Embryo Transfer: What to Do and What to Avoid During the Post-Transfer Period?

Embryo transfer is the final step of an IVF cycle and, understandably, one of the most emotional. After weeks or months of preparation, many patients worry that every movement, meal, or daily activity might influence whether the embryo implants. These feelings are completely normal.

It is important to remember that, biologically, there is nothing “fragile” about an embryo transfer. In a naturally conceived pregnancy, most women continue with their normal daily lives and are often unaware that they are pregnant for several weeks. The uterus is not an open cavity in which the embryo can simply “fall out.” Once the embryo has been gently placed within the uterine cavity, it remains protected by the uterine walls and the natural environment of the endometrium. Normal activities such as walking, climbing stairs, coughing, sneezing, laughing, using the bathroom, or sleeping in your usual position will not dislodge the embryo (Practice Committee of the American Society for Reproductive Medicine, 2017).

At the same time, we also recognize how precious this moment is. After investing so much physically, emotionally, and financially into treatment, it is entirely natural to want to do everything possible to maximize the chances of success. While there is no evidence that prolonged bed rest or major lifestyle restrictions improve implantation rates, following your medication regimen carefully, maintaining a healthy lifestyle, and avoiding known harmful exposures are sensible measures during this period (Practice Committee of the American Society for Reproductive Medicine, 2017; ESHRE, 2023).

The recommendations below are therefore intended to help you navigate the days after embryo transfer with confidence. Continue living your life as normally as possible, while making a few practical adjustments that support a healthy early pregnancy.

The Day of Embryo Transfer

While fasting is not necessary, we recommend having a light meal before the procedure. Avoid particularly large or fatty meals, as these may cause unnecessary bloating or discomfort while your bladder is full during the transfer.

Embryo transfer is a relatively quick and painless procedure in which a very fine catheter is used to place the embryo into the uterine cavity under continuous ultrasound guidance. This allows your physician to accurately position the embryo within the endometrial cavity. Occasionally, during the procedure, you may be able to notice a small bright flash on the ultrasound screen as the tiny droplet of culture medium containing the embryo is released.

A comfortably full bladder is important because it straightens the angle of the uterus and improves ultrasound visualization, making the procedure technically easier and more accurate. We recommend drinking approximately one liter of water beginning about one hour before your scheduled transfer. For example, if your transfer is planned for 11:00 am, empty your bladder and begin drinking water around 10:00 am and finish by approximately 10:45 am. It is often more comfortable to empty your bladder a few hours beforehand and then gradually refill it.

If you are using vaginal progesterone, please do not insert your morning dose before the embryo transfer, as we prefer the cervix and vaginal canal to remain as clear as possible during the procedure. You may continue taking all of your other prescribed medications unless advised otherwise.

Following the transfer, you will usually rest for a short period before returning home. There is no medical benefit to prolonged bed rest, and you may resume normal daily activities afterwards, provided you avoid strenuous physical exertion.

After Embryo Transfer

Continue Your Medications

Continue all medications exactly as prescribed. Progesterone is particularly important during the early weeks of pregnancy, as it supports the uterine lining until the placenta gradually takes over hormone production at approximately 10-12 weeks of gestation. Depending on your individual treatment protocol and progesterone levels, this may involve vaginal progesterone alone or a combination of vaginal and injectable progesterone. Do not stop any medications unless specifically instructed by your fertility specialist.

Pregnancy Testing

A blood test measuring beta hCG is usually performed approximately 12 days after embryo transfer. This is the most accurate and reliable way to determine whether implantation has occurred. Unlike home urine pregnancy tests, blood testing can detect much smaller amounts of hCG and provides an exact numerical result rather than simply a positive or negative answer.

We recommend avoiding home urine pregnancy tests during this early stage. Although some highly sensitive tests may become positive around this time, they are generally less sensitive than blood tests and can produce false-negative or occasionally misleading results, particularly if performed too early. In addition, residual hCG from a trigger injection (if one was used) or slight differences in urine concentration can sometimes create unnecessary confusion and anxiety. Waiting for the scheduled blood test provides a much clearer and more reliable answer.

