improves their stress management during this time. Part of stress is anxiety. Some women are prone to anxiety and it certainly does help with anxiety. If you're the kind of person who has a great response from a psycho emotional perspective from acupuncture, I can also use ear seeds, which are little tiny stickers with little tiny ball bearings on them, and I put them on acupuncture points in your ears. So it's something you can go home with and stimulate during the week whenever you're feeling anxious or stressed.
Jordi Morrison: You've mentioned that the ear seeds can be used to sort of self manage the stress. Often, you prescribe herbs or vitamins to your patients. Is this also the case during the two week wait?
Mandi Azoulay: So depending on when you start a journey with me, I often prescribe vitamins. It might be a prenatal multivitamin with all the ingredients your body needs for a healthy pregnancy. There might be some other things depending on your medical There might be some other things depending on your medical history and, you know, blood tests and other things that we look at. It's very rare that I'll prescribe herbs for a woman who is, undergoing an IVF cycle. If I feel, if we feel that you do need herbs, and this is a discussion that I would have with your IVF specialist, and this is often the case for women who have had recurrent miscarriages, but there would definitely be a discussion with your medical team. Often, one of the things I like to do during the two week wait is review the supplements. There might be supplements that I had prescribed, before an egg pickup or before an embryo transfer, but after an embryo transfer, I really believe less is best, and I will only prescribe things if they are definitely required.
Jordi Morrison: And do you have any advice on what to do or what to avoid during this time?
Mandi Azoulay: I encourage all my patients to eat nourishing anti inflammatory foods. So that's lots of fresh fruit and veg, whole grains, lots of seeds and nuts, and really good quality proteins. Good fish, good meat, good chicken. I always say stay away from alcohol. Try not to have any exposure to environmental toxins, to vaping, to cigarettes. Make sure that if you're in a work environment where there are certain toxins that you really do stay away from those. As emotional as it can be, I do say to people assume you're pregnant until you know otherwise. So if there are things that you wouldn't eat or do while you're pregnant, your time really starts during the two week wait. If you are the type of person who has been on a gluten free diet for whatever reason, now's not the time to start introducing it. So if you've been on a diet, stay on that diet until you've got a really healthy established pregnancy and then discuss it with your healthcare practitioner. From a Chinese medicine perspective, it's really important that you eat warm nourishing foods. Lots of soups, stews, stir fries. So even though I said eat lots of fruit and vegetables, if you can have them in the form of cooked, stewed, stir fried, steamed, that would really be more nutritious for you. It's easier for your digestive system to extract the nutrients out of those foods, and it means that the your energies is directed to your uterus and your womb and the growing embryo as opposed to having to worry about digesting, your food.
Jordi Morrison: A lot of people ask about exercise during this time. What's your advice regarding exercise during the two week wait?
Mandi Azoulay: I talk to a lot of my patients about exercise based on your menstrual cycle. We all know as women, there are some women, there are some weeks when we are full of energy and ready to do lots of exercise, sweating, panting, lifting weights. And there's other times of the month where we just feel like a gentle walk or yoga or Pilates. So in Chinese medicine, we call this yin and yang exercise. Yang exercise is where you're sweating and it's you exert yourself a lot. Yin exercise is more nourishing and relaxing. I like to tell my patients that during the two week wait, it's really important to concentrate more on yin exercise. It's a time when walking outside is really helpful. We know that when you're looking at nature, that helps to decrease your stress. Activating blood flow throughout your body during gentle exercise is very helpful for for fertility. If you are a marathon runner or a gym junkie and you've always done high intensity training, there's no reason to stop during the two week wait. But if that's not your norm, it's certainly not the time to start.
Jordi Morrison: Once one of your patients leaves your room, what's your advice to her on how her network can support her during the two week wait?
Mandi Azoulay: There are two parts to this question. The first is what I tell you to do. Things that you can do to take care of yourself and pass the time is catch up with friends, watch movies, get into a Netflix show, not something that's adrenaline pumping like Handmaid's Tale, but something really fun and something that will make you laugh. Start a creative project, sink into sink yourself into a good book. Really do things that'll make you smile and pass the time in a positive way. But it's also really important that if you've confided in your support network, that they know how they can help you. They might cook you a meal, they might take you out for dinner, or go with you to a movie, or encourage you to go for a walk with them. As someone who is supporting someone during the two week wait, it's really important to be able to read the cues. Does she wanna talk about it or would she rather just have company and pass the time together?
Jordi Morrison: Many of us have trouble sleeping at the best of times. How can you support someone in their sleep during the two week wait?
