ultrasound question -- what would you do? (intro)

farmerlynda · April 2012

Hi everyone,

Quick intro: It's nice to meet everyone and I hope to become a more regular contributor as I get closer to my EDD I'm currently pregnant with #1 after undergoing 2 IVF cycles (DH has severe MFI related to cancer treatment.) I'm going to apologize right now for not lurking before posting -- as a longtime reg of 3T and IF, I am usually much more polite. But I have a burning question... One I was going to ask this on my usual board (Pregnant after IF) but I realized I'm probably the only person who might refuse what we've all waited so long to see, and it somehow seems ungrateful. And I figured that this might be a good community to ask, one filled with people who are hoping to have a pregnancy/birth with fewer interventions.

Here's my dilemma. I have a transvaginal u/s scheduled for tomorrow (6w6d). After talking to the woman who will most likely be my homebirth midwife, I'm not so sure I want to go through with it.

Of course I want to see the heartbeat on the screen and know the LO (or LOs) are well. But as the MW pointed out, it's such an important time for the fetus developmentally... as she said, she operates on the "precautionary principle," i.e. do no harm. I've heard stories of women miscarrying immediately after a t/v u/s. I also know for a fact (having read the scientific studies) that ultrasound heats up the tissue of the fetus. And I know that I've spotted and cramped after infertility-related t/v u/s, which suggests it's doing something to rattle the uterine lining.

The MW pointed out that the result of my u/s wouldn't change the course of treatment. Even if I am pregnant with twins, my prenatal care wouldn't change for first tri. It kind of goes with the saying, "if it ain't broke, don't fix it."

So, what would you do? What did you do (when was your first u/s)?

Tash13 · April 2012

I was given a t/v u/s at an early stage because I have a history of ectopic pregnancies and my OB at the time felt it was necessary to make sure this one wasn't tubal (once you have a tubal pregnancy, it's more common to have it again). If I didn't have a reason to worry beforehand, I probably wouldn't have. I also hated the idea of going in and knowing there was a chance I wouldn't be able to see the hb even though everything was fine. After multiple losses, it was very emotionally trying to not see all of the details. Even after seeing the hb, I didn't really feel better about anything until I was 13 weeks.

It's a very personal decision that will really depend on your comfort level but I probably wouldn't go through with it if I was already hesitant going in. I'm all about following your instinct.

Jcrab · April 2012

I've lurked on 3T and am so glad to see your message here. A big congrats and wishes for an easy and healthy pregnancy! I had an early US this time 6w5d as I hadn't had a period since my BFP with DS and needed one for dates. I have never met an MD that has concern about ultrasounds although that certainly doesn't mean it isn't possibly a risk / danger. First trimester can be so hard mentally, especially after difficulties conceiving that my vote is to do whatever feels right to you and your DH and will give you the most peace. Sorry that really isn't much help. This board has an amazing group of ladies, feel free to post anytime!

julyjennifer · April 2012

farmerlynda:
The MW pointed out that the result of my u/s wouldn't change the course of treatment. Even if I am pregnant with twins, my prenatal care wouldn't change for first tri. It kind of goes with the saying, "if it ain't broke, don't fix it."

Congratulations on your pregnancy. The above quote from your prospective midwife sounds like a good practical perspective. From your post, it sounds like your gut is telling you to take a conservative approach and not go the route of an early elective ultrasound.

To me, your tone sounds as though you will be ok emotionally opting to go forth without the elective ultrasound, so that's what I would do if I were you (though I can understand why it's not an open and shut question for you). This might not be everyone's situation, and maybe for others the early u/s is the right choice for their mental well-being. For you, of course you'd love to see your babe(s) and know as soon as possible how many babies we're talking and that all is well right now, but you sound like you can stand to wait until you can hear the heartbeat(s) without u/s technology, and would feel more comfortable with that. As another poster pointed out, you could just as well see something inconclusive now that will cause you more worry than its worth and possibly lead to another follow-up early u/s.

Best of luck to you, and welcome to this board!

GypsyEsq · April 2012

Hmm, this is a tough one, having been in your shoes with early t/v u/s at the RE's office more than once. But, I'll say that while it's true that (perhaps) your standard of care won't change with twins, it may change if one of your embryos split. Now of course your MW would have things that might help her and her partners see that your uterus was growing at a greater rate than even they would expect with twins and maybe you'd get a later first tri u/s to address those concerns. Or not. I can tell you that we triggered with no mature follicles and a falling E2 and an LH surge - meaning nothing about this cycle should have worked for us. And we conceived triplets. Stranger things have happened. That said, you don't sound like someone who wants to live in the fear of the "what if" and so for that reason, I agree, you should follow where your instinct leads. Best of luck!

farmerlynda · April 2012

Tash13:
I was given a t/v u/s at an early stage because I have a history of ectopic pregnancies and my OB at the time felt it was necessary to make sure this one wasn't tubal (once you have a tubal pregnancy, it's more common to have it again). If I didn't have a reason to worry beforehand, I probably wouldn't have. I also hated the idea of going in and knowing there was a chance I wouldn't be able to see the hb even though everything was fine. After multiple losses, it was very emotionally trying to not see all of the details. Even after seeing the hb, I didn't really feel better about anything until I was 13 weeks.