The first beta hCG result gives us an initial indication of how the pregnancy is progressing. Any value above the laboratory’s detection threshold (typically 5 IU/L) is technically considered positive. However, very low values such as 5-10 IU/L should be interpreted cautiously, as they may represent an extremely early implantation, a biochemical pregnancy, or, occasionally, a false-positive laboratory result. Although there is no single beta hCG value that can guarantee a healthy pregnancy, we generally feel more reassured when the first result is above 50 IU/L at 12 days after a blastocyst transfer, while values exceeding 100 IU/L are often associated with an excellent early prognosis. It is important to remember, however, that there is considerable overlap between normal pregnancies, and a healthy pregnancy can certainly begin with a lower value. For this reason, the trend is far more important than any single number (Barnhart et al., 2004).

A second beta hCG blood test is usually performed 48 hours later. In a normally developing early pregnancy, we generally expect the beta hCG level to increase by approximately 70% or more during this period, although many healthy pregnancies will almost double. Occasionally, viable pregnancies can demonstrate a slower rise, which is why the results are always interpreted in the context of the overall clinical picture rather than using a strict numerical cut-off (Barnhart et al., 2004; Morse et al., 2012).

Once we have both results, we can provide you with much more accurate guidance regarding how your pregnancy appears to be progressing and advise you on the appropriate timing of your first ultrasound examination.

First Ultrasound Scan

Once your beta hCG levels are rising appropriately, the next milestone is your first pregnancy ultrasound scan. This is usually scheduled at approximately 7 weeks of pregnancy, calculated from the first day of your last menstrual period (or approximately 4 weeks after embryo transfer, depending on the stage of the embryo transferred).

At this stage, we expect to see a gestational sac within the uterus, followed by a yolk sac, a fetal pole, and, in most pregnancies, a visible fetal heartbeat. Detecting a heartbeat is an important milestone, as it provides reassurance that the pregnancy is developing normally. Although it is understandable to want an earlier scan, performing an ultrasound too soon often creates unnecessary anxiety. A perfectly healthy pregnancy may simply be too small to visualize clearly, resulting in uncertainty and the need for repeated scans. Waiting until approximately 7 weeks significantly increases the likelihood of obtaining a clear and reassuring assessment.

The purpose of the first ultrasound is to confirm that the pregnancy is located within the uterus, determine the number of gestational sacs, assess fetal development, and document fetal cardiac activity. Once a healthy heartbeat has been confirmed, the likelihood of an ongoing pregnancy increases substantially, although routine antenatal care and follow-up remain essential throughout the pregnancy (Doubilet et al., 2013).

Physical Activity

Remaining physically active is beneficial throughout fertility treatment and pregnancy. There is no evidence that prolonged bed rest after embryo transfer improves implantation or increases pregnancy rates. In fact, unnecessary inactivity may increase stress, reduce circulation, and contribute to stiffness and discomfort (Purcell et al., 2007; Practice Committee of the ASRM, 2017).

Following embryo transfer, you should continue your normal daily routine as much as possible. Walking, working, climbing stairs, driving, shopping, gentle household activities, office work and light recreational exercise are all considered safe.

The embryo is securely protected within the uterine cavity and cannot “fall out” during normal activities. Walking, coughing, sneezing, bending over or using the bathroom will not dislodge the embryo.

Until your pregnancy test, we recommend avoiding activities that place excessive physical strain on your body, not because they have been proven to prevent implantation, but because your ovaries often remain enlarged and more vulnerable following ovarian stimulation.

For approximately two weeks after embryo transfer, we recommend avoiding:

• Heavy resistance training requiring maximal effort.
• High-intensity interval training (HIIT).
• Running, sprinting or vigorous aerobic exercise.
• Contact sports.
• Activities involving jumping or sudden changes in direction.
• Exercises causing significant abdominal straining, such as maximal deadlifts or heavy squats.
• Heavy lifting of more than approximately 15-20 kg (35-45 lb) on a repetitive basis.

Gentle alternatives such as walking, leisurely cycling on a stationary bicycle, stretching, yoga designed for pregnancy, and light resistance exercise are perfectly acceptable, provided they remain comfortable.

The main reason for these temporary restrictions is not concern about implantation itself, but rather to reduce the small risk of ovarian torsion while the ovaries are still enlarged after stimulation.

Once pregnancy has been confirmed, regular physical activity remains one of the healthiest things you can do for both yourself and your baby.

For women with an uncomplicated pregnancy, current international guidelines recommend at least 150 minutes of moderate-intensity exercise each week, together with muscle-strengthening exercises on two or more days per week (ACOG, 2023).

