What to do after embryo transfer

Overview
What happens after the transfer
Acupuncture before and after embryo transfer
On the day of transfer
What to do in the two-week wait
What to avoid
Diet and nutrition
Supplements and medication
The TCM perspective on implantation
Symptoms to watch for
When to take a pregnancy test
If the transfer is successful
Frequently asked questions
References

1. Overview

Embryo transfer is the final — and perhaps most emotionally intense — step of an IVF or frozen embryo transfer (FET) cycle. The two weeks that follow the transfer, as you wait to find out whether implantation has occurred, can be one of the most challenging periods of the entire fertility journey.

Most IVF clinics advise patients to simply carry on as normal after the transfer. In my clinical experience, however, there are several things that can meaningfully support implantation and improve the chances of a successful outcome. The advice on this page is based on over 25 years of clinical experience treating patients through IVF and assisted conception, on the latest research into implantation support, and on the principles of traditional Chinese medicine (TCM). It applies equally to fresh embryo transfers, frozen embryo transfers and donor egg or donor embryo cycles.

2. What happens after the transfer

During the transfer, a thin catheter is guided through the cervix and the embryo is placed into the uterine cavity under ultrasound guidance. The procedure is usually quick and painless. The embryo does not need to travel far — it will drift slowly and settle within the uterine cavity over the following hours.

If the embryo is at the blastocyst stage (day 5 or day 6 of development), it will typically begin to hatch from its outer shell (the zona pellucida) within 24–48 hours of transfer, and will then begin the process of implantation — burrowing into the uterine lining. Full implantation is usually complete by around six days after the transfer. It is during this implantation window that the embryo establishes its blood supply and begins producing human chorionic gonadotropin (hCG), the hormone detected by pregnancy tests.

If the embryo is at the cleavage stage (day 3 of development), it will continue to develop in the uterine cavity over the following days before reaching the blastocyst stage and beginning hatching and implantation.

It is important to understand that once the embryo has been transferred, the outcome is largely determined by factors that were established during the preceding weeks and months — the quality of the embryo, the receptivity of the uterine lining, and the immunological environment of the uterus. This is why I recommend beginning preparation for an IVF cycle at least three months in advance, rather than focusing exclusively on the two weeks after transfer.

3. Acupuncture before and after embryo transfer

Having acupuncture on the day of embryo transfer — ideally 25 minutes before the procedure and again 25 minutes after — is one of the most evidence-supported things a woman can do to improve her IVF outcomes.

What the research shows

A meta-analysis of 25 randomised controlled trials involving 4,757 participants found that acupuncture significantly increased both clinical pregnancy rates (43.6% vs 33.2% in controls, P<0.00001) and live birth rates (38.0% vs 28.7%, P<0.00001) in women undergoing IVF.¹

A 2024 meta-analysis of 145 RCTs involving 27,748 participants found that acupuncture significantly elevated the overall clinical pregnancy rate compared to controls (RR 1.21, 95% CI 1.07–1.38, P=0.01).²

A 2024 meta-analysis examining the timing and dose of acupuncture found that for frozen embryo transfers (FET), acupuncture before the transfer significantly enhanced both the clinical pregnancy rate (RR 1.71, P<0.00001) and live birth rate (RR 2.40, P=0.01). Higher dosages of acupuncture were also associated with better outcomes.³

A randomised controlled trial of 186 IVF patients found that acupuncture 25 minutes before embryo transfer produced significant improvements in biochemical, clinical and ongoing pregnancy rates compared to no acupuncture.⁴

How acupuncture supports implantation

Acupuncture supports implantation through several mechanisms:

Increasing uterine blood flow — improving the receptivity of the endometrial lining and the quality of the implantation environment
Reducing uterine contractions — excessive uterine contractions in the hours after embryo transfer can dislodge the embryo; acupuncture has been shown to calm uterine contractility
Modulating immune response — supporting the immunological tolerance of the embryo by the uterine immune system
Reducing anxiety and cortisol — the procedure itself is anxiogenic; high cortisol impairs implantation, and acupuncture produces reliable, measurable reductions in anxiety on the day of transfer

Acupuncture during the two-week wait

I recommend having acupuncture at least twice during the two-week wait following transfer. This supports ongoing blood flow to the uterus, helps to manage the anxiety and emotional stress of the wait, and continues to support the immunological environment for implantation. For women who have experienced repeated IVF failures or who have a history of miscarriage, more frequent acupuncture during this period can be beneficial.