It's a very personal decision that will really depend on your comfort level but I probably wouldn't go through with it if I was already hesitant going in. I'm all about following your instinct.

Thank you so much for your thoughtful response. I completely agree that there is a time and place for early u/s, and that your case is a perfect example of why they're sometimes very helpful diagnostic tools! But you're right, I am hesitant, and I've thought to myself... If I do miscarry, which course of action would lead to the least regret?

Personally, I would feel guilty if I had the u/s and then miscarried. If I didn't have the u/s and miscarried, I would of course still be devastated -- but somehow it would feel more like nature taking its course.

farmerlynda · April 2012

julyjennifer:
Congratulations on your pregnancy. The above quote from your prospective midwife sounds like a good practical perspective. From your post, it sounds like your gut is telling you to take a conservative approach and not go the route of an early elective ultrasound.
To me, your tone sounds as though you will be ok emotionally opting to go forth without the elective ultrasound, so that's what I would do if I were you (though I can understand why it's not an open and shut question for you).

I think you hit the nail on the head Thanks for the advice, and the warm welcome!

GypsyEsq:
Now of course your MW would have things that might help her and her partners see that your uterus was growing at a greater rate than even they would expect with twins and maybe you'd get a later first tri u/s to address those concerns. Or not. I can tell you that we triggered with no mature follicles and a falling E2 and an LH surge - meaning nothing about this cycle should have worked for us. And we conceived triplets. Stranger things have happened. That said, you don't sound like someone who wants to live in the fear of the "what if" and so for that reason, I agree, you should follow where your instinct leads. Best of luck!

Thanks for the advice and it's great to see a fellow PAIFer over here I definitely would like to get a later first tri u/s, or early second tri, and my MW seemed to be in support of that as well.

By the way... what an amazing story you have! We had another reg just find out she has triplets from one transferred embryo, it sounds like you know pretty much exactly the shock that she's going through. Best of luck with your pregnancy and your two beautiful LOs. Congrats on being so close to V-day.

Kitttkattt · April 2012

The result of your Ultrasound wii change the course of treatment. Twins will get you started with an MFM most likely, IVF pregnancies have higher rates of ectopics,a missed AB will require you to stop your meds and be managed either medically or surgically.and will give you a clue to the health of the pregnancy.

DebateThis · April 2012

Honestly I think your MW is misinforming you. Correlation does not equal causation in this case - just because lots of women have early t/v ultrasounds does not mean those ultrasounds caused their miscarriages. There hasn't been an increase in early miscarriages since t/v ultrasounds (or any ultrasounds, for that matter) became routine.

That being said, if you're truly uncomfortable with one this early - there's certainly not any reason you absolutely have to have one. It can rule out ectopic pregnancy or make sure you're not having twins (both increased risks due to IVF as you know) but you can find that out at the NT scan at 12-13 weeks or at your anatomy scan around 20 weeks.

For me, personally, I think not knowing about twins til 13+ weeks (potentially even til 20 weeks if you don't elect to do an NT scan) is a bit more than I can handle. Especially since you are planning a homebirth, I'd say the earlier the better for finding out that kind of news.

ETA: One more thing - just bc you have spotted w/ other t/v ultrasounds does not mean they're messing with the uterine lining. Your cervix is very vascular in pregnancy so even just bumping it a tiny bit can cause some spotting - almost like how a head wound bleeds profusely with just a bump.

Good luck!!

lily225 · April 2012

I've never heard that a t/v u/s has risks... interesting.

I had one for my first pregnancy just to get a clear date (wasn't super regular at the time) and it was around 8w.

None with my second.

For my third I had 2 or 3? I had ZERO idea how far along I was so they did one. I wasn't even 5 weeks so they scheduled another one for two weeks later. At that one the heart rate was really low so I came back a week later to check for viability. That was an abdominal u/s if I remember.

I've never even had spotting or cramping with the t/v u/s.

So, if you are going to pass the u/s because of miscarriage risk, are you putting yourself on pelvic rest as well? If an u/s wand that is being inserted gently can cause m/s, then I would think a rousing session of sex would carry an even greater risk of m/s (which is typically not the case). Just a thought.