Suitable activities include:

• Walking
• Swimming
• Stationary cycling
• Low-impact aerobics
• Prenatal yoga or Pilates
• Light to moderate resistance training
• Elliptical training

If you were already exercising regularly before becoming pregnant, you can usually continue your exercise program with some sensible modifications.

Resistance training is considered safe during pregnancy, but the goal should shift from building maximal strength to maintaining fitness and muscle mass. Rather than attempting one-repetition maximum lifts or pushing to muscular failure, choose weights that allow you to comfortably perform 10-15 controlled repetitions while maintaining good technique and breathing normally. As a general guide, most women can safely continue lifting approximately 50-70% of their pre-pregnancy training loads, gradually reducing the weight as the pregnancy progresses and your center of gravity changes (ACOG, 2023).

High-intensity interval training (HIIT) has not been extensively studied during pregnancy. Women who regularly performed HIIT before pregnancy may be able to continue modified higher-intensity exercise under the guidance of their healthcare provider, but for most patients we recommend transitioning to moderate-intensity continuous exercise, where you are able to maintain a conversation while exercising (the “talk test”).

As pregnancy progresses, avoid exercises with a high risk of falling or abdominal trauma, including:

• Contact sports
• Horse riding
• Skiing
• Scuba diving
• Trampolining
• Activities involving significant collision risk

Exercise should always be stopped immediately if you experience vaginal bleeding, leaking of fluid, persistent contractions, chest pain, dizziness, severe shortness of breath, or significant abdominal pain, and medical advice should be sought promptly.

A simple way to judge whether you are exercising at an appropriate intensity is the “talk test.” During moderate intensity exercise you should still be able to carry on a conversation, although you may be breathing more heavily than usual. If you become so breathless that speaking in complete sentences is difficult, the intensity is probably too high and should be reduced.

Finally, remember that pregnancy is not an illness. The vast majority of women with uncomplicated pregnancies benefit from remaining active. Regular exercise helps maintain cardiovascular fitness, reduces excessive weight gain, improves mood and sleep, lowers the risk of gestational diabetes and pre-eclampsia, and may even contribute to a shorter labor and faster postpartum recovery (ACOG, 2023).

Diet and Hydration

Continue eating a balanced diet containing adequate protein, healthy fats, whole grains, fruit and vegetables while maintaining good hydration. Although there is no specific “implantation diet” that has been proven to improve IVF success, good nutrition supports maternal health, placental development and early fetal growth (NICE, 2021).

Aim to include a wide variety of colorful fruits and vegetables every day, as these are naturally rich in polyphenols, flavonoids and other antioxidants that support endothelial function, healthy blood vessels and protection against oxidative stress. While no individual food has been shown to directly improve implantation, a diet rich in plant-based nutrients may help create a healthy metabolic and vascular environment for early pregnancy. Berries, pomegranates, citrus fruits, tomatoes, leafy green vegetables, beetroot, extra virgin olive oil, nuts, seeds and legumes are all excellent choices and form the foundation of a Mediterranean-style diet, which has been associated with improved reproductive health and pregnancy outcomes in observational studies (Karayiannis et al., 2018).

Healthy fats are equally important. Choose foods such as extra virgin olive oil, avocado, nuts and seeds, and include oily fish such as salmon, sardines or trout once or twice per week, while avoiding fish with a high mercury content. Omega-3 fatty acids contribute to normal placental development and help maintain a healthy inflammatory balance during early pregnancy.

Maintaining good hydration is also important. Aim to drink enough water throughout the day to keep your urine pale yellow. Good hydration supports normal circulation and overall wellbeing, although drinking excessive amounts of water has not been shown to improve implantation.

Foods to prioritize during the two-week wait include:

• Colorful berries (blueberries, strawberries, raspberries)
• Pomegranate
• Citrus fruits
• Leafy green vegetables (spinach, kale, rocket)
• Beetroot
• Tomatoes
• Extra virgin olive oil
• Walnuts, almonds and other unsalted nuts
• Avocados
• Beans, lentils and chickpeas
• Eggs
• Pasteurized Greek yogurt and other pasteurized dairy products
• Oily fish with a low mercury content such as salmon
• Lean poultry and other high-quality protein sources

Continue taking your prenatal vitamin containing methylfolate, together with any supplements specifically recommended by your fertility specialist. If you were already taking an omega-3 supplement before treatment, this can usually be continued throughout early pregnancy unless advised otherwise.

