Fetal Pole Not Visible at 9 Weeks: Understanding Potential Causes & Next Steps

Question
Hello, I m 34, and am pregnant for the first time. After 14 months of my husband and me trying, it finally happened naturally.  My last menstrual period was on 4/20/06. I went in for an early last week for lab work and a quick internal cervix exam. The doctor asked me if I had been spotting b/c there was slight bleeding in the internal vaginal area.  I told him I have not had any spotting or cramps what-so-ever.  He ordered an ultra sound the following day just to be sure everything was ok.  My HCG levels were at 40,000, which the ultrasound showed a gestational sac and yolk sac. Is it possible not to see a fetal pole or fetal heart beat at this point?  I have been told I have a retroverted uterus, could this have anything to do with not seeing a fetal pole?  The doctor wants to check the HCG levels again next wk to see if they have increased.  All of a sudden yesterday afternoon I noticed a slight brownish discharge, but it has stopped.  I have no cramping or light/heavy bleeding.  He said the pregnancy could be earlier then we think.  I'm so scared and waiting in limbo until mid next wk.  Am I doomed for a miscarriage?  

Answer
If your last period started on April 20, you should now be  9 weeks 2 days pregnant. After 6 weeks gestation, we usually see (on sonogram) a gestational sac, a fetus, and a fetal heartbeat. Prior than 6 weeks, we see only a gestational sac  but no fetal pole or heartbeat. I would repeat the sonogram in 2 weeks. If there is still no fetal pole or heartbeat , it is a non viable pregnancy. I'j sorry.