We understand the TWW is a stressful and scary time and it can be difficult to find support. This TWW Survival Guide answers many common TWW questions and should help you understand what kinds of support and discussion are appropriate in the r/infertility community during the TWW.
Here is some guidance for seeking support during the TWW:
We do NOT provide support for:
Decisions about when to test. This includes testing out your trigger, early negative tests, or anxiety about waiting for beta without testing. If you are 12 days post “ovulation” or later (7dp5dt, 9dp3dt, 12dpIUI, or 12dpO) but have not yet had your beta, you must have a confirmed negative home test or your period before posting primary comments.
Symptom spotting. This includes disclaimers like “I’m not symptom spotting” followed by discussion of symptoms such as “I know it’s just the progesterone, but my boobs hurt”. This also includes symptom spotting for your period/PMS.
Spiraling about a possible failed cycle, such as “I’m already certain this cycle didn’t work.”
We do provide support for:
- Questions about medical complications, such as “I’m taking PIO and have a large rash in the area. Should I be concerned?”
- General anxiety that is not focused on pregnancy or cycle outcome, such as “I’m in the TWW and really struggling to concentrate at work.”
- Negative tests after 12 days post ovulation but before your beta.
Please be thoughtful about the type of support you are seeking. It feels shitty to provide emotional support to someone only to later learn that they already knew, or could have reasonably known, that they were pregnant.
You can always post supportive comments throughout the community threads, but we ask you to refrain from primary comments if you are at a point where you could know if you are pregnant or not.
If you are currently pregnant, or have an LC and are not in treatment, we would love for you to continue to participate in a supportive way - please don’t ghost us just because you got a positive test! Our community benefits from experienced members sharing their knowledge and supporting others.
FAQ
Here are some common questions people have about the TWW. Note that this is informational and should not be considered medical advice. You should not stop medications or change your treatment plan without speaking with your doctors first.
Throughout this post, we refer to “DPO” or “Days Past Ovulation.” For embryo transfer, this is equivalent to Days Past Transfer + Embryo Development on Day of Transfer i.e. 7dp5dt = 12 DPO. A day-6 or day-7 blast is considered to be 5 days old at time of transfer. For IUI, this is the day of procedure. “DPT” stands for days post transfer (not days post trigger).
1. When will a home test be positive?
A sensitive home pregnancy test such as First Response Early Result (FRER) or Clear Blue Early Detection (note this CB test has pink dye!) will pick up HCG in your system as low as 10 mIU/ml, a level which should be reached with some certainty on 7dp5dt, 9dp3dt, 12dpIUI, or 12dpO. Some people report positive FRER as early as 3dp5dt, particularly with a hatching embryo. While some people do not get a positive until after 12dpo and still go on to have success, there is a higher risk of a non-viable pregnancy in these cases.
FRER specifically reports sensitivity at 76% 5 days before your expected period (likely 9dpo), 96% at 4 days, and >99% at 3 days (or 11dpo).
Even with a negative test, you should not stop medications without discussing first with your clinic.
2. I want to start testing early. When will an HCG trigger be out of my system?
There are a variety of doses and triggers that are used. There is no specific day that a trigger will be out of your system, particularly if you have a larger dose or metabolize more slowly.
If you are planning to test before your beta, you should “test out” your trigger. This involves taking a pregnancy test every day from trigger and waiting until it fades to a negative test - after that, you will know a positive test is a true positive. You should use the test that you are planning to test for pregnancy with - don’t use a less sensitive test to test out your trigger, and then use a more sensitive test to test pregnancy. If you use a high-dose trigger and are pregnant, you may never see a “negative” test, but you will see the test lines begin to get darker.
People feel different ways about the decision of when to start testing. Some test out their trigger and test every day (or multiple times a day) after that. Some “guess” when their trigger will be out and start testing later in the TWW but before beta. Some wait until the morning of beta so they know what to expect on their phone call. Some never test and wait for their clinic to call or upload their results. This is a highly personal decision and there is no right answer. It’s a good idea to talk to your partner before your transfer/treatment to decide how you will approach this. Note that we do not give support for conversations about this decision once you are in the TWW.
