Bleeding after an embryo transfer: is it serious, and what should you do once you get home?

Bleeding after an embryo transfer almost always makes you fear the worst, especially when it occurs a few days before the blood test. However, light, pinkish or brown spotting is common after a transfer and in early pregnancy, and this alone does not indicate whether the embryo has implanted. The only reliable way to find out is through a blood test, followed by an ultrasound scan.

What matters is knowing what to do – and, above all, what not to do: stopping your treatment on your own. Here are some guidelines and steps to follow once you’ve returned home.

Is bleeding after an embryo transfer common?

Yes. In a large American cohort of 4,510 pregnancies, 27 per cent of women experienced bleeding or traces of blood during the first trimester. Light bleeding, especially if it lasted only one or two days, was not associated with miscarriage; heavy bleeding was, with an approximately threefold higher risk of miscarriage, particularly when accompanied by pain.

Following IVF, the data points in the same direction. In a study published in 2023 involving 1,858 singleton pregnancies achieved through embryo transfer using the patients’ own eggs, approximately 17 per cent of patients experienced bleeding before eight weeks’ gestation. When the six- or seven-week ultrasound scan was normal, this bleeding did not increase the risk of miscarriage, and birth rates were comparable to those of patients who had not experienced bleeding.

Where might the blood come from?

• The cervix. The passage of the catheter may cause blood-tinged discharge in the days following the transfer. During pregnancy, the blood vessels in the cervix change and may bleed, for example after sexual intercourse.
• Vaginal progesterone. The summary of product characteristics for a vaginal progesterone gel lists frequent vaginal discharge, as well as light bleeding and local irritation.
• ‘Implantation’. The UK National Health Service lists implantation bleeding as one of the possible causes in the very early stages of pregnancy. However, a prospective study that specifically investigated this in 151 women who had conceived naturally found no evidence to support this: bleeding rarely occurred on the day of implantation, but rather around the expected date of menstruation, and 12 of the 14 women who had bled went on to give birth to a child.
• A subchorionic haematoma, a small collection of blood in contact with the gestational sac, visible on an ultrasound scan. In a 2024 study of 1,539 pregnancies achieved following the transfer of a genetically tested embryo, this occurred in approximately one in five women; early miscarriages were more common, at 10.1 per cent compared with 5.6 per cent, but 85.6 per cent of these pregnancies resulted in a live birth, compared with 91.2 per cent in cases without a haematoma.
• A pregnancy that does not continue: biochemical pregnancy or miscarriage, explained in the article on biochemical pregnancy and in the risk of miscarriage week by week.
• An ectopic pregnancy, rare but possible even when the embryo has been transferred to the uterus: approximately 1.6 per cent of pregnancies achieved through assisted reproduction in the United States in 2011.

The type of cycle also appears to play a role. In the Swiss IVF registry, out of 7,342 pregnancies achieved following a frozen embryo transfer, first-trimester bleeding was recorded more frequently after a hormone replacement cycle than after a natural cycle: 8.4 per cent versus 3.5 per cent. This is an observed association, not proof of a causal link.

Before the blood test: my advice

• Do not stop taking progesterone, or oestrogen if you are on hormone replacement therapy. The instructions given after a transfer make this clear: do not change any medication without the clinic’s advice. The usual durations are set out in the article on progesterone.
• Take the test on the scheduled day, even if you are bleeding. Bleeding, even if it resembles a period, does not prove that the transfer has failed, and a urine test carried out too early will not provide a clearer answer (see implantation after a transfer).
• Notify the clinic on the same day, in writing: start date, colour, amount (traces, thin pad, full pad), any pain.
• Use pads rather than tampons: this will allow you to state precisely how much you are losing.

After a positive test: the ultrasound scan provides the definitive answer

If your beta-hCG is positive and you are bleeding, the clinic will generally want to monitor how the levels change, followed by an ultrasound scan, sometimes brought forward. It is the scan that really provides the information: in the 2023 study cited above, bleeding accompanied by a normal scan did not increase the risk of miscarriage, whereas an abnormal scan – showing no heartbeat or an embryo too small for the gestational age – significantly increased the risk. How to interpret the figures is explained in beta-hCG after a transfer.

What to do, depending on the situation

The symptoms listed in the last row are those that the UK health service considers to be an immediate emergency. Within the European Union, 112 works everywhere, free of charge; it is also used in Switzerland.

You’ve returned home: who to call, what to say

Bleeding often occurs once you’ve already returned home. First, call the Greek clinic, which is familiar with your treatment protocol; if there are any warning signs, or if no one answers and you’re worried, seek medical care near your home. The doctor you see will not be familiar with the clinic or your treatment. Keep the following in your phone and on paper:

• the date of the transfer, the stage of the embryo (blastocyst on the fifth or sixth day) and the number of embryos transferred;
• fresh or frozen transfer, natural or hormone replacement cycle, egg donation or not;
• the exact list of your medications, including the prescribed route of administration and schedule;
• your beta-hCG results, including dates and units;
• your blood group and Rhesus factor, which the doctor may need in the event of a miscarriage;
• the number of the Greek clinic, and mine.

Further monitoring, once the pregnancy has been confirmed, is described in the article on returning home.

What I do in such situations

I am not a substitute for the clinic or your doctor, and I do not give medical advice. However, when a patient writes to me saying she is bleeding, I pass the information on to the clinic – in Greek if necessary – and ensure she knows who to call next. If you’d like to draw up this plan before you return, do write to me.

Frequently asked questions

Source: https://fertilitegrece.com/en/blog/bleeding-after-embryo-transfer/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on

Triada Baloukoudis
Independent IVF patient coordinator in Thessaloniki, with 24 years of experience supporting patients travelling from abroad. More · Contact · Facebook