First ultrasound should show ... ???

[zogy101]

I'm scheduled for my first ultrasound later this week, when I should be about 5w4d/25DPO.

My understanding is that an ultrasound this early should show a gestational sac with yolk, maybe the start of a fetal pole, but likely nothing else, i.e., no cardiac activity. But here's where I get confused: I've also read that the higher the HCG, the more you should see. For example, cardiac activity should be visible by the time HCG hits about 10,000.

But y'all, my HCG is so. high. It was 1032 on 15DPO, and 2292 on 17DPO. (They stopped betas at that point, so I can't say what it's been doing since then.) Good progesterone numbers too, FWIW. This pregnancy resulted from a stimulated IUI with monitoring, so if my dates are off, they aren't off by more than 3 days -- and based on my trigger timing and chart, I think they're spot on. I'm also pretty confident that implantation occurred on the early end, maybe 7DPO, as I was trying to test out the trigger and noticed the HCG line darkening by about 9DPO.

So ... what should I see on this ultrasound? Would early implantation explain my higher HCG numbers, or is this a twins scenario? (I had 2 mature follicles to trigger, so that's a real possibility.) I'm very anxious around ultrasounds specifically after a MMC in January, and I just want to go in knowing as much as I can. Thanks in advance for your replies.

Update: Just had the ultrasound. Saw two sacs, two yolks, two itty bitty fetal poles, and cardiac activity times two ... Relieved that it went so well, though stunned at the reality of twins! Thanks again to all who replied.

 

[romans82]

@zogy101 It’s a combo of how far along you are plus your beta. Those cutoffs are more for those with lower betas who are trying to determine viability. You won’t necessarily see more just because your betas are higher; you’ll see what you should be seeing at your gestation . Your betas are great- there’s such a wide range of normal, but they doubled appropriately and that’s perfect! HCG is also not an indicator of multiples. Congrats and good luck with your scans!

 

[emy12]

@romans82 Gosh this is good to keep in mind!! It makes sense but there are so many hcg cutoffs in the literature and they never talk about it like yes you should see a fetal pole at 10,000 IF you’re already 6 weeks.

 

[romans82]

@zogy101 I also want to add that my betas were wildly different between my two viable pregnancies (one IVF and one natural). At 5+ weeks with my son, it was around 12k, but at 5+ weeks with my daughter it was like 1,100. So the numbers really don’t matter at all or tell you anything at all, unless they’re dropping or not rising appropriately.

 

[michelerd]

@romans82 You have no idea how reassuring your comment is!! With my son my betas were like 16,000 at 6ish weeks. current pregnancy (sneak peek says girl) it’s SO LOW at 1,900 at 6ish weeks but rising appropriately per the care team

 

[romans82]

@michelerd Was it an IVF pregnancy???

 

[michelerd]

@romans82 Neither were IVF! No meds or anything on either. I have no explanation for the differences other than questioning my current pregnancy’s viability! And my dating with tracking ovulation and getting positives for both at 8dpo is spot on with my ultrasounds.

 

[romans82]

@michelerd Crazy how there’s no rhyme or reason to it!!

 

[daniel108]

@zogy101 My hcg at my first ultrasound (5w4d) was 17,000 and I did not see a fetal pole or heartbeat (only GS and YS). I of course freaked out but my OB was adamant that the notion of "over 10,000 = heartbeat," which gets parroted a lot (especially on here) is just categorically not true and for MANY women heartbeat and fetal pole visualization depends on gestational age. I'm now at 27 weeks with a (so far, knock on wood!) uneventful pregnancy!

Editing to add, I also thought multiples since my hcg was 2500 at 16dpo, but it's just one!

 

[jesusis4us]

@daniel108 Thanks for sharing! I wouldn't be "greedy" and ask for a heart beat right now, but a fetal pole... I scrolled back your history and I thought you did see a pole just no heart beat yet at 5w4d? Sorry I don't mean to question, just trying to learn from your experience!

 

[josephjurg]

@jesusis4us I have had 2 ultrasounds in the 5th week (two different pregnancies.) One at 5w2d and one at 5w5d. I did not see a fetal pole at either. Both were viable.

 

[michelerd]

@josephjurg I’m so glad to know this. I did not see a fetal pole at 6w0, got dated behind because of it. I saw a fetal pole and heartbeat just two days later. Crazy how quickly things develop!

 

[jesusis4us]

@josephjurg Thanks for sharing! Were the yolk sac clearly visible? Do you know if they should measure a certain size?

 

[daniel108]

@jesusis4us Trying to figure out where I would have commented that (I realize looking at my profile i comment WAY too often, lol), but if I did I definitely misrepresented myself. My scan at 5w4d did not show a fetal pole, only a yolk and gestational sac. I went back at 6w4d and saw a squirmy bean with a HR of 129! Just went back and confirmed all of this in my OB app

 

[jesusis4us]

@daniel108 Thanks again! One thing though, did the yolk sac look very clear to you on the images? I looked at all the images and very few of them showed it, and the ones that do it looks quite blurry. They shared the images after but didn't show me on the spot, so I couldn't ask anything.

 

[daniel108]

@jesusis4us No problem! Looking back everything just looks like blobs and it's hard to tell what's what, none of it screams "definitely a yolk sac." I do remember that at a later ultrasound the tech very helpfully explained to me that seeing something in a photo represents a single moment in time whereas the ultrasound in person is dynamic and fluid. She also showed me how just pushing down a little harder or easing up a little completely changes the image, and said to not get too hung up on how things "look" in your photos (unless you're a radiologist).

At another session a different tech reminded me it isn't just baby in there! There's also what she called "developmental debris." This was all to prepare me for when she handed me a 3d image of the baby where it looked like they had a straight up devil horn growing out of their head, but it was just a bit of tissue in front of the camera.

Anyway all of this to say- if the report was good and your doctor hasn't frantically called you, I think all is well!!

 

[dezmond]

@jesusis4us I could tell you if you have the actual images (block name, of course).

 

[jesusis4us]

@dezmond Could I DM you? (still blocking name of course!)

 

[dezmond]

@jesusis4us Sure (but probably getting to sleep soon)

 

[jesusis4us]

@zogy101 My betas were very similar. And yet today they only saw a gestational sac and yolk sac, not a fetal pole and I'm having the exact same questions...