Course / After the Transfer
Course Overview
The period following an embryo transfer is one of careful observation and support. While the major procedural steps are complete, the implantation phase and early pregnancy monitoring are critical to the success of IVF or surrogacy cycles.
This course provides a comprehensive overview of what happens after the transfer — from biochemical testing to early pregnancy scans — emphasizing medical management, expected outcomes, and professional guidance throughout this crucial phase.
1. Timing of the First Test
The first biochemical indicator of pregnancy is human chorionic gonadotropin (hCG), produced after successful implantation.
Testing is typically performed 9–12 days after embryo transfer.
Blood testing (β-hCG) is preferred over home urine tests for accuracy and quantitative measurement.
At Surrogacy4All’s partner clinics, the post-transfer protocol includes:
Day 10–12: Quantitative serum hCG test.
Day 12–14: Repeat hCG to confirm an appropriate rise (doubling every 48–72 hours).
A normal, steadily rising hCG trend strongly suggests early implantation and ongoing pregnancy development.
2. Understanding hCG Results
| Result Type | Possible Interpretation |
|---|---|
| Negative (hCG <5 mIU/mL) | No pregnancy detected. |
| Low but rising hCG (5–25 mIU/mL) | Early implantation or biochemical pregnancy. Requires repeat testing. |
| Normal rise (>30 mIU/mL with doubling) | Indicative of viable early pregnancy. |
| Falling or plateauing hCG | Possible biochemical pregnancy or early loss. |
Consistency and timing of serial measurements are crucial for accurate interpretation.
Once hCG levels reach ~1,500–2,000 mIU/mL, pregnancy can be visualized by transvaginal ultrasound, usually 5–6 weeks after embryo transfer.
1. Early Ultrasound Goals
The first ultrasound aims to:
Confirm gestational sac presence in the uterus (to rule out ectopic pregnancy).
Verify yolk sac and fetal pole development.
Detect fetal cardiac activity, generally seen by 6.5–7 weeks gestation.
For surrogacy pregnancies, this step is particularly important to:
Confirm single vs. multiple gestations.
Provide reassurance to intended parents.
Establish documentation for ongoing OB care transition.
2. Normal Findings by Timeline
| Gestational Age | Expected Findings |
|---|---|
| 4.5–5 weeks | Gestational sac visible. |
| 5.5 weeks | Yolk sac appears within the gestational sac. |
| 6–6.5 weeks | Fetal pole visible; heartbeat may begin. |
| 7+ weeks | Confirm cardiac activity and measure crown–rump length (CRL). |
Bleeding or spotting after embryo transfer is relatively common and does not always indicate pregnancy loss.
Possible Causes:
Implantation bleeding: Minor spotting around the time of embryo attachment (days 6–10 post-transfer).
Hormonal shifts: Progesterone supplementation can cause cervical irritation.
Subchorionic hematoma: Small collection of blood near the gestational sac seen in some early pregnancies.
When to Contact the Clinic:
Patients or surrogates should alert their fertility care team if they experience:
Heavy bleeding with clots.
Severe abdominal pain or cramping.
Dizziness or fainting.
Management Approach:
Continued hormonal support (progesterone and estrogen) unless directed otherwise.
Serial hCG testing and repeat ultrasounds to assess viability.
Supportive care and monitoring as guided by the fertility physician.
Most cases of mild bleeding resolve spontaneously and result in normal pregnancies.
Despite advances in reproductive medicine, early pregnancy loss remains a possibility, occurring in approximately 10–15% of confirmed IVF conceptions.
1. Biochemical Pregnancy
hCG rises initially but drops before a gestational sac is visible.
Usually due to chromosomal or implantation-related issues.
Managed expectantly; no intervention typically required.
2. Early Miscarriage
Ultrasound shows a gestational sac without fetal growth or heartbeat.
Often caused by chromosomal abnormalities or embryo-endometrial asynchrony.
Management options include medical therapy (misoprostol), surgical evacuation (D&C), or expectant monitoring.
3. Ectopic Pregnancy
Occurs in <2% of IVF cases, but careful monitoring is vital.
Suspect if hCG levels rise abnormally without intrauterine sac formation.
Managed medically (methotrexate) or surgically depending on the case.
At Surrogacy4All, partner clinics prioritize early detection and compassionate management, ensuring both the surrogate and intended parents are fully informed and supported throughout.
Once a viable intrauterine pregnancy is confirmed (typically around 8–10 weeks gestation), patients or surrogates are transitioned from the fertility clinic to routine obstetric care.
1. Criteria for Transition
Positive heartbeat and normal fetal development confirmed on ultrasound.
Stable hormonal support (progesterone often continued until 10–12 weeks).
No complications such as subchorionic hematoma, ectopic risk, or abnormal hCG trend.
2. Documentation and Handoff
The fertility team provides:
Summary of IVF and embryo transfer details.
Medication list and tapering plan.
Genetic screening results (if applicable).
Early pregnancy scans and lab reports.
This ensures a smooth handover to the obstetrician, who will continue standard prenatal monitoring.
3. Emotional and Medical Support
Surrogacy pregnancies involve multiple parties — intended parents, surrogates, and medical teams. Surrogacy4All facilitates a clear communication pathway, ensuring all stakeholders understand the progress and medical status before transitioning to OB care.
Our job is to listen, to connect the dots between your needs, and to determine how we can best help you have your baby. If you’re asking how much does it cost for a surrogate, we’ll walk you through every step of the process to ensure there are no surprises.
To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.
Surrogacy4All is a unique international surrogacy service targeted at providing state of the art IVF and surrogacy services to Intended Parents irrespective of age, sex or color, at the lowest possible cost in the world.
Secret Guide to Minimizing Surrogacy Costs
All Rights Reserved to Surrogacy4all