InfinityDreamer · April 2012

For this pregnancy because we were unsure on dates I had an early ultrasound. If you keep a very full bladder prior to the ultrasound you don't necessarily have to have a TV/US unless you are of a heavier weight or the placenta is positioned to obscure the fetus. At my first (and likely only) ultrasound for this pregnancy it was determined that I was 6wks2days and there was absolutely no issues seeing the full uterus/placenta/etc.

farmerlynda · April 2012

DebateThis:

Honestly I think your MW is misinforming you. Correlation does not equal causation in this case - just because lots of women have early t/v ultrasounds does not mean those ultrasounds caused their miscarriages. There hasn't been an increase in early miscarriages since t/v ultrasounds (or any ultrasounds, for that matter) became routine.

That being said, if you're truly uncomfortable with one this early - there's certainly not any reason you absolutely have to have one. It can rule out ectopic pregnancy or make sure you're not having twins (both increased risks due to IVF as you know) but you can find that out at the NT scan at 12-13 weeks or at your anatomy scan around 20 weeks.
Good luck!!

Just to clarify... my MW didn't at all insinuate that there was a direct link between m/c and tv u/s. She just said that she operates under a precautionary principle of as little intervention as possible, and that little is known about the long-term impacts of very early tv u/s. Which is true, and most medical organizations I've found that have published recommendations on tv u/s essentially recommend as few as possible, and to have them done as quickly and efficiently as possible.

In research I've done, I found a fair number of posts from women who miscarried immediately after a tv u/s. (FWIW, many of those posts also indicated a long, painful u/s experience.) Of course there is zero causation to be drawn from those anecdotes, but it was more my personal experience with spotting and cramping from a mid-cycle tv u/s that worried me.

I just recall literally thinking "Remind me not to do this if I ever get pregnant!" And I've never had midcycle spotting and cramping before no matter how rough the romp in the hay was, so I really do feel it had something to do with the ultrasonic waves and not the penetration of the wand bumping my cervix.

lily225:
So, if you are going to pass the u/s because of miscarriage risk, are you putting yourself on pelvic rest as well? If an u/s wand that is being inserted gently can cause m/s, then I would think a rousing session of sex would carry an even greater risk of m/s (which is typically not the case). Just a thought.

That's a good question. I've been on pelvic rest since the IVF cycle (precautionary self-enforced, the RE actually said it was fine). I think from here on out we're going to be careful and gentle, but not avoid. (We're both dying to, frankly!) But it's actually the ultrasonic waves and not the penetration itself that worries me. Some studies mentioned the shear pressure created inside the uterus by the waves, so there is an actual force exerted on the fetus, unlike with sex. (Unless YH has a magic... nevermind.)

I don't think that TV U/S = miscarriage. Obviously the vast majority of women who have them go on to have perfectly happy, healthy babies. But I just think that there are enough unknowns about the effect of the technology on developing fetuses that, if it doesn't seem necessary, I think I'll pass. If I had any symptoms of an ectopic, I'd do it in a heartbeat. But even if I have twins, I don't need an MFM until second tri.

NKview · April 2012

You've gotten some great feedback from PPs and I agree with those who suggested following your instincts. I wanted to add my experience, but just to provide another perspective. I don't think it's necessarily a reason to opt for the u/s.

I got pregnant with injectables and also questioned the usefulness of an early t/v u/s. I did end up having the u/s and my RE found a large ovarian cyst. He told me to immediately limit my physical activity because there was a fairly high risk of ovarian torsion. I had been running and attending fitness classes, so my daily habits changed quite a bit when he saw the cyst. While I was very happy that I had the u/s, I think that I feel that way largely because I feel like I "dodged a bullet" and I wouldn't have known about the cyst without an u/s. If I didn't run on a daily basis, however, the u/s and cyst diagnosis wouldn't have made much of a difference.

Good luck and congratulations on your pregnancy!

jessandandy09 · April 2012

just a thought, but if you are worried, and I can understand why you would be, I would say wait for a later date to do a 1st trimester u/s. My very first pregnancy (16 years ago) my hospital did not even do ultrasounds which I was okay with. Now my second child (13 years ago) we looked at him all the time! sometimes all ultrasounds do is scare us anyway. Deep down inside I believe evey mother knows what is right for her and I think your decision is already there for you, you just want to be reassured. I wish you the best of luck and congratulations on your pregnancy. Update us if you can.

blue+skies · April 2012

FWIW, my RE was more concerned with checking my ovaries than the baby at my first t/v u/s. He wanted to check for an eptopic preg, enlarged ovaries and/or cysts. It only took a few minutes, so I personally don't see how it could affect an otherwise healthy fetus, but that's just my opinion! Do whatever you feel comfortable with after consulting with your MW and RE. Congrats and good luck!

