Pregnant After IVF or IUI: What to Do Next and What to Expect

You finally got the positive test after IVF or IUI — now what? In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols walks you through the first steps after a positive pregnancy test, from confirming with beta hCG bloodwork to your first ultrasound. Learn why rising numbers matter more than the absolute hCG value, why it’s crucial not to stop progesterone or estrogen too early, and what milestones to expect in the first 6–10 weeks.

Dr. Amols also shares common myths, tips for healthy habits, and insight into the emotional rollercoaster of “graduating” from your fertility clinic to your OB. Whether you’ve just seen those two pink lines or are preparing for this moment, this episode offers practical guidance, reassurance, and hope for your next chapter.

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Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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Today we talk about what do you do once you finally get that positive pregnancy test after an IVF transfer or IUI? I, Im Dr. Mark Amols, and this is Taco about fertility. Tuesday, the big day has come. Youve ve been waiting for this the entire time, and now your're pregnant. For some of you, that test feels like the finish line, but in reality, it'the starting line for the next chapter pregnancy. So today, let's talk through what happens next, step by step. Okay, first things first. Celebrate. You'been through a lot to get here. Ive literally seen patients come in with a ziploc bag of, ah, 20 pregnancy tests with some showing faint positives and others showing darker positives. Like a little museum of hope. And if thats you, youre not strange. Thats very normal because youve been working a long time to get to this point. When my wife and I saw our first positive pregnancy test, I took a picture of it and put it on Facebook. I was so excited, I didnt even notice that her pee was still on the stick. Everyones reaction is different. Ive seen couples cry in disbelief because after years of trying, they finally saw a positive test. Now, that may not be your emotions. They might not match that movie moment that you imagined. For some people, they jump for joy. Others feel numb, anxious, thinking, can this be real? And m both of these are valid reactions. The point is, let yourself feel what you feel. This is your moment. There is no wrong or right way to feel about it. When we got our positive, we were happy, but we were very cautious because we felt, how could this be? How could we be this lucky? Because we felt like everything was against us. The point is, there is no wrong emotion now when it comes to confirming the pregnancy. The home test is a great start with the official confirmation comes from the blood test, also called a beta hcg. This is the hormone thats made by the embryo once it implants. And we dont just look at the number, we actually look at the rise of the number over time. A good rule of thumb is that the number should roughly double every 48 to 72 hours. So if your first test is 200, we expect the next one to be close to 400 or higher. Now, technically, it doesnt have to double, only needs to go up 66%. That means if your number is 100, 166 is considered normal for the next blood test 40 the hours later. Its very common to read into these numbers because again, you work so hard to get to this point, you start getting scared. But why is this number not higher than my friends number? She had 400 for her first one and Min is only 100. Does that mean my pregnancy is not doing as well or. There are things that can affect the HG level. Things like hydration, the size of placenta and even having a biopsy can make the difference because the biopsy takes the trophectoderm cells and the synidiotropoblast that make the HG come from those cells. So if you have a biopsy it's very possible that the HG may be a little bit lower. I'm always glancing at the Facebook post where someone says my number is only 100 and El says there'a 600. And everyone either thinks the 600 has twins and then funnily enough, the 600 had a singleton and the one who had 100 something ended up having twins. That's because the numbers are not really correlated to everything but associated with things. Yeah, a really high ACG could mean twins. It also could mean that your baby has a big placenta, is very healthy, whereas a lower number can be perfectly normal. Doesn't mean there's anything harmful. It's the number that rises over time that matters, not the absolute number that you are looking at. Now after that blood test, the next milestone is going to be the ultrasound. And Ill be honest, this can be very scary waiting that time to get to that ultrasound. Matter of fact, for patients who have multiple miscarriages, Ill sometimes even do multiple blood draws before we get to the ultrasound so they dont have to wait as long. The first ultrasound is very early, around five weeks, three days to five weeks. Five days. At this point we're just looking for what's called a gestational sac. This is a sac that's inside the uterus and one of the important things we want to see on it is the yolk sack. The yolk sac tells us this is a normal pregnancy. If there is no yolk sac, then we don't know if it's not a pregnancy, which can be a pseudocyst or if it's what's called a blinded ovum. Now the scary thing is sometimes you just can't see the yolk sac and you start getting worried. And its is common to be worried. But a lot of times in the next week when you look again, the yolk sac is there and the fetal heart rate is there. But if you do not have a yolk sac, it'not saying you have an ant embryic embryo, but there'a chance. And so definitely talk to your doctor if you don't see both the gestational sac and the yolk sac. Now, around six weeks, three days, we start to see the heartbeat. It will start to be a little flicker. And by six weeks, five days, it's usually a normal heartbeat at a normal rate, somewhere between about 110 and 180. Do not be worried if you dont see a heartbeat prior to six weeks, in three days, that is normal. For many of us, when we see that heartbeat, its almost like theres this release of stress that, oh my God, its here, the baby there. Now, if you were like everybody else and it wasnt hard to get pregnant, you probably would even think twice about. But for those of us who went through hell