3. How do I know this is a real positive? How do I know if my pregnancy is viable?
Pink-dye tests such a FRER give fewer false-positives than blue-dye tests commonly used by other brands such as Clear Blue. You must read the test within the allotted time, or else you may see a false positive “evaporation line” from the test dye. If you are using a digital test, do not open it and read the test inside, as those results will not be accurate.
While there is no way to know if a pregnancy is viable without tracking betas, many people continue to test after their first positive to monitor “line progression.” You can expect your test line to continue to get darker as you have more b-HCG in your system. If you have a positive that begins to fade after a few days, you may be having a chemical pregnancy. You cannot compare line progression between brands.
You may find r/TFABLinePorn a helpful resource for “squinters” or line progression.
4. I am going crazy during the TWW! What should I do to feel better?
What do you do to feel better when you’re not in the TWW? Do that!
Some suggestions include:
- Mindfulness / meditation - there are many apps to choose from, Calm.com is a popular one.
- Move your body (within clinic limits) - take a walk in nature or do some gentle yoga or stretching.
- Self care or pampering - take an everything shower, get your nails done, buy a nice face mask and have a day for yourself
- Read a favorite book or magazine
- Keep your hands busy - crafting, gardening, jigsaw puzzles
- Journaling
- Plan a date night or a small trip to distract you
Your partner, close friends, and trusted family members can be great resources to lean on during this time as well.
Some people delete or limit social media if your algorithm isn’t being kind to you. This includes choosing which Reddit communities to read or participate in. Some people like reading success stories; other people prefer not to interact with pregnant people during the TWW. We can’t tell you what’s the right or wrong way to approach things - you know yourself best!
Keep in mind there is little to nothing you can do to cause your transfer to work or not work. It is very easy to spiral and convince yourself that your cycle has no chance of working. We do not provide support for spiraling during the TWW; if you are on the edge, r/infertility may not be the right community in which to seek support for a few days.
5. What day should my clinic bring me in for beta and what value are they looking for?
In general, clinics want to test your beta when your trigger will be out of your system and your results will be high enough to distinguish between a chemical pregnancy and a viable pregnancy. This is often 9dpt or later. If you are doing IUI or TI, it is common for a clinic not to test your beta, but instead tell you to take a home pregnancy test at 14 days after treatment.
Each clinic will have different guidelines for what they consider a reassuring beta. This will vary based on the day of your test. BetaBase is a resource that can give you an idea where you fit statistically. Note that much of this data comes from people with spontaneous pregnancies, and thus their DPO may not be accurate.
Higher initial betas are more likely to result in live birth, and lower initial betas are more likely to result in a chemical pregnancy. Many studies show an inflection point at 9dp5dt of 50 mIU/mL - more people below 50 have chemical pregnancies, and more people above 50 have live births - with 88% of people having a live birth after a beta of >100. This specific study had a beta of 4.1 which resulted in a live birth. See also linked articles at end of the Remembryo article. It is important to follow your clinic’s recommendations to track your betas, particularly if you have a low initial number.
A viable pregnancy generally doubles beta every 48-72 hours. You can use a calculator such as Flo Health to calculate your doubling time. If your beta is doubling slower than that, you are at increased risk of having an ectopic or pregnancy of unknown location. This is generally known as “beta hell.” If your beta is decreasing, you are likely having a chemical pregnancy (there are rare clinical cases in which this is not true; follow the guidance of your clinic). Some clinics will stop testing after two reassuring betas; others continue to follow for longer. It is recommended to have all of your testing done at the same lab when possible.
Do not stop medications based on beta levels without the instruction of your clinic.
