# Sticky  2WW ~ FREQUENTLY ASKED QUESTIONS



## LizzyB

Hi there and welcome to the 2WW

Below is a list of Frequently Asked Questions on the 2WW Board.

Many thanks to Natasha (Minxy) for providing a huge amount of
support and advice....many of the answers have been collated
from her invaluable responses to many members of this site.

This is also a work in progress.....more information will be added
in time and of course if there are any questions you would like
adding please IM me.

Lizzy xxx

​
• The information provided on this site is designed to support, not replace, the relationship
that exists between a patient/site visitor and his/her existing physician ​
• Some posts contain unconfirmed links/information and readers are reminded that FertilityFriends.co.uk
or its owners are not responsible for the content of external internet sites ​


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## LizzyB

Implantation Bleeding​
What is Implantation Bleeding?
Implantation bleeding is lighter than menstrual bleeding, and consists of pink or brown colored blood. Implantation bleeding occurs when the trophoblast, or tissue that surrounds the egg, attaches to the endometrium and slowly eats its way into the lining. As it does so, it eats through the mother's blood vessels, forming blood lakes within itself. When these blood lakes form near the surface of the trophoblast, they often cause implantation bleeding.

Remember, the difference between period and implantation bleeding is the amount; implantation bleeding is considerably lighter than menstrual bleeding. Menses and implantation bleeding should be different enough so that you can tell. Here are some frequently asked questions about spotting:

When does implantation bleeding occur? 
In natural conception, implantation happens around 5-12dpo so with assisted conception you need to take into account how old embies were when put back eg day 2 transfer, day 3 transfer etc. Only once embies have reached blastocyst stage at approx 5 days will they be ready to start implanting.

What does implantation bleeding look like? 
Implantation bleeding signs are a light pink or brown colored spotting

Can I still get a BFP if I don't have an Implantation Bleed?
Yes.....absolutely. Symptoms vary enormously and there are many people on the site who have had BFPs with no spotting/bleeding at all.

Useful Links:

http://www.fertilityfriends.co.uk/forum/index.php?topic=67298.0
http://www.fertilityfriends.co.uk/forum/index.php?topic=48236.0;viewResults


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## LizzyB

Testing​
Do I need a blood test or can I use a HPT?
The BETA hcg blood tests are qualitative which means they check the actual level of hcg in the blood.

An HPT detects to see if there's a certain amount of hcg in the urine...many will only show +ve if there's a level of around 25 miu or more, although some may detect as low as 10 miu, it depends on the actual hpt. However, even tests that say you can use early as they're more sensitive are only about 65-69% accurate when used early.

With a blood test checking the level of hcg hormone in the blood they will be able to detect much earlier as they will obviously show the actual amount eg whether its only 1 miu or 301 miu etc etc so are obviously way more sensitive than a peestick !!

The hcg hormone is released from the embryo once its implanted...so it would depend on whether early or late implantation (which happens around 5-12dpo in natural conception...with assisted such as ivf then you need to take into account how old embie was when put back). So if early implantation then some women may get +ve result on HPT early but if late implantation then may not show until at least 14 days after transfer (or ovulation if natural conception)...but with hcg blood test then would be able to detect the level of hormone even a day or so after implantation.

When should I test?
Most clinics advise to test around 14 days after ET although they do tend to vary. If you have had blastocysts transferred you will probably be asked to test after approx 10 days as the embryo is older when it is transferred.

How long before HCG is out of my system?
The HCG injection can stay in your body for approx 10-14 days but obviously we all eliminate the drugs from our systems at different rates. As a very basic approximation, 1000iu of pregnyl eliminated from body per day so gives you a rough idea.

Can I test early?
It doesn't matter that the hcg injection may have left your body...its whether theres enough hcg released from the implanted embryo for the HPT to detect. Implantation happens around 5-12 dpo and only once its complete will the hcg hormone be released. If you have late implantation then it may not show up on an HPT. The reason clinics give you testing dates is because you're far more likely to get an accurate result then. The possiblity of a false result may cause added stress at an already anxious time but it is ultimately up to personal choice.

Useful links:

http://www.peeonastick.com/hpts.html
http://www.fertilityplus.org/faq/hpt.html


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## LizzyB

Food and Drink​
What should I eat on the 2WW?

The usual advice is to eat as though you are pregnant so a fairly healthy balanced diet. It's also important to drink 2-3 litres of water. This helps flush out the empty follicles which will keep filling with blood & helps prevent OHSS as well as flush out all the drugs from treatment & during EC...and obviously ensure you're hydrated.

http://www.food.gov.uk/multimedia/pdfs/life02eatingwhenpregnant.pdf

Why do people suggest Pineapple Juice?
Pineapple contains selenium...and selenium (an anti-oxident) helps promote a healthy womb lining which is why it is thought to aid implantation. Pineapple also contains an enzyme called bromelain which is contraindicated during pregnancy as it may cause uterine contractions (many people, especially in Asian cultures, suggest eating fresh pineapple to induce labour if overdue)....however, during processing this delicate enzyme is destroyed which is why its ok to drink pineapple juice in moderation when ttc or pg but not to eat fresh pineapple/pineapple pieces etc .

The preferred juice to drink is fresh, pressed or "not from concentrate"....although not the best, its still ok to drink "from concentrate"...all this means is that the pineapple pulp has been frozen or freeze dried for exportation and then reconstituted with water.

A small glass of pineapple juice a day is supposed to be good but there are also many other food sources richer in selenium than pineapple (brazil nuts included!)

This link provides some info on selenium & a list of food souces:

http://ods.od.nih.gov/factsheets/selenium.asp


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## LizzyB

Pregnancy Symptoms​
Thanks to Sue MJ for finding this info on early pregnancy symptoms.

