Understanding an Unidentified Intrauterine Pregnancy: What It Means

Question
Hello. I am normally a 28-day cycle.  I had a normal period on August 30.  I suddenly then had a heavier, longer period that lasted 9 or so days on 9/20/05.  I had a positive home pregnancy test on 10/25/05.  On Friday 10/28/05, I had an abdominal and transvaginal ultrasound and the provider was unable to identify an intrauterine pregnancy.  At that time my urine pregnancy test would not show up positive at the doctor's office, which requires at least 2,000 units of HCG.  On Tuesday 11/1/05, I had both ultrasounds repeated and still, they were unable to identify an intrauterine pregnancy.  They were able to see uterine fibroids this time.  The urine pregnancy test in the office provided on this date bareley showed positive this time.  However, I am pregnant.  I am worried that they are unable to see an intrauterine pregnancy and that my HCG levels remain that low.  Is this suspicious of an ectopic pregnancy?  Also, are these uterine fibroids paying some sore of role?

Answer
If you have a positive pregnancy test, but nothing is in the uterus (on two sonograms), you must rule out ectopic pregnancy (tubal pregnancy). I would suggest that you take two blood tests for pregnancy (Beta HCG) 48 hours apart. If there is a doubling of the results in 48 hours, it indicates a viable pregnancy. If it plateaus (both values are similar) it can indicate an ectopic pregnancy. If both values are less than 5, you are definitely not pregnant anywhere (either uterus or tubes). If there is suspicion of tubal pregnancy  you may need laparoscopy to definitively get a diagnosis.