and back to get this pregnancy, it still scary. Usually your doctor will have you come back for another ultrasound in about a week or two to verify that the pregnancy is growing appropriately. If it is, a lot of times, then you are graduated onto your obstetrician or midwife or family doctor. I tend to wash patients a little bit longer, especially if they've ever had a miscarriage. I like to get past that point because its something we all fear. How can this be happening to us? It's probably going in the miscarriage. And so if you have that fear, it's not unreasonable to ask your doctor, hey, can I get another ultrasound? It makes me feel better so I dont t have to wait six weeks until I see my next doctor. One of the more common mistakes that happen is patients will stop their medications too early. I get it. Progesterone shots suck. Taking estrogen through patches to injections, even vangeinally, is not fun. But, those medications are very important and you should never stop them without talking to your doctor. Even if the pregnancy was natural and youve had miscarriages, your body may not produce progesterone as well. And so if you are on progesterone, you should not stop it until they tell you to, which usually is after 10 weeks when the placenta takes over in a fresh IVF cycle, where you did a retrieval and then theyre doing the transfer. The the body doesnt make progesterone as well because you interrupted those cells. When you went and took out the egg, you also took out granulosa cells, and those are the cells that ludinize to eventually make progesterone. So you dont make progesterone as well, and you need to supplement it with progesterone. And that Situation can be vaginal, so may use injectable. But when it comes to a frozen transfer, your body is not making the progesterone because you didnt ovulate. And in that situation, if you stop progesterone, you could lose the pregnancy. Several times Ive had patients stop the progesterone. One time was because she read someone said you dont have to take it that long. Not realizing her situation was different the other time, unfortunately. And I felt guilty for this. The patient asked me how long do I have to take the progesterone for? And I said well techn until the pregnancy test because if youre not pregnant you can stop it, but if youre pregnant, youll keep taking it or for some reason. And I dont know why she didnt hear me say you have to keep taking it. And she stopped it as soon as the pregnancy test was positive. I still to this day feel very guilty about that. I no longer say that anymore. The point is I dont care what you read online. I dont care what your friend is doing, even if theyre doing it at the same clinic. Do not stop medications without talking to your doctor and cause more problems than helpful. When it comes to healthy habits, you want to keep doing the good stuff, such as taking your prenatal vitamins. Make sure they have folic acid in them so that helps with neural tube development in the first trimester. Eat balanced meals, don't try some fad diet at that time and make sure that you stay hydrated. It'always good to drink plenty of water when pregnant. Now for the fun part. One of the bittersweet parts of this entire journey as what we call graduation. This is where youre graduating from the fertility clinic. Its usually around 8 to 10 weeks. Once you see the pregnancy is developing normally and that is the point where we transition you from the fertility clinic to your regular ob. Everybody is happy about the step because it means you have made it there. But others and many of you may feel like youe losing your safety net because where you'going theyre not going to have people sitting they waiting in case you call to get you in right away. Things are going to be a little bit longer between ultrasound scans and getting those constant updates. Now under OB appointments they can be every four weeks and that can feel like you're free falling. The good news is the reason why those appointments are out four weeks is because you're at a healthy point in your pregnancy that doesn't need to be want so closely. It may feel like you are being abandoned, which are not. Youre winning because now you have a healthy pregnancy that no longer needs intensive monitoring. But I Im not going to lie. Its'scary because until those symptoms of nausea and vomiting start kicking in and you last saw your REI doctor at 8 weeks and having a WA until 12 weeks to see your OB doctor, its scary. And you start thinking, what if things arent good? But statistically speaking, but chances are very small that anything would happen that is bad. The last part I want to talk about is theotional roller coaster. Infertility doesnt just vanish the moment you see a positive test. Many patients still feel anxious every day and sometimes more anxious than before. So dont feel weird if thats you. This is normal. If you find yourself struggling, lean on support groups, therapy, mindfulness, or even just journaling some of your thoughts. Sometimes patients tell me they set boundaries with their friends or their family. Like asking people not to check in daily because that helps them not think about as much. The important thing to understand is its not abnormal to still have anxiety even after you get pregnant. You feel like, I shouldnt feel this way. I finally got what I want. Why am I not happy? And youre not broken because you feel that way. Its normal. Youve been through so much already. Give yourself some grace to, In closing, what do you do now that youre pregnant? After IVF or iui, you celebrate. You follow your clinics instructions, you keep your healthy habits and you prepare for the next chapter. Remember, this is not the end of your story, but a new beginning. You thoughtought hard to get here and, you deserve to experience this with both joy and confidence. You deserve this. This is not a dream. It is a dream come true. Maybe you become pregnant and relate to some of the things I talked about. Maybe you haven't been pregnant yet and you're looking forward to this and now have this idea of what to expect. Either way, if you like this, know a friend who had something like this, Please tell a friend about it. Let us know you loved it by giving us a five star review on your favorite medium. And most of all, keep coming back. I look forward to talk talking you again next week on Taco Bell Fertility Tuesday.