The 14 days between embryo transfer and pregnancy testing are notorious for being especially difficult, leading to the acronym TWW. For intended parents, the TWW can be one of the most stressful dips of the surrogacy journey, especially when experienced for the first time. It’s very normal to find yourself hoping for the best but expecting the worst outcome and preparing for disappointment.
Having no control over the outcome and being at a distance, can generate enormous anxiety. It can feel like being in a state of suspension as both positive and negative results call for dramatically different planning – emotionally, logistically, and budget-wise. On the up-side, intended mothers can sometimes feel a slight relief that they aren’t experiencing the stress of the TWW whilst carrying, which can compound fears of miscarriage, quickly snowballing into feelings of guilt.
Your surrogate partner shares in your anxiety during the TWW and can spend this period in a hyper-cautious state. Although groundless, she can feel personally responsible for an unsuccessful outcome.
While it may feel like 2 years for the intended parent and surrogate partner in limbo, a full two-week wait time ensures accurate pregnancy confirmation.
The date of embryo transfer (when the embryo is strategically placed into the uterus of the gestational carrier) is considered the first day of the two-week period. Prior to transfer, your surrogate partner will be hormonally prepared to encourage thick uterine lining growth for optimum implantation. Implantation occurs when the embryo buries into the uterine lining and begins to nourish itself and develop. Should implantation be successful, a hormone called human chorionic gonadotropin (also known as hCG) is released in the body; otherwise, the uterus sheds its lining and your gestational carrier proceeds to menstruation.
What is hCG?
Human chorionic gonadotropin, is a hormone produced by the outer layer of the early embryo known as ‘the blastocyst’. This outer layer (called the trophoblast) nourishes the embryo and later forms part of the placenta and fetal membranes.
Presence of the hCG hormone usually means positive pregnancy but can also indicate other factors at play. hCG is detectable in blood and urine throughout pregnancy and increasing levels alert the body that pregnancy is established, engaging the womb to create a safe nest for a baby to grow. With a normal pregnancy, hCG levels will eventually become undetectable—typically by six weeks after delivery.
Pregnancy can be detected and confirmed in three ways, early on via blood and urine testing, and at a later stage via ultrasound scan.
A urine test can only tell you whether or not there is hCG in the body but not how much there is and requires higher levels of hCG to read positive, resulting in a slightly higher rate of false-negative results.
A blood test is more sensitive than urine and provides more information. Most blood tests can detect lower levels of hCG, and confirm pregnancy a bit earlier. The most common blood test is ‘quantitative’ or ‘beta’ which determines how much hCG is in the blood. The measurement of hCG is reported in units called milli-international units per milliliter of blood (mIU/mL).
hCG levels can vary dramatically from person to person as well as pregnancy to pregnancy; however, generally, an hCG level of less than 5 mIU/mL means pregnancy was not achieved, while levels above 25 mIU/mL indicate positive pregnancy.
Typically, hCG levels will nearly double every two days in early pregnancy. If levels aren’t high or are borderline, repeat blood testing will be performed in two-day intervals. This serial blood testing can offer a better understanding of what’s happening in the body and alert your medical team to monitor appropriately.
What do low hCG levels mean?
Low hCG levels can simply be a sign of very early pregnancy, but if they fail to increase a few days later, they could suggest an ectopic pregnancy or miscarriage.
What do high hCG levels mean?
Elevated hCG numbers could indicate a multiple pregnancy; however, this is not conclusive and an ultrasound will be required for confirmation.
Tips for Coping and Staying Grounded During the TWW
1. Set a Date
Most clinics will provide a firm date for the initial hCG reading, which can help ease the feeling of being on tenterhooks throughout the 14 long days of waiting.
2. Get support
Share how you’re feeling and ask for support from your partner, friends, family, or other intended parents in the same situation. Fertility counsellors are trained in this area to help with anxiety management.
3. Express yourself
Like with any form of anxiety, the expression and release of negative emotion can be a tool in understanding what you are feeling and why. Some intended parents recommended keeping a journal during the TWW or using art, music, or dancing as a means to vent nervous energy and negative thoughts.
4. Get active
The benefits of exercise are as much for your mind as for your body, as the psychological benefits of physical activity have a neurochemical basis. Exercise is proven to reduce levels of stress-inducing hormones such as adrenalin and cortisol. Any form of exercise can bring positive change to your mood, clarify your thinking and restore calm.
5. Proactive Distraction
Nourish yourself through rest. Use breathing techniques, take naps, enjoy a massage, or soak in a hot bath with essential oils. Meditation or mindfulness helps train the mind to achieve mental clarity. We become more capable of coping with negative thoughts and feelings when we practice viewing heightened emotions as passing states rather than facts. One of the most profound advantages of meditation is that it can bring, not only a change in perspective but also a rewiring of the brain towards a more positive mindset.
6. Proactive Distraction
Plan a mini-break or start a new project during the TWW. Keep your mind busy with simple and controllable dynamics. Watch movies, read books, cook, bake, and socialize if these activities bring you joy. Social connection and laughter can trigger physical and emotional changes in the body, lightening burdens and mood.
7. Count your blessings
When caught in a spiral of anxiety and negative thought patterns it’s easy to catastrophize and feel that nothing will ever go your way. Take time to list your achievements, the areas of your life that are going well and the blessings you are grateful for.
8. Let go
Despite the incredible science and altruism in the mix, surrogacy is not a magical process. A positive or negative hCG outcome is just as likely as with any routine pregnancy and these results are entirely out of your control. Let go and trust your medical team, a higher power, the universe or the stars, if this is what you believe. Connect and share your fears with your agency team; they are designed to be a foundation of support and may be able to answer questions that are adding to your anxiety.
9. Plan ahead
At last, the wait is over, and it’s time to receive the news you’ve been waiting for. This could mean great joy or disappointment so communicate to your coordinator in advance if there is a preferable time of day for you to be contacted. This way you can better control your environment and it may help to also specify ahead of time if you prefer to receive news by message only or on a call.