What Happens at the 5 Week Ultrasound?

If you’ve undergone an IVF cycle before or have tried to conceive naturally, you are probably familiar with the uncomfortable “two-week wait.” That’s the nickname for the time between your suspected ovulation or embryo transfer and the first positive pregnancy test. But even if you do end up with a positive pink line, the next big milestone to wait on is the five-week ultrasound.

For women who conceive naturally, having an ultrasound at five weeks seems pretty early, since many don’t even know they’re pregnant yet. But for women and couples who have undergone fertility treatments, the five-week ultrasound is an important insight to understanding if your pregnancy is established and on its way to developing successfully.

Why five weeks?

By the fifth week of pregnancy, doctors and sonographers can begin to detect a heartbeat using an ultrasound machine. This is also a time when doctors can begin to parse out if the fetus is developing according to medical guidelines. This early ultrasound can give you peace of mind in knowing that your fertility treatment may have been successful, while also cluing in doctors to any issues that may be occurring.

What are doctors looking for at the five-week ultrasound?

Five-week ultrasounds are important because they allow doctors to get a first glimpse at your developing baby and pregnancy. Initially, they’ll be used to confirm that you are, in fact, pregnant. Despite a pregnancy test giving a positive result, it’s still possible to not have conceived. That’s because IVF medications and hormones can sometimes cause a false positive on a home pregnancy test, which measures for hCG — human chorionic gonadotropin, the pregnancy hormone your body produces after implantation. Unfortunately, some IVF medications use hCG, which can cause false readings on a home pregnancy test.

After confirming that you are pregnant, doctors will use the five-week ultrasound to look at other important pregnancy factors, such as:

  1. Abnormalities. While it is early on in pregnancy, doctors can examine the gestational sac, yolk sac, and fetal poles to detect any abnormalities. At this point, an ultrasound should show evidence of a developing embryo, despite being so small.
  2. Growth. Because embryos develop at similar rates early on, it’s easier now for doctors to determine if your pregnancy is progressing as it should. The five-week ultrasound also allows doctors to determine how far along you are. Even if you know the date of ovulation or IVF transfer, doctors will begin dating your pregnancy based on this ultrasound to determine a due date.
  3. Number of babies. If your hoping for a singleton or twins, the five-week ultrasound is your first glimpse into how many babies you should begin shopping for. Even this early on, a sonographer can determine how many fetuses you are carrying based on the number of gestational sacs — whether that be one baby (one sac), twins who share a gestational sac (identical twins) or multiples who have their own (fraternal twins).
  4. Placenta and positioning. Even this early on, your placenta is already beginning to form. Doctors can use the five-week ultrasound to see how this new, temporary organ is forming and its placement. Though, because there’s much room to grow and time for it do to so, the position of your placenta is likely to change.
  5. For an ectopic pregnancy. All ultrasounds for possibly pregnant women will determine if the pregnancy is viable, and will confirm that it is not ectopic. Ectopic pregnancies occur when fertilized eggs or embryos attach themselves into areas of the uterus where they shouldn’t — such as the fallopian tubes. Ectopic pregnancies are rare with IVF pregnancies, but still a possibility, and are dangerous for the pregnant woman.

What can I expect at my five-week ultrasound?

If you’ve never had an ultrasound before, heading to the doctor’s office or hospital can be nerve-racking. It isn’t painful, and can be exciting to take a glimpse into your uterus.

In most cases, five-week ultrasounds are performed endovaginally — meaning through the vagina. That’s because the gestational sac is quite small at this point, and picking up a heartbeat can be difficult, simply because of size. If you have an endovaginal ultrasound, expect a thin wand covered a protective sheath — usually made of plastic or latex, such as a condom — to be lubricated and inserted into your vagina. Some imaging specialists will allow women to guide the wand inwards, while others will insert the ultrasound wand themselves. While internal examinations aren’t usually comfortable, don’t expect the ultrasound to be painful. In fact, the excitement of possibly seeing your developing baby may remove any tension or discomfort. And unlike an external ultrasound, you won’t have to worry about arriving with a full bladder; for some women, the pressure of external ultrasound equipment on top of a full bladder can be uncomfortable.

In some cases, doctors can see the gestational sac through use of an external ultrasound. In this case, you’ll be asked to arrive with a full bladder, which helps imaging specialists further differentiate between internal organs. A lubricating gel will be placed on your lower abdomen, and a imagine wand will glide along. You can expect some pressure as the doctor or sonographer locates the gestational sac and tries to measure the baby’s heartbeat.

Whether you have an endovaginal or external ultrasound, waves will create an image on a screen that your doctor may share with you. You shouldn’t worry about the number of measurements or images the doctor may take; this is routine with all ultrasounds and allows doctors to accurately assess and date your pregnancy.

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What happens next?

What happens following your ultrasound appointment depends on who performs the imaging. In many cases, an ultrasound technician or sonographer will record measurements, a heartbeat, and images, and pass this on to a radiologist or your doctor to examine. You’ll likely be told your expected due date, but any possible abnormalities may be reported later on, depending on the need for further examination of measurements. If your fertility specialist or doctor performs the ultrasound, you may receive initial feedback at the appointment. From there, they can let you know if there are any concerns and how to move forward accordingly. If everything looks great, your doctor may reassure you that your pregnancy is progressing, and that you’re on your way to having a healthy baby.