Wednesday, February 29, 2012

Canadian Is Nine Weeks Pregnant, Has Enlarged Yolk Sac And No Fetal Pole: Is There A Problem?


Hi Dr Ramirez,

I was prescribed Clomid this cycle and am now pregnant. I am currently 9 weeks along. I went for an ultrasound at 8 weeks, 1 day pregnant and my measurements indicated that I was 8 weeks, 6 days pregnant. There was no fetal pole found. The yolk sac is measuring 8.6 mm. I am doing HCG/progesterone testing every other day -- so far all levels are within range. I am going for a follow up ultrasound at 10 weeks pregnant. Is the enlarged yolk sac a bad sign, even though my measurements and bloodwork are good?

Thanks, E. from Canada.


Hello E. from Canada,

Assuming that your dates are correct, the yolk sac size is not a problem but the fact that there was no fetal pole or fetal heart motion at 8 weeks is bad. Usually by 6.5 weeks gestational age, a fetal pole and heart beat can be detected. This is seen for sure by 8 weeks. An empty gestational sac is called a "blighted ovum" and basically means that the sac developed but the fetus did not. You should not have to wait until 10 weeks gestational age to make the diagnosis. Your doctor should make that diagnosis already and recommend treatment.

If you wait too long, then a D&C (surgery) would be required to clear the uterus. At an earlier stage it can be done using medication alone. I should not be the one to be the bearer of bad news so I am sorry that this answer is not reassuring. You need to talk with your doctor right away and don't let them put you off or avoid the issue, like they seem to be doing.

Take care and good luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program


  1. I went for ultra sound at 6 wk 2 days yesterday due to possible bladder infection. Fetal pole measured 5 wks 5 days and yolk sac measured 6wk 5 days. Is that normal?

  2. Hello Lindsay,

    The margin of error (variance in dating) for dating with an ultrasound at 6 weeks gestational age is +/- 14 days. So the daing that you had, despite being 1 week different is still within the margin of error. We would make the determination that the fetal pole is consistent with the dates. It would not be alarming. The fact that there was a fetal pole and yolk sac are good signs, as opposed to seeing an empty sac. Was there heart motion present? That is also a good sign. Those are the only conclusions that can be made at this stage.

    Good Luck

  3. My last depo shot was April 4th ..yesterday I went to the doctor to check if I got a cyst in my ovary again..and surely enough I had a cyst .but to my surprise the doc said I had a yolk sac !im on birth control?but they gave my a pregnacy test and it came out negative?

  4. Hello April 28,

    Definitely something in your doctor's story is incorrect. You'll need to query him further. If the pregnancy test is negative, you are not pregnant. If a yolk sac were present, the pregnancy test would be absolutely positive! This finding must be something else and was interpreted incorrectly.

    Good Luck

  5. Hello sir

    sir i take a progyluton tablet one a daily basis for continuing the menstural cycle,if i did't take progyluton in one month my menstural cycle is stop,,my doc says to me that happen due to the harmone defencies so for ever i will be take that medcine,,,,,,
    now im a single female,if i got a marriage-question is that pregency is possible after marriage if not then have any treatment or medcine for the pregency???

  6. Hello May 25th,

    You have some type of ovulation dysfunction, which means that you are probably not ovulating. There are several causes for this so you will need to undergo an evaluation to see what the problems is (it could be hypothalamus, thryoid, pituitary or ovarian).

    When you decide that you want to become pregnant, you will probably need to see treatment with an infertility specialist to take fertility medications that induce ovulation. If there are no other problems, that should help you get pregnant.

    Good Luck.

  7. Hello Dr. Ramirez,

    As per my LMP date, my baby's gestation age shall be 12w 5 d.
    I went for usg 2day.
    The radiologist reported baby has stopped growing after 9w; baby is still and with no heartbeat; sac size is however 11w.
    I am yet to go back to my gynaec. Will do so in d evening.
    Till then - what does it mean?
    Is the baby dead? If so, then the baby has been dead for 2/3 weeks. I didnt and dont feel any complication, infection, trouble - nothing.

    Also if yes, how is the abortion to be done now? Can you pls thorw some immdiate light on this?

  8. Hello June 4,

    If the fetus is clearly visible and there is no heartbeat at 9 weeks gestational age, that means that the fetus has died. Since you are 12+ weeks gestational age, yes it died 3 weeks ago. You will need to have a medical induction of miscarriage or a D&C to remove the contents.

    A Medical induction of miscarriage is done by using a medication called Misoprostol vaginally. This causes your cervix to dilate and the uterus to start contracting to expel the contents as would occur in a natural miscarriage. Sometimes, if all the tissue is not expelled this way, a D&C might be required. It is also more uncomfortable because you have pretty strong cramping and heavy bleeding before everything is expelled.

    A D&C (dilation and curettage) is a minor surgical procedure whereby the cervix is dilated and the contents suctioned out and then the cavity scraped gently to remove anything that sticks to the wall. It is done under anesthesia so is more comfortable and only takes about 15 minutes to do.

    I'm sorry for your loss.

  9. Question hello Dr Ramierz , my husband got Globozoosprmia with that I had 2 icsi cycle first was completed and used pills for 21days then Gonal F injection 10 eggs been found 3 fertilised and 2 transferd been pregnant had miscarige after 3 weeks. My second icsi my dr changed the medication 150 microgram nasal spray and Menopur 1200iu then 600iu injection had a 8 day scan then day 12 scan been told day after tmr egg collection so went for retentivel dr said we only found eggs all the follicles were empty second day had a call from them they said non of them fertilised. What can you sugest thanks

    1. Hello Jul 1 Anonymous,

      I'm afraid I don't understand the scenario because you state that "all the follicles were empty" but then "none of them fertilized". Which is it?

