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6w2d ultrasound-- irregular results? opinions?
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6w2d ultrasound-- irregular results? opinions?

I'm a 39yo female who is currently 6w2d pregnant from IUI treatment. This is my third pregnancy after 5 years of "unexplained infertility" . The first (age 36) was lost to severe preeclampsia/HELLP at 26 weeks. The second (age 38) was an unexplained m/c at around 7 weeks.

Due to bleeding at the start of the pregnancy, they did an initial t/v ultrasound at 5w2d. Two empty gestational sacs were seen. One was a little under 8mm, the other was very small-- 3mm.

Today I had an ultrasound at 6w2d. The second sac had completely disappeared. The original sac was 15mm and there was a clear yolk sac and fetal pole. RE said progression was "beautiful" in relation to where I was last week, but behind what he would expect for my LMP.

He said that in a non-IUI pregnancy, he would not be worried, since I could just be off on my dates. Since this is IUI, there is some variation possible (late implantaion, for instance) but it bothers him that I seem to be running 4 days behind in development. He gave about 50/50 chance for a viable pregnancy, but freely admitted that this just reflected his lack of a gut feel. Because of the vanished twin, they prefer to monitor with ultrasound than use HCG levels. (notching?)

I'm going back on Friday, but I have several questions:

1. What is "late implantation" exactly? Does it have consequences aside from being small for LMP?
2. Can embryo development be consistent but behind without consequences?
3. Google anecdote implies that it is easily possible not to see a embryonic HB at 6w2d using a t/v ultrsound and still have a normal pregnancy. Is this true, or would these be cases where people were off in their dates?

Thank you for your answers. This is very frustrating, and very frightening.

Cheryl
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Hi Cheryl,

I think it is best you save these questions for your RE specialist, as their input will be the most important.  

I can tell you it is possible to see no fetal heart rate at your gestational age and go on to have a normal pregnancy, but only time will tell.  

Late implantation implies just that: a fertilized ovum attaches and imbeds itself into the endometrium later than expected.  Your RE should be able to speak to this in a more practical way based on his or her experience.  

I wish you the best and can appreciate how difficult this process is.  At this point the best you can do is stay encouraged and positive.

Best regards,

Dr. Downing
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