Early Pregnancy Complications: Why Can't We See the Embryo?

Q: Early Pregnancy Complications: Why Can't We See the Embryo?

Hello： Typically, when serum human chorionic gonadotropin (hCG) levels exceed 2900 mIU/ml, a transvaginal ultrasound can visualize the gestational sac. <br>When levels exceed 6000 mIU/ml, an abdominal ultrasound can detect the gestational sac. <br>Furthermore, before 10 weeks of

Unable to visualize the embryo?

I had my normal menstruation on September 14, and in October, it came early on October 12, a week ahead of schedule.
Then in November, I experienced bleeding on November 3, and later I tested positive for pregnancy with two lines.
However, when I went to the hospital for an examination, the doctor said they couldn't see the embryo, which might indicate a miscarriage, but they weren't sure if the baby was still there.
Therefore, I received progesterone injections and took medication to support the pregnancy.
I haven't had any bleeding since, but I do notice some spotting when I move around too much, and my breasts are no longer swollen or tender.
I would like to know why the embryo couldn't be seen—could it be a problem, an ectopic pregnancy (even though I don't have any pain in my uterus), or is it possible that I truly lost the pregnancy?

Huang Jie, 20~29 year old female. Ask Date: 2015/11/13

Dr. Yang Wangjun reply Obstetrics and Gynecology

Hello: Typically, when serum human chorionic gonadotropin (hCG) levels exceed 2900 mIU/ml, a transvaginal ultrasound can visualize the gestational sac.
When levels exceed 6000 mIU/ml, an abdominal ultrasound can detect the gestational sac.
Furthermore, before 10 weeks of pregnancy, serum hCG levels should double every 48-72 hours.
If the levels are gradually declining, it may indicate a spontaneous miscarriage.
Therefore, if the gestational sac is not visible in early pregnancy, it could be due to an early gestational age, an ectopic pregnancy, or a spontaneous miscarriage.
Continuous monitoring of serum hCG levels and transvaginal ultrasound is necessary.
Thank you for your message!

Reply Date: 2015/11/13

More Info

In early pregnancy, it is not uncommon for women to experience complications that can lead to uncertainty about the status of the embryo. The situation you described, where you had a positive pregnancy test but were unable to see the embryo during an ultrasound, can be concerning and may arise from several factors.

Firstly, it is essential to understand the timing of the ultrasound in relation to your pregnancy. Typically, an embryo can be visualized via transvaginal ultrasound around 5 to 6 weeks of gestation, which is approximately one to two weeks after a missed period. If your last menstrual period was on September 14 and you experienced bleeding in early November, it is possible that the ultrasound was performed too early to detect the embryo. In some cases, the embryo may not be visible if the pregnancy is still in the very early stages or if there are irregularities in the pregnancy.

Another possibility is that the pregnancy may not be developing normally. This could include a missed miscarriage, where the embryo stops developing but is not expelled from the uterus, or a biochemical pregnancy, where a fertilized egg does not implant properly. In these cases, the body may still produce pregnancy hormones, leading to a positive test, but the embryo may not be viable.
Ectopic pregnancy is another concern, where the embryo implants outside the uterus, often in a fallopian tube. This condition can be life-threatening and typically presents with symptoms such as abdominal pain and bleeding. However, you mentioned that you do not have pain, which makes this less likely, but it is still important to monitor for any changes.

The fact that you are experiencing some bleeding, especially after physical activity, could indicate that your body is still adjusting to the pregnancy or that there is some irritation in the uterus. It is crucial to follow your healthcare provider's advice regarding bed rest and medication to support the pregnancy.
In terms of your concerns about whether the embryo is still present, it is advisable to have follow-up ultrasounds. If the bleeding continues or worsens, or if you experience any new symptoms such as severe pain, it is essential to seek immediate medical attention.
In summary, the inability to see an embryo on ultrasound can be due to several factors, including the timing of the ultrasound, the possibility of a non-viable pregnancy, or an ectopic pregnancy. It is crucial to maintain open communication with your healthcare provider, follow their recommendations, and attend all scheduled follow-up appointments to monitor the situation closely. Early pregnancy can be fraught with uncertainty, but with proper care and monitoring, many women go on to have healthy pregnancies.

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