      Also, in evaluating your previous cycle, you were able to get pregnant which is good. That means that the IVF did what it is supposed to do, which is give you the opportunity to get pregnant. IVF CANNOT get you pregnant because the last two steps of the process are natural steps. My other observation is that you were stimulated only using Menopur. This is certainly acceptable but I prefer a mixed protocol using both FSH (such as Gonal-f or Follistim) in addition to the Menopur.

      Good Luck

  10. Dear Sir,

    This is my first pregnancy. Yesterday I had my 2nd u/s and it showed a 2cm gestational sac (6wks 3 days) and a 7mm yolk sac with no fetal pole. Am I at a threat of having a miscarriage or a Down syndrome baby because of the enlarged yolk sac?

    Thank you very much

    1. A 6 week gestational sac is still early and the fact that a yolk sac was present is a good sign. The fetal pole may just be too small to see by your Doctor's ultrasound. You cannot draw any conclusions until you have an 8 week ultrasound. Down syndrome cannnot be diagnosed by ultrasound at this point.

  11. Dr. Ramirez
    I am 8 weeks along and the doc said there is an enlarged yolk sac. The baby's hr was167 and measurements were good. Prior to this we had a d&e at 15 weeks because the baby had a cystic hygroma and turners syndrome. I became pregnant just two weeks after the d&e. Is it possible we got pregnant too soon? Is there a chance we will have another chromosomes abnormality like downs? They want to do another ultrasound at 12 weeks is it better to ask for one at 10 weeks? Thanks!

    1. Hello,

      I'm sorry for the delay in getting back to you. Somehow, your question/entry got lost in my extensive queu. By now, hopefully things turned out well and your worries are over.

  12. Hello Dr. Ramirez. I just recently experienced 2 missed miscarriages, back to back. Both fetus' were 7 weeks, but I found out during ultrasound at 10.5 weeks (for both).

    My question to you is as follows: In both cases an enlarged yolk sac was found. I was wondering why an enlarged yolk sac happens, and whether this would be an indicator for chromosomal issues, or tells me what tests I should be having? Thanks!

    1. An "enlarged yolk sac" is not a specific indicator or a specific description of a problem, as far as I know. I don't know why such a description would have been given.

  13. Hello Dr I had my 7 week scan and two yok sacs were seen enlarged the PA keeps talking d&c how long can I wait and is there any hope?

    1. NEVER listen to what a PA or technician tells you. They are not the doctor and do not have the doctor's knowledge or training.

      Some pregnancies with an enlarged yolk sac lead to miscarriage or fetus loss in the pregnancy but NOT all of them. It does NOT predict a dire result! The only thing that can be done is to wait and see how things turn out.

  14. Dear Dr. Ramirez,

    I had my 8 week US today with a yolk sac and gestational sac measuring at 5.5-6 weeks. They saw no fetal pole and no heartbeat. They suggested a D&C due to missed misscarriage. Should I see a fetal pole and heartbeat this soon? Could the development just be slow? Thank you. A.D

    1. If your dates are well defined (known), then the lack of a fetal pole and heartbeat at 8 weeks makes the diagnosis of a "missed abortion" or miscarriage that hasn't occurred yet. By well defined dates I mean that either you have very regular menstrual cycles so your last menstrual cycle date is reliable, or you underwent infertility treatment with ultrasound surveillance so the date of ovulation is known or you underwent IVF and the transfer date is known.

      If your dates are not well defined, then you should have a repeat ultrasound in one or two weeks to confirm the non-viable pregnancy. If that has already been done, that is that this ultrasound was already a repeat, then the diagnosis is made.

      At this point you have three options: (1) wait for a natural miscarriage. You can wait up to 2 more weeks vs (2) undergo a medical induction of miscarriage using medication vs (3) have a D&C. I rarely do D&C's these days because of the availability of option 2. Since the sac is small, the miscarriage will be like a heavy period. There will not be much tissue to shed.

      Sorry for your loss.

    2. Thank you Doctor.

      I got off the pill in december last year and resumed my period 26 days later. Each month I had fairly regular periods (26-28 days) and have been charting. My last period was April 15th and I know by the LH strip that I ovulated around day 15-16 (strong positive day 15 and 16 on strip) of my last cycle in April. I tested positive 10 days post ovulation on May 10th, so that would make me over 8 weeks now.
      They did the scan on Monday and saw a yolk sac, but no fetal pole or heartbeat. I had a second opinion yesterday and the same result.
      My doctor seems to think there will be no progress because even at 6 weeks I should see a heartbeat and pole. She thinks it better to start over now. I am scheduled for a D&C tomorrow so I can start trying again soon.
      Is there any hope for waiting a week?
      Can the D&C hurt my chances of getting pregnant again?

      Thank you.


  15. My wife is 5 1/2 weeks. She just had a vaginal ultrasound and the doctor said she has an enlarge yolk sac. He said due to the irregular sac she has a high chance of miscarriage within the next two weeks. Should we seek a second opinion ? Does the enlarge yolk sac determine the odds of a miscarriage?

    1. An abnormal yolk sac size has been correlated with an abnormal pregnancy and increased rate of miscarriage. However, it is not an exact science or predictor. Certainly, because of this fact, the odds of a miscarriage is increased, but it doesn't mean that a miscarriage will occur. At this point, no conclusion can be drawn and you must take a wait and see approach. I would not necessarily recommend a "second" opinion on this particular matter because no one can make a prediction, but if the fact that you are asking the question on the internet is a sign that you have a doctor that you can't access easily for such questions, maybe you need to find a better one. For example, in addition, to answer the questions of stranger patients on this and another site, my patients have access to me via email as well.



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