Why is the first pregnancy ultrasound done after IVF, what is looked at, what if nothing is seen yet, and how does follow-up go? Information and warnings.
The first pregnancy ultrasound is done after a positive pregnancy test following IVF, to assess the location, viability and number of the pregnancy. The doctor determines its timing; at a very early stage the expected findings may not yet be seen, and this on its own does not carry a negative meaning; a repeat ultrasound may be needed. The information below offers a general framework and does not replace a diagnosis or treatment recommendation specific to the individual.
Why is the first pregnancy ultrasound done?
According to a current first-trimester ultrasound guideline on this subject, the purposes of the first-trimester ultrasound include showing viability, and determining the number of fetuses and, in a multiple pregnancy, the state of the placentas and membranes. After IVF, confirmation of the location of the pregnancy is added to these.
How is the location of the pregnancy assessed on ultrasound?
According to current terminology recommendations, every pregnancy is classified as normally located, ectopic or of uncertain location. On ultrasound it is looked at whether the pregnancy is normally located. Some pregnancies seen inside the uterus may also not be counted as normally located; the interpretation belongs to the doctor performing the ultrasound.
What does seeing a heartbeat mean?
Viability is shown by seeing an embryo with a heartbeat. Seeing a heartbeat is a favourable finding; however, this does not mean that antenatal care is complete, and follow-up continues.
What is looked at if there is more than one pregnancy?
How many pregnancies there are is looked at on ultrasound. If there is more than one pregnancy, the location of each is recorded; in a multiple pregnancy the state of the placentas and membranes is also assessed. The follow-up plan is made by the doctor according to these findings.
When is the first pregnancy ultrasound done?
The timing of the first ultrasound after the positive test depends on your doctor's plan and may vary from person to person. Because the gestational sac or the embryo may not yet be distinct on a very early ultrasound, timing is important in this respect too.
How is the first pregnancy ultrasound done?
The ultrasound can be done over the abdomen (transabdominal) or through the vagina (transvaginal). In early pregnancy your doctor determines which route will be used according to image quality. If there is any preparation to be done before the ultrasound, your doctor will tell you.
Which findings are expected at the first ultrasound?
The expected findings are the pregnancy being normally located, the gestational sac and the embryo being seen, and a heartbeat being detected. At which stage the findings are expected to be seen varies with the week of pregnancy.
What if the expected findings are not yet seen?
In a very small embryo the heartbeat may not be distinct at first sight. The measurements of the gestational sac may also be uncertain in the early period, and current guidelines recommend waiting for the embryo to become distinct if you have no complaints. For this reason no decision is made on the basis of a single early ultrasound; your doctor may request a new ultrasound after a short time. In a person who has a positive test but in whom no pregnancy can be seen on ultrasound, and whose general condition is good, the doctor proceeds by following the hormone values and symptoms.
Can there be an ectopic or heterotopic pregnancy after IVF?
In IVF, even though the embryo is placed in the uterus, an ectopic pregnancy can be seen. Having a normally located pregnancy and an ectopic pregnancy at the same time is called a heterotopic pregnancy, and it is reported more often after assisted reproduction than in natural pregnancies. For this reason the location of the pregnancy is assessed carefully at the first ultrasound. If you have pain or bleeding, seek care without waiting for your ultrasound appointment.
How does follow-up continue after the first ultrasound?
Even if favourable findings are detected at the first ultrasound, antenatal care continues. Your doctor tells you the frequency of follow-up, additional ultrasounds and at which stage, and by whom, monitoring will be continued. Your doctor also tells you when the medicines you used during treatment will be stopped; do not stop the medicines on your own.
What can you do if you feel anxious while waiting for the first ultrasound?
The period between the positive test and the first ultrasound can pass anxiously because of uncertainty. This feeling is very common. Talking with those close to you or, if necessary, getting support from a specialist can be helpful.
Frequently Asked Questions
Does ultrasound harm the baby?
According to current guidelines, diagnostic ultrasound is regarded as safe because of its limited acoustic output. In practice the principle of keeping the output as low as is reasonable (ALARA) is adopted, and in the first three months Doppler is used only if clinically necessary. It is also recommended as good practice that its benefits and limits be explained to you before the ultrasound.
Does a previous caesarean section change anything on the ultrasound?
In those with a history of caesarean section there may be a predisposition to conditions such as caesarean scar pregnancy, and the scar area is examined carefully at the first-trimester examination. For this reason you need to tell the doctor performing the ultrasound that you have had a caesarean section.
Are structural problems of the baby seen on the first ultrasound?
Many anomalies or major malformations may not be seen in the first three months. Nuchal translucency and chromosome screening are a separate assessment. The purpose of the first ultrasound is different from these; for this reason a normal first ultrasound does not mean that everything has been assessed.
How is the week of pregnancy calculated in IVF?
In a natural pregnancy, because the true day the pregnancy formed cannot be known reliably, dating by ultrasound is important. In IVF, since the day of fertilisation is known, the need for dating by ultrasound is reduced. The doctor tells you by which date the week will be calculated.
Does a positive test take the place of the first ultrasound?
No. The first ultrasound is done to assess the location, viability and number of the pregnancy.
Is the first ultrasound necessarily done through the vagina?
No. It can be done over the abdomen or through the vagina. Your doctor chooses the method in early pregnancy according to image quality.
Does not seeing a sac on a very early ultrasound mean a definite loss?
No. The expected findings may not yet be distinct. No decision is made on the basis of a single early ultrasound; follow-up can be done together with the hormone values and symptoms.
Does follow-up end once a heartbeat is seen?
No. Seeing a heartbeat is a favourable finding; antenatal care continues.
What does heterotopic pregnancy mean?
It is the presence of a normally located pregnancy and an ectopic pregnancy at the same time. It is reported more often after assisted reproduction than in natural pregnancies; the location of the pregnancy is assessed carefully at the first ultrasound.
Should I wait for my ultrasound appointment if I have pain or bleeding?
No. If you have pain or bleeding, seek care without waiting for your ultrasound appointment.
If the first ultrasound looks good, can I stop my treatment medicines?
No. Your doctor tells you when the medicines will be stopped; do not stop them on your own.
Can follow-up change if there is more than one pregnancy?
Yes. The location of each, and the state of the placentas and membranes, are assessed. Your doctor makes the follow-up plan according to these findings.
Get Your Free Consultation
Fill out the form below and our team will contact you
