QuestionQUESTION: Hi again, it's Carrie in NY. I went for my first u/s today at 5w 3d. I also had HCG levels drawn but they are not back yet. Sunday it was 510 up from 139 4 days prior. I took Femara this cycle and at the follicle u/s, there was one follicle measuring 17 and one measuring about 13. I ovulated approximately 4 days later, so most likely only one egg released. Today on the u/s, the tech immediately saw a yolk sac with a clearly defined white border. As she looked for another view, she saw another area that she ended up marking as "questionable". She said it could be fluid or it could be another yolk sac, but she couldn't tell. She was pretty certain it was fluid given that she could not clearly see a white ring around the entire sac (only clearly seen at one end), and the fact that they only anticipated one egg being released and my numbers were not excessively high. She could not see it well enough to make a final conclusion. I have to go back in 2 weeks for a follow up u/s. How common is it to have fluid present and how can you distinguish it? Does it cause any problems if it is present or could it indicate a problem? Could it be a yolk sac that is a day behind the other? I have never heard of this. Thank you so much!
ANSWER: Hello Carrie from the U.S.,
A "yolk sac" is a clearly defined finding or structure. It basically looks like a balloon. On the other hand, fluid within the endometrium looks like fluid within the endometrium, but this is usually referred to as a gestational sac. The gestational sac is where the fetus lies. The yolk sac, the initial nutrient source for the developing fetus, is within the gestational sac. It is of no consequence at this point, in fact, it proves that the pregnancy is within the uterus and not elsewhere. Since your ultrasound was so early, usually you can't see a fetal pole until 6 weeks, a gestational sac (fluid within the endometrium) is all that you can usually see and sometimes you can see a yolk sac within. The next ultrasound should show a lot more.
Good Luck and congratulations.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
---------- FOLLOW-UP ----------
QUESTION: The tech saw two round black areas. One she could clearly identify as being in the correct location and having the correct parts to it. The second area was also a black circle about the same size located above the first one, but a white ring was not obvious and she couldn't see it well enough to see if there were any "parts". She labeled it as inconclusive/questionable because she couldn't get a good enough look at it, but felt is was most likely fluid based on my numbers and previous follicle ultrasound results. Would fluid appear as a small circle and look similar to a gestational sac, or could this be a blighted ovum or another gestational sac that is just difficult to see? Thanks.
AnswerHi Carrie,
I'm sorry but I can't add anything to my previous answer despite this additonal information. I would not want to lead you in the wrong direction. I would need to see the ultrasound to be more specific.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