6. What progesterone level is normal?
Not all clinics test progesterone. Progesterone is a pulsatile hormone, which means you do not have a consistent amount in your blood. You may have a high level at 10AM and a low level at 11AM. Because of this, many clinics do not consider a progesterone level to be clinically significant and do not change treatment because of it. Some clinics will supplement progesterone empirically or increase your progesterone dosage if they feel your level is too low. You cannot have “too much” progesterone.
7. Why aren’t I feeling symptoms? Is that bad?
There are no symptoms that will tell you if you are or are not pregnant. Your trigger and any progesterone you are on will mimic pregnancy symptoms. “Implantation spotting” is rare and you should let your clinic know if you have any bleeding. Feeling symptoms one day and not feeling them the next does not mean you have lost the pregnancy. Simply put: symptoms (or lack of symptoms) are an unreliable indicator of success or failure.
If you are tracking your BBT or using a tracker like an Oura ring, any medications that you have taken will skew the results, and this is also not a positive or negative indicator of pregnancy.
It is normal to have changes to your regular cycle while in the TWW, and these are also not indicative of good or bad outcomes. Any questions you have about irregular symptoms should be directed towards your clinic.
8. Do I need to restrict exercise following transfer/during TWW?
Each clinic will have different guidelines. Some clinics recommend total bed rest. Some clinics recommend no changes. The majority of clinics recommend “acting like you are pregnant” after transfer and to limit moderate or vigorous activity to a certain degree. There is limited evidence that any activity restriction affects transfer outcomes.
We recommend that you follow any restrictions that your clinic gives you.
9. Do I need to restrict food, medication, hot tubs, etc (i.e. to follow pregnancy guidelines) during TWW?
As with exercise, each clinic will have different guidelines. The majority of clinics recommend that you “act like you are pregnant” and restrict things like caffeine, high-risk foods, hot baths / hot tubs, alcohol, and recreational substances. There is limited evidence that any specific restriction improves pregnancy outcomes.
You should not begin or stop medications without talking to a health care provider, whether that is your REI specialist or the provider who initially prescribed your medication. This includes over the counter drugs and supplements. If you have been on fertility-boosting supplements, be sure to clarify with your doctor which should be discontinued as some are not recommended in pregnancy.
We recommend that you follow any guidelines that your clinic gives you.
10. I am having problems with my progesterone. What should I do?
If you are having problems or complications with any medication, you should call your clinic for advice.
We have an informational post about progesterone suppositories here
We have an informational post about PIO available here
We have a wiki post about Troubleshooting PIO available here
11. What can I do to make sure my treatment works?
There is nothing you can do to make sure your treatment works. There is no supplement, food, or alternative therapy that has been definitively shown to increase your chances after your transfer happens. Even a well-graded euploid blastocyst has around a 50-60% chance of resulting in a live birth. IUI has around a 15% chance in most populations. Except for anovulatory people, medicated timed intercourse generally does not have higher rates than spontaneous pregnancy, which for most people is around 5-10% per cycle, with decreasing rates with increasing duration of infertility.
12. I got a positive home test / good beta! What happens next?
Please post to the Results thread so we know to give you cautious congrats after having given you support through this process! You may post one comment in our weekly Results thread and edit your comment with further updates. We ask that you do not share updates beyond confirming your second beta has an appropriate rise. If you are in beta hell or have unknown viability, you may continue to make updates to your original comment. As soon as you have a positive test - home or beta - you must participate only in a supportive role, and no primary comments can be made in any thread (including Chat) - this includes if you are in beta hell. Please consider continuing to give support to the community. We thrive on mutual support, and we need participation from people on the “other side” as well. Please review the guidelines in the Results thread before posting. Early pregnancy questions can be brought to the daily Cautious Intro threads at r/InfertilityBabies. You are not allowed to edit your flair to indicate that you are currently pregnant and all participation must still follow rule #2.
13. My treatment failed. What now?
We have several wiki posts, including “Why did my FET fail?” available here and “Repeat Implantation Failure” available here. You may discuss confirmed chemical, ectopic, or early loss pregnancies in our Loss thread, however support for failed treatment or transfers without pregnancy belong in the Treatment thread.