Mandi Azoulay: Good quality sleep and a a good amount of sleep is really important for healing. It's really important for your body to create the right environment to optimise fertility and therefore embryo implantation, the beginnings of a of a healthy pregnancy. However, from a Chinese medicine perspective, during this two week wait, we explain that our yang is rising. So our body temperature rises. We know progesterone causes this body temperature to rise. And often what may happen is we find ourselves not able to fall asleep easily at night. Acupuncture is a really effective treatment for people with insomnia or sleep issues. So it can help people who have trouble falling asleep or people who who fall asleep easily but then wake up. Again, the ear seeds are a really useful thing that I can send you home with. And when you are lying in bed tossing and turning, you can activate those acupressure points using those ear seeds. Please don't stress about get not getting enough sleep because then it'll be a vicious cycle. But certainly, make sure that you get into bed at a good time, that you set up set up a really good sleep hygiene program so that you can wind down, turn your screens off, and have a good night's sleep.
Jordi Morrison: Thank you, Mandi. And now we speak to Wendy Fedele, clinical dietitian. We're talking about the two week wait today, and I think many people are probably thinking, why are we speaking to a dietitian about the two week wait? Wendy, why are we talking to you about the two week wait?
Wendy Fadele: Well, I'm glad that you asked, and I'm glad that you're talking to me. And the reason that you're talking to me is that nutrition definitely can have an impact on, I guess, what we're trying to achieve in the two week wait, which is obviously a positive pregnancy test. But, you know and even when you emailed me about this, what I did say to you is, look, the two week wait is great. But, ideally, what we wanna be doing is trying to prepare for the two week wait well before the two week wait if we can because what we're trying to support in this time is really implantation and also preparing our body to support pregnancy and for a healthy pregnancy. And so it's never too late, but, obviously, there are some factors that, you know, when we get to the two week wait, we can no longer influence. So things like the the health of our eggs and sperm health certainly can be impacted by nutrition and in creating a healthy embryo, therefore, as well as sort of really optimising and creating a healthy and thick and receptive endometrial lining, which nutrition can have an impact on as well. And so with those things, if we can start preparing ahead of time, it's really great. But even in the two week wait, there's still considerations there from a nutrition point of view.
Jordi Morrison: I think that's a really great point to make is that we're so focused when it comes to assisted reproductive technology about that moment of IVF, but actually the lead up and then ultimately the healthy pregnancy is really the focus.
Wendy Fadele: Absolutely. And so I that's why I say, like, it's never too late to start, but the earlier that we can start to prepare, the the more chance that nutrition has to have an impact. And to sort of, you know, where at at its core, we're also looking to improve your overall health, and that can take some time as well.
Jordi Morrison: So when it comes to nutrition, what should we be focusing on for that two week wait or to support implantation?
Wendy Fadele: At that time, I guess there's a few different foods and nutrients that I'd really be focusing on trying to make sure that you're getting enough of in your diet. And one of them is omega three fatty acids. So we know that the types of fatty acids in your diet are really important around that implantation side of things and also for early pregnancy, and omega three fatty acids are a really important one. The type that we get in particular from oily fish and seafood, so the EPA and DHA. So if you're focusing on trying to get two to three serves of your low mercury oily fish each week, that's a pretty good aim, and that's actually associated with higher pregnancy rates. So that's that's the first thing that I would be focusing on. There are a few other particular nutrients that play important roles sort of in the implantation process, but as well as supporting that early phase of pregnancy as well. And so that's things like folate and choline and iodine and zinc. And so to get those nutrients in our diet, there are few different key foods that are are good to be focusing on at the moment. So eggs are a really great one right now, excellent for choline, which, like folate, plays a role in, reducing the risk of neural tube defect and in that defects and in sort of, the development of that neural tube in early pregnancy, as well as your folate rich foods. Most people know that folate is important in early pregnancy, which you will be getting some if you're taking your prenatal multivitamin, but it's also important to focus on getting enough from food as well. So right now focusing on getting things like your dark leafy greens in and your beans and legumes. Eggs are another reasonable source as well there. We also want zinc rate rich foods at the moment. Your protein sources are great for zinc, so things like fish and seafood again, your lean meats, chicken, beans, and legumes, tofu, nuts, and seeds. And then iodine as well, which again, hopefully, you're getting from your prenatal multivitamin, but trying to get enough of that through your diet as well. And fish and seafood and seaweed, your dairy foods, iodised salt as well is another source there. So quite a few key ones that we can focus on. And also a couple of other little suggestions is there is a bit of evidence that getting enough whole grains in your diet supports implantation and a healthy lining. It's one I see a lot of clients that are really, you know, off the carbs, reducing their grain intake, but, actually, it's one that we wanna make sure that we're getting enough of. Things like, you know, oats, quinoa, barley, freekeh, using whole grain breads, and things like that is a good idea. And then also focusing on getting a couple of pieces of fruit in every day seems to be a really good thing too.
Jordi Morrison: So you've just mentioned fruit there and it makes me think of the pineapple myth. Is it a myth? What what do we I guess I know I know of two myths when it comes to two week wait. One is about eating I think it's either a whole pineapple or a pineapple core, and the other is Macca's fries.
