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

Question:

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.

Answer:

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
www.montereybayivf.com

Empty Gestational Sac After IVF

Question:

Hello, Dr. Ramirez,

Does In Vitro increase the odds of an empty gestation sac? I am 6 weeks pregnant and had an ultrasound with no heart beat detected. I bled just before the ultrasound but there was no bleeding before that.

Two frozen embryos were implanted but only one sac is visible on the ultrasound after the bleeding. The sac is round and empty. What do you think?

Answer:

Hello,

I'm sorry about the news. The answer to your question is no, IVF does not increase the risk of genetic abnormalities in the fetus. An empty gestational sac is due to the lack of development of the fetus. That occurred AFTER implantation, and therefore, after the IVF. It probably occurred due to a genetic defect in the embryo that implanted. It is considered a form of miscarriage, which can occur in up to 40% of pregnancies whether natural or IVF.

Many women who get pregnant naturally are not aware that they are even pregnant before they "lose" the pregnancy. Because we test and ultrasound IVF patients soon after transferring the embryos, they have the opportunity to learn if their pregnancy is proceeding or not proceeding earlier than most. This is not necessarily a bad thing, since actions can be taken to prevent miscarrying in subsequent IVF cycles.

Good luck and keep trying!

Sincerely,

Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.