Mom2Cinderella · April 2012

I have been lurking because I'm trying to become more informed about natural births as my sister-in-law is planning one and quite honestly I'm skeptical. My feeling is if she wants med free that's her decision, but I had both of my children in a hospital ( I will keep my opinions to myself). My oldest was delivered by a MW-by chance because I go to a ob/gyn/midwifery care office and she happened to be there and I didn't personally like the ob on call that day. Anyway-that's neither here nor there.

I've also had 2 early miscarriages and I wanted to point out a few things from your original post that may or may not encourage you to go one direction or the other in your choice. From my understanding, early ultrasounds no not increase the likelihood of miscarriage. Most miscarriages (1 in 3 pregnancies) happen in the first 12 weeks and you can't prove that if you m/c after a u/s that it wouldn't have happened regardless. More women are getting their BFPs earlier and are therefore aware of miscarriages more than many years ago.

Also, the spotting after a transvaginal u/s is coming from the cervix and has nothing to do with what is going on in the uterus. I have spotted in all of my pregnancies-1 that ended in m/c and both of my full term pregnancies. I would spot after an u/s, a bowel movement (gross sorry), sex, anything that irritated my cervix, which is much more sensitive during pregnancy.

And lastly, maybe there isn't enough research on the effects of u/s but I don't know if there is any data to prove that u/s heat up fetal tissue.

In any case-I do believe that the less u/s the better. But if I were you and having gone through early m/c I would want an early u/s and the anatomy scan. I ended up having 5 or 6 throughout my pregnancy, but probably the fewer the better. Good luck and I hope everything goes well for you no matter what you decide to do.

Cheekers2010 · April 2012

I'm probably coming from the far more conservative end of things but I chose not to have a u/s until 20 weeks and the big anatomy scan. I almost passed on that as well but decided that I would like to have some reassurance that things were proceeding well in the pregnancy.

If you are comfortable with some uncertainty then I would think waiting until your nt scan is a good idea. I like your mw's very practical approach.

H&H 9 months to you!

theworms · April 2012

farmerlynda:

I don't think that TV U/S = miscarriage. Obviously the vast majority of women who have them go on to have perfectly happy, healthy babies. But I just think that there are enough unknowns about the effect of the technology on developing fetuses that, if it doesn't seem necessary, I think I'll pass. If I had any symptoms of an ectopic, I'd do it in a heartbeat. But even if I have twins, I don't need an MFM until second tri.

I don't think this true. I met with my MFM during my 10th week and then they did the NT scan for me at during 12th week.

If you are pregnant with twins you want to meet with an MFM sooner rather than later and it may take you a couple meetings to find one you like.

I am only seeing an MFM with this pregnancy since reg OB is not enough for multiples.

GL with whatever you decide.

and FWIW, I know several ladies who had ectopic pregnancies w/o the traditional symptoms or whacky betas and w/ IVF I would do the u/s to be extra cautious.

flyer23 · April 2012

Just to throw in another opinion... I had an early loss (5 weeks) with my second pregnancy.

With my third, I opted to have an early ultrasound (at 6 weeks), because I needed the reassurance of seeing the heartbeat. But I found that the reassurance lasted all of about an hour. Then I started hearing stories of women who saw a healthy heartbeat at 6, 7, 8, 9, even 10 weeks, and later found out that the baby died a day or two, or a week or two later. NOT saying that the ultrasound caused the m/c, at all -- just saying that it didn't provide me any reassurance because I knew that a h/b at 6 weeks didn't necessarily mean that everything would be fine.

So, with my fourth pregnancy (my current one), I skipped the early ultrasound. Of course, I still wanted that reassurance that I wouldn't miscarry, as I think we all do... but honestly, there IS no such reassurance in the first trimester, unless you believe in crystal balls.

That said, I conceived spontaneously in all my pregnancies, so I wasn't dealing with any of the additional risks posed by IVF.

maddiemoon43 · April 2012

By now your appt has come and gone and you've made a choice, but for me, I think about my 1st pregnancy where I didn't get to have an u/s until I started spotting at 10.5 weeks. If I had been able to get one earlier as I'd hoped, I would have known a month earlier that I had a blighted ovum, that there was no baby developing, and I wouldn't have spent that extra month trying to relax and enjoy my pregnancy, pushing aside my instincts something was wrong.

Want a personalized experience?

ultrasound question -- what would you do? (intro)

Re: ultrasound question -- what would you do? (intro)

Choose Another Board

Search Boards