Wendy Fadele: Both delicious. Maybe not the Macca's maybe not the pineapple core, but both. I say I love pineapple. Don't know about the core, but but, yeah, you're right. They are they are common myths, and I get asked about both of those quite a lot. And look, when it comes to the pineapple, the pineapple core, it is high in enzymes, bromelain, and that look. There's actually no research showing that it will improve implantation rates or pregnancy rates. There is some, I guess, method in the madness. So where it potentially comes from is that it may have anti inflammatory and mild blood thinning properties, and both of those things can potentially help with implantation. Reducing, inflammation is a really important thing in the on a in a healthy uterine lining. And so, look, potentially, it could hurt. It's probably help. It's probably not going to hurt. You know, don't be doubting loads and loads of of pineapple cause, particularly if you're on blood thinning medication just in case. But, otherwise, including pineapple in your diet is not a bad idea. It's also a good source of vitamin c, which is another important nutrient at the moment, but there's not really any evidence that it is gonna have a lot of difference. The other one is, Macca's fries. That's that's one that commonly sort of in the IVF context. A lot of people have heard that having Macas fries can increase your chances of implantation in pregnancy. Look. It's not it's not a food that I would generally be encouraging people to have on a regular basis. We talk about the types of fats from a fertility point of view and the impact that they have on your fertility, and and Maccas fries are high in the types of fats that we want to be avoiding. At the same time, if, you know, you need a bit of a pick me up after your cycle, then, you know, having Maccas fries occasionally is not the end of the world. They are high in electrolytes, so sodium and potassium, and I know that some women are advised to have more of those electrolytes to reduce the risk of ovarian hyperstimulation syndrome. So maybe that's where it originated from. Again, absolutely no research, but not the end of the world if you wanted to include it occasionally. Funnily enough, one food that there is a tiny bit of research for is beetroot, and in particular beetroot juice. And so beetroots are high in nitrates, which is converted to nitric oxide in the body, And, actually, it can help with promoting blood flow and so blood flow to your reproductive organs and that can therefore help with implantation. There's not a heap of evidence, but there was one small study looking at sort of beetroot juice and having that around the time of of the implantation, and that in this study did sort of improve outcomes. So, look, not a bad idea to include some some beetroot if you're up for it. It's also really high in other important nutrients. It's actually a really great source of folate, and high in antioxidants and polyphenols. If there's one thing that you can go for there.
Jordi Morrison: Thank you, Wendy. Now Rayleigh. You've mentioned about having a network and how we can support at Women's Health Melbourne. And as we've heard, one of the themes that both Mandi and Wendy have spoken about is that, yes, they can support to a degree during the two week wait, but really, they can help you get ready for the two week wait and the pregnancy in advance. We've had Wendy and Mandi have their input on the two week wait, and they both spoke about how they can support before and beyond this. What what's your view here?
Dr Raelia Lew: Absolutely. The fact that you're contemplating a two week wait in a medical context, particularly if you've had assisted reproductive treatment help, is that you've been trying to have a baby and it's been a challenge. My advice is to integrate supports right from the beginning of your fertility journey because we can help you the most prepare for treatment, during treatments, and while you're awaiting results. And, of course, afterwards when you're pregnant to help with early pregnancy symptoms and general health in pregnancy. So I would encourage to build your team and find your tribe. And at Women's Health Melbourne, we're very lucky to have such an amazing integrative team take advantage of it.
Jordi Morrison: Another person I spoke to about the two week wait, who's an integral member of our assisted reproductive treatment team is Louise, one of our IVF nurses.
Louise: Tips that we've got for the two week wait are just to try and stay as calm as possible. Easy for us to say, but we like to encourage our patients to find something that they enjoy, whether that's Netflix, whether that's going for a walk, spending time with family, friends. Try not to symptom spot. I know it's really hard. Every little symptom, you're wondering whether that's going to be a pregnancy sign, and just be wary that you can have a tiny little bit of bleeding, which can be very, very normal, and it's no reason to panic. And also, we still like patients to do their pregnancy test and not stop their progesterone even if they have a little bit of bleeding because it doesn't always mean that things haven't worked.
Dr Raelia Lew: Exactly.
Louise: Yes. We always recommend keep going with all of the progesterone support. It's extremely important. Go for your pregnancy blood test and the nurses will be in touch with the results, and hopefully with some good news.
Jordi Morrison: So, Jordi, it's been really interesting having all these perspectives on the two week wait.
Dr Raelia Lew: It has. And I really think for me, the takeaway is that you're not just focused on the two week wait. It's what you can do before to prepare and also be ready to once you're pregnant. And just remembering for anyone out there whose journey hasn't been easy that I always say IVF is a marathon, not a sprint. Just because a single embryo transfer hasn't had a positive result doesn't mean that you're not gonna ultimately be successful. If you need support at any stage along your fertility journey, remember that there are a team of amazing professionals at your disposal who can really help a lot.
Jordi Morrison: To support Knocked Up, leave us a review or recommend to a friend. Join us on Instagram at @knockeduppodcast and join Raelia at @doctorraelialew, and email us your questions to podcast@womenshealthmelbourne.com.au.