I offer IVF acupuncture at my Wokingham clinic and am available for out-of-hours appointments on transfer day when needed.

4. On the day of transfer

Before the transfer

Keep warm — apply gentle warmth to your lower abdomen in the hours before transfer. A warm (not hot) wheat bag or heat pad on the lower abdomen, below the navel, can increase blood flow to the uterus. Remove this before leaving for the clinic.
Avoid perfumes, cosmetics and scented products — on the day of transfer, avoid wearing perfume, scented body lotion or heavily fragranced products. Some fertility specialists believe synthetic fragrance chemicals may interfere with the implantation environment, and it is sensible to minimise any potential exposure.
Drink water — your clinic will ask you to arrive with a full bladder, which assists with ultrasound guidance. Drink enough water beforehand as instructed.
Stay calm — take time that morning to breathe, relax and approach the procedure with as much equanimity as you can. If acupuncture before the transfer is part of your plan, schedule it for 25 minutes before your appointment time.
Eat warm foods — a warm, nourishing meal before transfer helps to support blood flow to the uterus. Avoid cold foods and drinks on the day.

After the transfer

Rest briefly — lie down for 20–30 minutes after the transfer if possible. This is not because the embryo will "fall out" if you stand up — it will not — but because brief rest helps to reduce anxiety and allows the body to settle after the procedure.
Do not apply heat to your abdomen after transfer — unlike before the transfer, direct heat applied to the abdomen post-transfer is not recommended. If you are cold, apply warmth to your lower back rather than directly over the uterus.
Eat warm, nourishing foods — continue with warm, easily digestible meals for the rest of the day.

5. What to do in the two-week wait

Rest, but not complete bed rest

Complete bed rest after embryo transfer is not supported by evidence and is not recommended by most fertility clinics. A 2021 study published in Reproductive Biomedicine Online found no difference in embryo transfer success rates between patients who resumed regular activity immediately and those who reduced activity.⁵ The key is avoiding activities that are physically strenuous or emotionally exhausting. Gentle activity — slow walks, light yoga, easy daily tasks — is perfectly fine and can help to manage the anxiety of waiting.

Keep warm

In TCM, warmth supports the yang energy needed for implantation. Keep yourself comfortably warm — appropriate clothing for the season, avoiding sitting in cold draughts, and drinking warm rather than cold beverages. A warm wheat bag applied to the lower back (not the abdomen) can be soothing and supportive.

Prioritise sleep

Aim for seven to nine hours of good-quality sleep per night during the two-week wait. Sleep is when cellular repair, immune regulation and hormonal stabilisation occur. Maintaining a consistent sleep schedule and a calming bedtime routine helps both implantation and the emotional management of the wait.

Stay well hydrated

Adequate hydration supports good blood flow and hormonal balance. Drink plenty of warm or room-temperature water throughout the day. Avoid very cold drinks, as these can impair digestive function and, according to TCM, cool the uterine environment.

Manage stress and anxiety

The two-week wait is one of the most anxiety-inducing experiences in fertility treatment. Chronic anxiety elevates cortisol, which directly suppresses the immune tolerance mechanisms needed for successful implantation. Acupuncture, mindfulness meditation, gentle yoga, and time with supportive people are all beneficial. Avoid reading excessive amounts of IVF-related forums, social media or online symptom-checkers during this period, as these are typically more anxiety-provoking than helpful.

Visualisation and positive intention

Taking time each day to lie quietly and visualise positive outcomes — imagining the embryo implanting safely, blood flowing warmly to the uterus, your body welcoming the pregnancy — is a practice I recommend to my patients. The evidence for specific visualisation techniques in IVF is limited, but the practice of directed relaxation and reducing the tension of "waiting" has clear benefits for the neuroendocrine environment of implantation.

