ectopic with empty sac?
7 Replies
sonia989 - May 30

I am 4.3 weeks pt of 2 embryos. My hcg started low, but then doubled at a normal rate and today was at 9500 or so. Last week and again today, they saw an empty sac in the uterus. Because of the rising hcg, they don't want to terminate the pregnancy just in case it is just developing slowly and they want me to have another scan next week.
They say they can't rule out an ectopic. I am afraid to wait for a whole week for the next scan.

They told me to watch for pain, vomiting, etc. Don't these symptoms only show up when it's too late and the ectopic has already ruptured?
Shouldn't they do a laparoscopy rather than just have me wait it out?

Please tell me, what is the likeliness of it turning out to be a viable pregnancy vs ectopic or just an empty sac at this point?
Please help. This is such a nightmare.


B. Jacobs, M. D. - May 30

Tubal pregnancy is extremely rare with IVF. I would have expected to see a fetal heatr, but give it another week.
Good luck.


sonia989 - May 31

thanks for your reply. Could you please tell me whether you have personally ever seen
1) an anembryonic pregnancy cause a regular 48-hour beta doubling?
2) a yolk sac appear only by the 5th week post transfer?

I know i just have to wait it out, but it's so stressful.


B. Jacobs, M. D. - May 31

In an early normal pregnancy, the hCG should at least double every 48 hours. At 5 weeks of pregnancy, I would not expect to see much more than a gestational sac and yolk sac.
Good luck.


sonia989 - June 1

I am actually 6.6 weeks pregnant by LMP, not 5. At 6.3 weeks the 'sac' was 13 x ? mm, which the drs averaged out to '8' mm.
Today my doctor said they are [i]not sure [/i]that it is really a gestational sac and not a pool of blood, and are [i]not sure[/i] if the double sac sign is present. How can a world-renowned team of IVF experts at a reputable Montreal hospital not be able to tell the difference between a sac and a pool of fluid? Isn't it usually possible to determine if the 'double sac sign' is there?


sonia989 - June 2

I think I might have found the answer to this. Apparently, the 'double sac sign' is useful for transabdominal u/s, but not vaginal u/s because the yolk sac is visible before this sign.

This is from:
Faye C. Laing, MD and Douglas L. Brown, MD
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
in response to a report by Dr HC Yeh on u/s techiques in identifying a gs vs. a pseudosac.

"In our introductory and discussion comments, we mentioned briefly the double decidual sac sign and stressed its usefulness with a transabdominal approach. We agree with Dr Yeh that this is not a useful sign in transvaginal scanning because the yolk sac (which is more reliable for diagnosing an early intrauterine pregnancy) is visible normally before the double decidual sac sign is present. Therefore, we concur that, when using a vaginal approach, the double decidual sac sign is not helpful for identifying early intrauterine pregnancies."

So, now I just don't understand why they are letting me wait around with a possible ectopic when the yolk sac was not even visible at 6.4 wks in an 8mm 'sac'. If it were a real but empty sac, would it have been doubling my beta hcg levels like it has been, around every 48 hours up to 10000? Do empty sacs do this?


sonia - June 2

Hi Sonia989,

Just curious to know which clinic you are dealing with. I am at OVO Fertility on Decarie.


sonia989 - June 15

Wow- you're in montreal, and your name is Sonia, too! I've done 2 cycles at McGill repro ctr. The 1st one, we froze 4 eggs, the 2nd one i had 4 poor quality and 2 abnormal (which we didn't use). Only 2 /8 eggs fertilized with icsi, only 1 embryo cleaved, and i ended up having a blighted ovum pregnancy, which I have been miscarrying for the last 3 days. I am using misoprostol to get rid of some stuck placenta. I never thought i'd be trying so hard to end a pregnancy spending 20k just to get pregnant in the first place. Oh the irony.
Anyway, how do you find OVO? Did you respond well to stims? with only 5 and 6 mature eggs per cycle, i didn't have a great response and i sure hope they pick the right protocol. For now, I just got a puppy. :)
I hope everything goes GREAT for you and that your IVF experience is as short as possible!



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