Author Name: Dr. Pavitra B.S. || Mentor Name: Dr. Shyam Gupta on April 11, 2020

In Vitro Fertilization (IVF) treatment and the advances in it are making possible for a lot of couples to experience parenthood. IVF treatment and the course of implantation involved are quiet stressful, especially the two week wait period after Embryo Transfer.

What is implantation during pregnancy?

Implantation is one of the unpredictable biological events of entire pregnancy — conception being the first and unique after embyo transfer. But unlike conception, one may not even notice that implantation is taken place, although some women experience varierty of vague symptoms & sign as period-like cramping and a little spotting.
Implantation is the time frame during early pregnancy when a cluster of rapidly dividing cells called a blastocyst, makes its way through the fallopian tube and burrows deep inside endometrial lining of uterus especially in case of natural pregnancy but in IVF similar process happens when transfer inside the endometrial cavity directly. Thereafter, the embryo hatching starts and releasing hormones that prepare uterus and body for baby, tune off period, creating the placenta, and possibly making women feel crampy and tired.

When does implantation occur?

Implantation is described as a time frame because it occurs about 8 to 9 days post-fertilization, though it can happen 6- 12 days after ovulation during natural conception. While considering IVF, implantation occurs within 72 hours of embryo transfer. Moreover, many people consider fertilization to be the start of pregnancy which happens in Embryo Laboratory, but successful implantation is the more crucial hurdle.

What are the signs and symptoms of implantation?

Any signs and symptoms related to implantation indicate body start preparing itself for welcoming pregnancy.
The most of going to be mother don’t feel anything during the process, but others may experience various symptoms which may be signs of embryo implantation, among them.

A) Vaginal discharge and spotting – Around 7-42% of the cases may experience slight bleeding in IVF, which may be dark brown/blackish in color. Spotting that occurs halfway through the two-week wait is attributed to “implantation bleeding” which occurs due to the embryo implanting itself into the uterine wall.
Actually These blood flows happen when cells shed from the oxygen-rich tissue that lines the uterus during the process. Implantation bleeding mostly will appear days before expected menstruation day to start, and, compared to period flow, it will be scant and spotty, looks like pink and turning brown. Mostly it won’t flow much or contain any brown clots, and probably should stop within a day or two.
Another cause for spotting during this period may be due to vaginal progesterone applicators which touch very sensitive ectocervix leading into minor spotting. Sexual intercourse too may cause slight spottin.

B) Abdominal Cramping – Many women don’t have any symptoms of implantation, but the subsequent hormonal shifts can cause cramps called implantation cramps which shouldn’t be as uncomfortable as compare to discomfort before and during the period.

Besides, mild cramps and pelvic discomfort are also common after embryo transfer due to the high doses of gonadotropins and ovum pick up related fluid around ovaries and subsequently sometime ovarian hyperstimulation. However, mild to moderate cramps can be a sign of embryo implantation. Implantation isn’t exactly painful, but very early pregnancy — no matter how joyful — can make women feel sick.

C) Breast changes – Breasts become heavy, sore and tender to touch which is usually caused by progesterone hormone therapy used in IVF. Breasts become heavy and tender even in normal pregnancy due to the raise in hormone levels as pregnancy advances.

D) Nausea and Morning Sickness – experienced by few cases due to increased levels of hormones in the body. In a normal pregnancy, nausea is associated with increasing levels of beta-hCG which can occur even in IVF cases.

E) Fatigue and weakness – occurs due to increased levels of progesterone supplements used in IVF which causes increased metabolism which in turn depletes energy.

F) Urine pregnancy test – UPT during IVF – to be avoided as ‘Trigger’ given for maturation of eggs before pickup can be beta-hCG, which may give false positive results if tested too early.

G) Amenorrhea – Absence of menstruation-period usually comes 14-18 days after Embryo Transfer.

H) Elevated temperature called an implantation dip – During pregnancy, a woman’s basal body temperature rises and increases about 1 degree at conception and remain higher throughout her pregnancy. If the temperature falls, it reflects that period might be on its way to happen, indicating that implantation didn’t occur. Body temperature could a sign of ongoing successful implantation

Predictors of Implantation

Apart from signs and symptoms of implantation after embryo transfer, nowadays we can predict the process of successful implantation due to various techniques and advanced technologies. The predicting implantation before conception can be a way for confirmation of much successful pregnancy.

Various studies have been done, to predict the implantation of the embryos in IVF.

A study was done to establish a correlation between embryonic aneuploidy and Soluble human leukocyte antigen(sHLA-G) concentration in the spent culture media where media was analyzed for sHLA-G by ELISA assay and Day 3 embryo tested for aneuploidy. Usually sHLA-G concentration of > 1.9mIU/ml was considered a positive predictor of implantation and while comparing with PGD, there is no statistical significant in correlation.

In another study AMH value as a predictor of implantation and clinical pregnancy after IVF was done. It was found that AMH has weak association with implantation and clinical pregnancy rates in ART.

One more study was done to know cytokines TNF alpha and IL1 beta as early predictors of embryo implantation. The study group had no significant differences regarding demographic, clinical and laboratory data except for the duration of pregnancy and concentration of TNF-alpha and IL-1beta which was tested in the uterine fluid obtained through intrauterine flushing using ET catheter just before embryo transfer.

The concentration of THF-alpha and IL-1beta were significantly higher in the pregnant group than the nonpregnant group in the study, thus the use of TNF-alpha and IL-1beta to predict implantation in IVF has meaning after embryo transfer.


Implantation is a very crucial event but easy-to-miss many time. It often simulates as your period, causing spotting, discomfort to mild pain, swollen breasts and abdomen, and headaches. If any of these symptoms persist and you are wondering whether or not you are actually pregnant, better to perform a home pregnancy test or see your practitioner for confirmation. While implantation itself may not be to blame, the series of hormonal changes in the body will help to launch a new life which can leave females feeling temporarily weak and woozy.

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