High HCG, No Yolk or Heartbeat

Patient

Q: Good Afternoon. I am a 34-year old female who is exactly 6 weeks pregnant. I went to the ER two days ago when I was 5 weeks, 5 days, due to severe cramping. They did a transvaginal US and it showed that my pregnancy is in the uterus (not ectopic), which was good. However, they also took a quantitative blood analysis and my HCG levels were at 9,000, and they did not see a heartbeat or yolk during the US, so they were concerned. I had another blood test today, and my numbers doubled to 18,963. I am scheduled for another US on Friday (4 days from now). My question is - should I be concerned, or does this sound normal?
One other thing - even though I'm 6 weeks, I ovulated on day 19 out of my 29-day cycle, which I believe is pretty late, so could it mean that it was just too early at 5 weeks, 5 days to see the yolk and heartbeat?
Thank you so much.

Symptoms:  Early pregnancy, High HCG levels (that have doubled in the last 48 hours), no yolk or heartbeat
Doctor

A:   Hello, ,
If there is a intrauterine pregnancy but yet there is no fetal pole at 6 weeks of gestation , but the hcg levels have doubled in 2 days , it indicates that this is probably a delayed conception and fetal pole should arrive in a week. There is no concern of worry at the moment as the hcg levels are doubling indicating that the pregnancy is developing and growing fine. Heartbeat shall be seen once the fetal pole is visible. It is too early for expecting a fetal pole at 5 weeks+5 days gestation in a lady with delayed ovulation as well.
So, don't arrive at a decision so early , wait for a week for the next ultrasound before deciding for or anembryonic pregnancy.
I hope i have answered your query in detail,
wishing you good health,
regards

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