6. What to avoid

Strenuous exercise — avoid high-impact exercise, heavy lifting, vigorous aerobics or anything that significantly raises your heart rate or generates significant physical stress during the two-week wait.
Hot baths, saunas and steam rooms — elevated core body temperature is associated with impaired implantation. Showers are preferable to baths; if you do have a bath, keep the water comfortably warm rather than hot.
Alcohol — avoid alcohol entirely during the two-week wait. Alcohol impairs embryo implantation and increases miscarriage risk.
Caffeine — limit caffeine to no more than one cup of coffee or two cups of tea per day. High caffeine intake is associated with increased miscarriage risk in early pregnancy.
Smoking — do not smoke during the two-week wait or at any point during fertility treatment. Smoking significantly impairs implantation and early pregnancy.
Sex — most clinics advise avoiding penetrative sex for the first few days after transfer, though the evidence that it affects implantation specifically is limited. Follow your clinic's guidance.
NSAIDs (ibuprofen, aspirin) — avoid ibuprofen and other non-steroidal anti-inflammatory drugs unless specifically prescribed by your doctor, as they may interfere with implantation. Paracetamol is generally considered safe if you need pain relief.
Early pregnancy testing — avoid taking a home pregnancy test before the date your clinic has specified (typically 10–14 days after transfer). Testing too early risks a false negative (not enough hCG has accumulated yet) or a false positive (if you received an hCG trigger shot). Both outcomes cause unnecessary distress. Wait for the official blood test at your clinic.
Watching frightening or highly distressing content — this is a small but practical point: strong emotional shocks — from disturbing films, upsetting news or stressful conversations — activate the stress response and raise cortisol. During the two-week wait, prioritising calm and positive input is sensible.

7. Diet and nutrition

Diet in the two-week wait follows the same principles as throughout the IVF preparation period:

Eat warm, nourishing food

From a TCM perspective, warm, cooked foods support uterine blood flow and the yang energy of implantation. Avoid raw, cold and very chilled foods during this period — soups, stews, lightly cooked vegetables, warm grains, and nourishing protein are ideal.

Prioritise iron-rich foods

Iron is essential for the development of the uterine lining and for supporting early pregnancy. Good sources include lean red meat, chicken, lentils, spinach, tofu and fortified cereals. Combining iron-rich foods with vitamin C (citrus juice, peppers, kiwi) improves absorption.

Include antioxidant-rich foods

Antioxidant-rich fruits and vegetables continue to support the implantation environment by reducing oxidative stress. Berries, leafy greens, tomatoes, sweet potato, pomegranate and cruciferous vegetables are all beneficial.

Eat adequate protein

Protein supports the hormonal environment of implantation and provides the raw materials for early embryonic development. Include a quality protein source at each meal.

Drink warm water and herbal teas

Warm water, herbal teas (avoiding those not recommended in pregnancy such as high-dose liquorice or nettle) and warm broths are all supportive. Ginger tea in small quantities supports digestion and blood flow. Avoid very cold drinks.

8. Supplements and medication

Take your prescribed medications

This is the single most important supplement instruction for the two-week wait. Your IVF clinic will almost certainly have prescribed progesterone support — whether as vaginal pessaries, oral capsules or injections — and you must continue this exactly as directed. Progesterone is essential for maintaining the uterine lining and supporting early implantation. For frozen embryo transfer cycles (where the body has not produced progesterone naturally), exogenous progesterone support is particularly critical. Do not stop taking it, even if you feel certain the cycle has not worked, until your clinic confirms the result and advises accordingly.

Continue with folate/folic acid

Continue taking 400–800 mcg of folic acid or methylfolate daily. Folate is essential from before conception and throughout early pregnancy for neural tube development. If you are not already taking a good prenatal supplement, this is the time to start.

Vitamin D

If you have been supplementing with vitamin D before transfer, continue during the two-week wait. Vitamin D plays a role in endometrial receptivity and immune modulation relevant to implantation.

Omega-3

If you have been taking omega-3 supplements, continue them. Omega-3 fatty acids support the hormonal environment of implantation and are safe and beneficial in early pregnancy.

Avoid new supplements without guidance

Do not introduce new supplements, herbal preparations or high-dose vitamins during the two-week wait without discussing them with your fertility doctor first. Some supplements — including high-dose vitamin A, certain herbal preparations, and high-dose vitamin E — should be used with caution or avoided in early pregnancy.

9. The TCM perspective on implantation

In traditional Chinese medicine, successful implantation requires the convergence of three conditions: sufficient Kidney yang to provide the warmth and activating energy for the embryo to embed; adequate blood and yin to nourish the uterine lining and sustain early development; and the smooth flow of qi and blood through the uterus, free from stagnation.

The period after embryo transfer corresponds to the beginning of the luteal phase in TCM — the yang phase of the cycle. Treatment at this time focuses on warming and strengthening Kidney yang, supporting blood flow to the uterus, and calming the Heart (which governs the mind and spirit) to reduce anxiety and stabilise the emotional state. Acupuncture points typically used include CV4 (Guanyuan), ST36 (Zusanli), SP6 (Sanyinjiao), KI3 (Taixi) and PC6 (Neiguan), selected and combined according to each patient's individual pattern.