If you normally drink coffee or tea, moderate caffeine intake is acceptable. Current guidelines recommend limiting caffeine to less than 200 mg per day, which is approximately equivalent to one or two regular cups of coffee (ACOG, 2020). Filtered coffee is usually

Avoid alcohol, tobacco products and recreational drugs throughout this period. In addition, we recommend discontinuing supplements that have not been specifically approved by your fertility specialist, particularly herbal or high-dose antioxidant products for which safety during early pregnancy has not been established. This includes supplements such as high-dose resveratrol, concentrated curcumin (turmeric extracts), high-dose green tea extract (EGCG), ginkgo biloba, and other herbal preparations marketed for detoxification, anti-ageing or circulation. While some of these compounds have theoretical health benefits before conception, there is insufficient evidence regarding their safety during the earliest stages of pregnancy, and some may influence prostaglandin activity, folate metabolism or blood clotting. Once an embryo has been transferred, the guiding principle should be to keep things simple and continue only those medications and supplements that have been specifically recommended by your fertility specialist.

Finally, avoid unpasteurized dairy products, raw or undercooked meat, raw seafood and other foods that are generally discouraged during pregnancy to reduce the risk of food-borne infections (NICE, 2021).

Heat Exposure

During the first few weeks of pregnancy, it is sensible to avoid activities that can significantly raise your core body temperature, such as using hot tubs, Jacuzzis, saunas, steam rooms, or spending prolonged periods in very hot environments. Unlike a warm shower or bath, these activities can increase your internal body temperature to levels associated with maternal hyperthermia.

The embryo undergoes its most rapid period of organ development during the first trimester, particularly between the 3rd and 8th weeks of pregnancy. Several observational studies have suggested that sustained maternal hyperthermia during this critical period may be associated with a small increase in the risk of certain congenital abnormalities, particularly involving the neural tube, although the absolute risk remains low (Moretti et al., 2005; ACOG, 2023). For this reason, most obstetric and fertility societies recommend avoiding situations that are likely to raise your body temperature above normal.

This recommendation does not mean that you need to avoid warm showers, normal baths, cooking, spending time outdoors in warm weather, or other everyday activities. These do not typically increase your core body temperature sufficiently to pose any concern. Instead, the aim is simply to avoid prolonged exposure to excessive heat or any activity that leaves you feeling overheated, flushed, or causes excessive sweating. If you do become overheated, move to a cooler environment, drink plenty of water, and allow your body temperature to return to normal.

Swimming and Public Pools

Swimming itself is not known to interfere with embryo implantation. However, many clinics recommend avoiding public pools, hot tubs and spa facilities until after your pregnancy test as a simple precaution, particularly because of the combination of warm water and the small risk of exposure to poorly maintained facilities.

Sexual Intercourse

Although there is no strong scientific evidence that sexual intercourse after embryo transfer reduces implantation or pregnancy rates, many fertility specialists recommend avoiding vaginal intercourse until your pregnancy test. This advice is largely precautionary and is intended to minimize uterine contractions associated with female orgasm during the short implantation window. While these contractions are a normal physiological response, there is currently no convincing evidence that they negatively affect implantation in humans (Practice Committee of the American Society for Reproductive Medicine, 2017).

If your pregnancy test is negative, you may resume sexual intercourse whenever you feel physically and emotionally ready.

If your pregnancy test is positive, intercourse is generally considered safe and can usually be resumed after confirmation of an ongoing intrauterine pregnancy with a fetal heartbeat, provided there has been no vaginal bleeding, significant pain, placenta previa, cervical insufficiency, recurrent pregnancy loss requiring individualized precautions, or any other complication for which your physician has advised pelvic rest. Sexual intercourse during a normal, uncomplicated pregnancy has not been shown to increase the risk of miscarriage, and the baby remains well protected within the uterus by the amniotic sac, cervix and mucus plug (ACOG, 2023).

As with many aspects of IVF, there is no universal rule. If your fertility specialist recommends a longer period of pelvic rest because of your individual medical circumstances, such as bleeding, ovarian enlargement following stimulation, or a difficult embryo transfer, you should follow their advice.

Air Travel

Commercial air travel is considered safe following embryo transfer and has not been shown to reduce implantation or pregnancy rates. If travelling causes you significant anxiety, you may prefer to remain locally for a few extra days simply for your own peace of mind. From a medical perspective, however, flying is considered safe.

