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Worried-first sonogram 6 weeks, 2 days
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Worried-first sonogram 6 weeks, 2 days

Hello.  I just completed first round of IVF and it was successful. We did a 3 day transfer of 2 embies (grades 1 and 2, 8 and 9 cells respectively-with 1 being highest at this clinic). First beta 165, progesterone 98 (13 days past 3dt), second beta 695 (16 days past 3dt), and third 1857 (19 days past 3dt). Just went in for 1st ultrasound at 6 weeks, 2 days and he saw gestational sac and yolk sac but no fetal pole or hb. He said it may be too early,could have implanted late, but this is not what he expected. When asked what odds were he said he couldn't really say-maybe 50/50. As a side note I have had zero spotting, but am on progesterone injections. Could this really have just been too early or is it most likely going to end in mc? Are there published percentages regarding what day fetal pole/hb should appear? Thank you in advance for your opinion.
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Dear Annabelle72-

There is an order to when things appear on ultrasound. The first feature imaged is a gestational sac. A after the gestational sac first appears a yolk sac can be seen. Then a week later a heart beat. I agree with your RE that it might just be too soon to see a heartbeat - it is not until 6 weeks 4 days of 6 weeks 5 days that a heartbeat can be seen 100% of the time in normal pregnancies. In other words, even at 6 weeks 2 days not all normal healthy pregnancies will image a fetal heart, and if you are only 5 weeks 6 days, or 6 weeks, because of a slight delay in implantation, the time to seeing a fetal heart will be delayed yet another couple of days.

If you are looking for published percentages, there is an old paper from 17 years ago that looked at this - Rempen A. Diagnosis of viability in early pregnancy with vaginal sonography. J Ultrasound Med 1990;9:711-6. These statistics may be off a couple of days as IVF pregnancies were not considered.

Also, Dr. Celso Silva and I wrote a chapter on early pregnancy loss in ACOG PRECIS GYNECOLOGY III that addresses this issue.

I know this is going to make for a long week for you - but a repeat ultrasound in a week will tell the story. I think your chances of a normal pregnancy are a little better, maybe 2/3 - 1/3, but really it is 0% or 100& for you, and only time will tell.
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Just wanted to say thank you for your informative and thoughtful reply.  It is much appreciated.  
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