Chinese herbal medicine can also be used to support implantation in the two-week wait, with formulae tailored to the patient's TCM pattern. Herbs that warm and tonify Kidney yang, nourish blood and calm the Heart are frequently employed. I prescribe Chinese herbs in this period only when I have been treating the patient throughout the cycle and know their pattern well — the prescribing should be individualised and adjusted according to the phase of treatment.

10. Symptoms to watch for

Normal symptoms

Many women experience symptoms during the two-week wait that can be confusing to interpret, because the effects of the progesterone medications your clinic has prescribed closely mimic early pregnancy symptoms. These include breast tenderness, bloating, mild cramping, fatigue, emotional sensitivity and light spotting (implantation bleeding). None of these symptoms on their own confirm or rule out pregnancy.

When to contact your clinic

Contact your IVF clinic promptly if you experience:

Severe abdominal pain or cramping
Heavy vaginal bleeding (more than a light period)
Signs of ovarian hyperstimulation syndrome (OHSS) after a fresh cycle — severe bloating, rapid weight gain, difficulty breathing, reduced urination
High fever or signs of infection
Severe pain on one side, particularly if also experiencing dizziness or shoulder pain (which could indicate an ectopic pregnancy)

11. When to take a pregnancy test

Your fertility clinic will give you a specific date for a blood hCG test, typically 10–14 days after transfer. This blood test is significantly more sensitive and accurate than home urine pregnancy tests, and is the definitive test your clinic will use to confirm whether the transfer has been successful.

Resist the temptation to take a home urine pregnancy test before this date. If you transferred a fresh embryo using an hCG trigger shot, a home test will give a false positive in the first week or so after transfer (detecting the trigger medication, not pregnancy). Conversely, taking a test too early may give a false negative, even if implantation has occurred, because hCG levels in early implantation are below the threshold most home tests can detect. Either result will cause unnecessary distress.

If the blood test confirms pregnancy, your clinic will typically schedule an ultrasound scan at around six to seven weeks gestation to confirm a heartbeat.

12. If the transfer is successful

If the transfer is successful, I recommend continuing with acupuncture through the first trimester — ideally weekly until 12 weeks. Research and clinical experience both suggest that acupuncture during early pregnancy reduces the risk of miscarriage and supports the health of the pregnancy. This is particularly important for women who have conceived after repeated IVF cycles, those over 40, and those who have had previous pregnancy losses.

Continue all medications prescribed by your clinic — particularly progesterone support — until instructed to stop. Do not stop progesterone when you see a positive pregnancy test; your clinic will advise on the tapering schedule.

You can read more about supporting a healthy pregnancy in my book My Pregnancy Guide.

13. Frequently asked questions

Should I do complete bed rest after embryo transfer?

No. Complete bed rest is not recommended and is not supported by the evidence. A 2021 prospective study found no difference in outcomes between women who resumed normal activity immediately after transfer and those who reduced their activity.⁵ Gentle, calm activity is fine. Strenuous physical activity should be avoided, but this is different from bed rest.

Can I use a heat pad on my abdomen after the transfer?

Before the transfer, gentle warmth on the lower abdomen is beneficial for increasing blood flow to the uterus. After the transfer, direct heat over the uterus is not recommended. If you are cold, apply warmth to your lower back instead.

Do I need acupuncture on the same day as the embryo transfer?

Acupuncture on the day of transfer specifically — before and/or after the procedure — has the strongest evidence for improving IVF outcomes. However, acupuncture in the weeks leading up to the transfer and during the two-week wait also adds value. If same-day acupuncture is not logistically possible, weekly treatment in the lead-up to and following transfer still provides meaningful benefit.

I have no symptoms. Does that mean it hasn't worked?

No. The absence of symptoms does not indicate a failed cycle. Many women who go on to have successful pregnancies have no symptoms whatsoever during the two-week wait. Conversely, many women who experience significant symptoms — breast tenderness, cramping, nausea — find the cycle has not been successful. Symptoms in the two-week wait are largely driven by the progesterone medication you are taking, and are not a reliable indicator of outcome either way.

What if this transfer doesn't work?

A failed transfer is one of the most difficult experiences in the fertility journey. If this happens, please know that it does not mean IVF can never work for you, and that there is almost always more that can be done. I would recommend a thorough review of what might be improved — including the preparation protocol, any potential immune factors, and the quality of the uterine environment — before the next cycle. Fertility coaching and continued fertility acupuncture in the months between cycles can significantly improve the chances of success in a subsequent transfer.