Avoid Harmful Substances

Avoid alcohol, tobacco products, vaping and recreational drugs throughout this period, as all have the potential to adversely affect an early pregnancy. If you require assistance stopping smoking or vaping, speak with your healthcare provider.

Medications and Supplements

Do not start any new prescription medications, over-the-counter medicines, herbal products or nutritional supplements without first discussing them with your fertility specialist or obstetrician. While many medications are perfectly safe during pregnancy, others may not be appropriate during this critical stage of embryonic development. If you are unsure whether something is safe, it is always best to ask before taking it.

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A Final Word: Perhaps the most important piece of advice is this: do not let the two-week wait take over your life. The embryo has already been placed exactly where it needs to be. Whether implantation occurs depends largely on the biological interaction between the embryo and the endometrium, rather than on how much you rest or how carefully you walk around. Continue your normal routine, keep yourself occupied, spend time with family and friends, enjoy activities that help you relax, and try not to analyze every sensation you experience. Mild cramping, the absence of symptoms, breast tenderness, spotting, bloating or no symptoms at all can all occur in both successful and unsuccessful cycles and are not reliable indicators of the outcome.

The waiting period is often the hardest part of IVF. Be kind to yourself, follow your treatment plan carefully, and remember that there is very little you can do at this stage to either help or hinder implantation. Your job now is simply to look after yourself while nature takes over.

References

American College of Obstetricians and Gynecologists (ACOG). (2020) Moderate Caffeine Consumption During Pregnancy. Committee Opinion No. 462. Washington, DC: American College of Obstetricians and Gynecologists.

American College of Obstetricians and Gynecologists (ACOG). (2023) Physical Activity and Exercise During Pregnancy and the Postpartum Period. Committee Opinion No. 804. Washington, DC: American College of Obstetricians and Gynecologists.

American College of Obstetricians and Gynecologists (ACOG). (2023) Sexuality During Pregnancy. Frequently Asked Questions FAQ156. Washington, DC: American College of Obstetricians and Gynecologists.

Barnhart, K.T., Sammel, M.D., Rinaudo, P.F., Zhou, L., Hummel, A.C. and Guo, W. (2004) ‘Symptomatic patients with an early viable intrauterine pregnancy: hCG curves redefined’, Obstetrics & Gynecology, 104(1), pp. 50-55.

Crawford, G., Ray, A., Gudi, A., Shah, A. and Homburg, R. (2015) ‘The role of seminal plasma for improved outcomes during in vitro fertilization treatment: A systematic review and meta-analysis’, Human Reproduction Update, 21(2), pp. 275-284.

Doubilet, P.M., Benson, C.B., Bourne, T. and Blaivas, M. (2013) ‘Diagnostic criteria for nonviable pregnancy early in the first trimester’, New England Journal of Medicine, 369(15), pp. 1443-1451.

European Society of Human Reproduction and Embryology (ESHRE). (2023) Good Practice Recommendations for Add-ons in Reproductive Medicine. Grimbergen, Belgium: ESHRE.

Karayiannis, D., Kontogianni, M.D., Mendorou, C., Douka, L. and Mastrominas, M. (2018) ‘Adherence to the Mediterranean diet and IVF success: A prospective cohort study’, Human Reproduction, 33(3), pp. 494-502.

Moretti, M.E., Bar-Oz, B., Fried, S. and Koren, G. (2005) ‘Maternal hyperthermia and the risk of neural tube defects in offspring: A systematic review and meta-analysis’, Epidemiology, 16(2), pp. 216-219.

Morse, C.B., Sammel, M.D., Shaunik, A., Allen-Taylor, L. and Barnhart, K.T. (2012) ‘Performance of human chorionic gonadotropin curves in women at risk for ectopic pregnancy: Exceptions to the rules’, Fertility and Sterility, 97(1), pp. 101-106.

National Institute for Health and Care Excellence (NICE). (2021) Antenatal Care. NICE Guideline NG201. London: National Institute for Health and Care Excellence.

Practice Committee of the American Society for Reproductive Medicine. (2017) ‘Performing the embryo transfer: A guideline’, Fertility and Sterility, 107(4), pp. 882-896.

Purcell, K., Schembri, M., Frazis, A., Rall, K. and Kovacs, G. (2007) ‘Bed rest after embryo transfer: A meta-analysis’, Fertility and Sterility, 87(3), pp. 528-531.