We're all guilty of it, in our 2ww - as we know we have our lovely embies on board, we assume that our bodies will suddenly start kicking out all the pregancy hormones and we should all be feeling something 'positive' to say 'YES' we're definately pregnant!

Well, I've been trying to think a bit logically about this (OK, have the occasional blip - where logic just goes out of the window!). Lets face it, we have our embies put back between 2-5 days post EC, well the day of EC, is classed as the day of Ovulation, so you then need to allow 6-10 days post ovulation, for the embies to implant (or there abouts anyway!). Once implanted, it's not suddenly going to produce mountains of hormones, these will build up over the coming weeks, or months, at which point you may then expect the various symptoms (bare in mind, many women don't experience any symptoms at all!).

I think we are all so desperate for some sign, that our imaginations run wild, we analyse every twinge, every bit of tiredness etc......

So, not sure if this is helping anyone, but I've found the following information about Early pregnancy Symptoms, which I think has to be the most down to earth stuff I've read;

*Q: What are typical early pregnancy symptoms and pregnancy signs? Can I feel the pregnancy signs and symptoms before missing my period?

Many women have typical pregnancy symptoms even before they miss their period. However, most of the typical pregnancy symptoms and signs are directly related to the pregnancy hormone hCG. Small amounts of hCG enter the blood stream several days after implantation, about 8-10 days after ovulation. Thus, typical pregnancy symptoms typically do not appear until the hCG has reached sufficient levels which is about 1-2 weeks after you miss your period (3-4 weeks after ovulation, or 2-3 weeks after implantation), at a time when the hCG has risen enough. Nothing will really confirm a pregnancy except a positive pregnancy test.
The first symptoms and the time of their appearance are listed here:*


Temperature drop (dip) on Implantation day
Implantation bleeding or spottinga slight staining of a pink or brown color on average 8-10 days after ovulation))
Lower abdominal cramps
A positive blood HCG pregnancy test: About 10 days after fertilization/ovulation
An elevated bbt curve for 15+ days without a menstrual period
A missed menstrual period (amenorrhea):
A positive urine pregnancy test (HPT): As early as 10-14 days after ovulation/fertilization or 3-4 days after implantation. The more sensitive the HPT the earlier the pregnancy test will be positive.
Nausea: as early as 2-4 weeks after ovulation (BrJObGyn 1989b;96:1304)
Nipple or breast tenderness: 3-4 weeks after conception
Fatigue: 3-10 weeks after conception
Vomiting: 3-10 weeks after conception
Food cravings: 1-2 months after conception
Frequent urination: usually after 1-2 months
Softening of cervix: usually not before 6 weeks after LMP
Constipation: later on
Lower back pain: later on
Darkening of areola (breast nipple): After 14 weeks
Fetal heart beat on sonogram: 8-9 weeks after conception
Fetal movements: 16+ weeks after conception

The Link for this site is;

http://www.babymed.com/docs/english/21.asp

Hope you find this useful - so lets stop stressing!!! Remember everyone is different and there are many pregnant people that were convinced they were not pregnant and thought af was about to arrive any moment!

Take care all,

Love,

Sue 

 This post contains unconfirmed links/information and readers are reminded that
FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites.


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## LizzyB

EMBRYO GRADING​
Day 1 Check eggs for fertilization (the presence of two pronuclei or PN's)
Day 2 Embryos at the 4-cell or more stage of development
Day 3 Embryos at the 8-cell or more stage of development
Day 4 Embryos at the compacted morula (16-32 cell) stage
Day 5 Embryos at the blastocyst stage of development

...Critical points in development are (1) fertilization, (2) 4 to 8 cell stage and (3) morula to blastocyst stage.

With regards to grading, some clinics use the reverse scale so that Grade 4 is best...you would need to check with your own clinic and some clinics don't grade at all...

Numeric grading systems for multicell embryos usually have 4 levels (this showing Grade 1 as best):

Grade 1: even cell division, no fragmentation
Grade 2: even cell division, small fragmentation
Grade 3: uneven cell division, moderate fragmentation
Grade 4: uneven cell division, excessive fragmentation

Blastocysts are graded differently with a number and two letters.

The number refers to the degree of expansion of the blastocyst (1 is the least expanded, 6 is the most expanded). The first letter (A,B, or C) refers to the quality of the inner cell mass (the part of the blastocyst that is going to be the baby) and the second letter (A, B, or C) refers to the quality of the trophectoderm (the part of the blastocyst that is going to be the placenta).

Sometimes the laboratory uses the reversed scale where a grade 4 embryo is equivalent to a grade 1 embryo on the above scale. Check with your lab

And here's some more info...

http://www.ivf-bath.co.uk/treatments/embryo_grading.htm

However, lower grades and less cells doesn't necessarily mean that won't implant, just as higher grades can't guarantee success...

This website shows pictures of the different embryos and uses the reverse grading where grade 4 is best...

http://www.advancedfertility.com/embryos.htm

Many clinics will also only freeze grade 1 embies so usually an embie with more than 2 cells. The problem is that embies are so fragile and with the thawing process they can sometimes lose cells...so if only 2 cell embie frozen then it may not survive the thaw...although some do so would also depend on whether there was any fragmentation...

Some women may only get 3 or so eggs and some may have "lower" grade embryos but still go on to get that much wanted BFP......whilst others may get lots of eggs and "high" grade embies and BFN...there really are no guarantees sadly which is why it's probably best not to dwell too much on it.

 This post contains unconfirmed links/information and readers are reminded that
FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites.


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