TVS shows empty gestational sac with no pain or bleeding. Do I need medical help to expel it?

Hi,

Welcome to icliniq.com.

I would advise you to repeat your scan after one week as your beta hCG has progressively increased. If you still have just the sac and no pain or bleeding, you can go for medical management to terminate. Then it will be a missed abortion. TVS (transvaginal scan) has good sensitivity in detecting the sac and location so do not worry.

Thank you.

Hi,

Welcome back to icliniq.com.

Yes, the beta hCG should have been more by now. There are more chances of the pregnancy being a missed or blighted ovum. There is no harm in waiting for one more week. The rate of expulsion is good when pregnancy is around six weeks or more. There are more chances of spontaneous expulsion too at that time. With induced abortions, there are more chances of retained products. Your doctor have asked you to repeat next week just to rule out if there are any chances of delayed conception or to wait for spontaneous expulsion. One more week wait has no harm.

Thank you.

Hi,

Welcome back to icliniq.com.

It still looks more like blighted because the rise in hCG is very slight.

I would advise you to wait two to three days and then repeat and get one TVS again. You have already done so many hCG tests. Do not repeat on the 5th; do it after two to three days, and TVS, too. You have one high risk, 42 years of age, and it goes more towards blighted and missed. Repeat one scan, and if it is still only the G sac and increased weeks of gestation - it is confirmed blighted.

If it has reached till eight weeks with no progress 8weeks from your last period or your scan), then there is no need to go for more testing and scan. It Is a blighted ovum.

Thank you.

Hi,

Welcome back to icliniq.com.

We can surely try with medication. Sometimes, you need evacuation, too. I hope you wait two to three more days and repeat one scan before deciding. I will still tell you. It is up to you if you want it to be cleared in one go, then go for surgical or medical.

For medical (for missed abortion)-

I follow this: take the Mifepristone 600 mg on the first day and then after 48 hours take tablet Misoprostol 800 micrograms and wait till expulsion. Gap for one day and take tablet Misoprostol 200 mcg twice daily for three days. You do have heavy bleeding. Take painkillers - Meftalforte.

To reduce bleeding- Tranexamic acid 500 mg two times a day.

Just wait for a few more days. After one abortion - you should wait for three months and then try again or at least have two normal regular periods and start trying.

Thank you.

Hello,

Welcome back to icliniq.com.

You can take a tablet of Meftalforte as per your need for pain. Once you expel the products, it will become much less painful. No problem at all with using Clomid and IUI. It increases the chances of pregnancy by more than 15 to 20 %. Clomid will care for egg quality, but there are chances of multiple pregnancies, like twins with Clomid. I am just making you aware of that. Just discuss tablet options of Letroze or Clomid with your doctor. Letroz helps grow only a single egg, and Clomid (many times) can lead to twins. Both are equally good; otherwise, there is little preference for Letroze over Clomid, as per the literature.

I am glad that you are getting over this pain now. Do not worry much about the next pregnancy. It will grow better this time. Good luck with that. I hope that you are continuously taking a tablet of Folic acid 5 mg, one tablet daily, and I would suggest starting the progesterone support next time immediately when you miss your periods. Everything is going to be fine. You can contact me anytime.

Thank you.

Hi,

Welcome back to icliniq.com.

I did not think I could find exact literature saying that clomid improves egg quality, but as I said, it helps in picking the best eggs.

Apart from this, there are many other ways to improve the quality of the eggs, like

1. Reduce weight.
2. Decrease stress.
3. Stop smoking.
4. Reduce alcohol intake.
5. Sleep well and on time, regular sleep cycles.
6. Folic acid supplements.
7. Multivitamin supplements.
8. Micronutrients supplements.
9. Work out every day to improve your lifestyle.

It always helps, and taking supplements. Lifestyle changes are for both partners to improve the quality of eggs and sperm! To have a better embryo formation

I hope it helps.

Thank you.