Vanishing Embryo: Understanding Blighted Ovums

A positive pregnancy test, rising HCG levels, and all the symptoms of early pregnancy—yet no embryo ever forms. In this episode of Taco Bout Fertility Tuesday, we unravel the mystery of blighted ovums. Why does a pregnancy start but not develop? Is it a genetic issue or a developmental failure? Why do some women not realize there's an issue until their 12-week ultrasound, while fertility treatments catch it much earlier? We break down the science, the common misdiagnoses, and what this means for future pregnancies. Tune in as we separate fact from fiction and bring clarity to one of the most misunderstood early pregnancy losses.

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Transcript

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Today we talk about blighted ovum, why they happen, what they mean, and why some pregnancies seem to start strong but never develop an embryo. I'm, Dr. Mark Amol, and this is Taco about Fertility Tuesday. Did you know that in nature, some reptiles will lay eggs that seem they're perfectly normal, but then when you crack them open, there's something wrong? There's no embryo inside of the egg. Well, in human, something similar can happen. A pregnancy that looks normal, feels normal, but isn't normal can happen. And there's a sack like the egg, but there's no baby inside it. So today we're going to break down the science of blighted ovums. Why they happen and what do they mean for future pregnancies. Sometimes these blood ovums are called an embryonic pregnancy, meaning no embryo in the pregnancy. And from the standpoint of a patient, you would actually never know that something is wrong. Matter of fact, it's not uncommon for these not to even be diagnosed until women come into their OB appointment around 12 weeks. Now, in fertility, we catch them earlier because we're doing ultrasounds earlier, and so we can catch them earlier. So some of the things we're going to talk about here are what causes them, why do some people misdiagnose them, and is there any way to prevent them? Now, to truly understand the blight of ovum is you need to understand a little bit more of the science of a blastocyst. A, blastocyst essentially has two parts. There's a trophectoderm, which becomes the placenta, and then there's the inner cell mass which becomes the embryo. So if we look at the analogy we said earlier about the egg, the trophectoderm is kind of the shell, the egg in some ways, and the inner cell mass would be the embryo. And so a blighted ovum is when the ICM fails to develop, but the tropctoderm keeps growing. And because it keeps growing, it produces acg, because that's where the ACG comes from, the tropectoderm. And so now your pregnancy will be positive. And not only will it be positive, but all of the symptoms of pregnancy will be there. The nausea, the morning sickness, the increased reflux and constipation, pretty much everything. A pregnancy will be the same because the 8 CG that's being made is going to cause progesterone to go up, and that's going to cause all the symptoms of pregnancy. Now, what's interesting is a lot of clinics, when they see a patient, will call something a blind ovum when it's not. And what they're looking at is they're saying, well, the embryo never grew. But that's not a blighted ovum. It's not an early loss. It's when the embryo doesn't develop. And one of the first red flags of that is if there's no yoast sac, when you look at the embryo at around five weeks, five days, the yolk sac comes from the icm. And so if that is gone, but you see the gestational sac, which is the sufectedoderm, then you know, there could be the possibility of a blinded ovum. Now, before you get scared, if that's your situation, keep in mind that sometimes it's just hard to see the yoles sac. And so what we do is we usually bring people back a week later, we take another look, and then we go, oh, there it is. And then we're not as concerned. But that would be the first sign that it may be a blighted ovum. That's one of the benefits of fertility, is that we do early ultrasounds. So by six weeks, we early know something is wrong. But it's different if you're not going through fertility treatment or if you wait to do your first OBCAN until about 12 weeks, what will happen is you'll go in and they'll notice there's a big sack and no baby in it. And that is extremely difficult to even comprehend. And, you feel like the whole time you've been pregnant and you have been, and you feel like the whole time that baby has been developing, but there was never a baby. And from your standpoint, there was no different. You would never have known that it was an empty sac. So what's interesting is that the trophctoderm, which is the placenta, can keep growing and keep you from bleeding up to about 12 weeks. Now, around that time, things start to get spotting and may pass at that point. But the main point here is that you can even go into an OB scan at 12 weeks and find out there's a blight ovum, which seems devastating. So what causes a blighted ovum? Well, as we just discussed, as long as the ICM doesn't grow, then that's a blinded ovum. But a lot of times it could be for other reasons. Meaning it doesn't have to just be an error. It can be something wrong with the, DNA. So for some reason, for if it's unemloyed and the embryo is dividing and something goes wrong because of the chromosomes, that would be a blinded ovum. If it's due to something, let's say, for example, just development when embry is dividing and something goes wrong, that disrupts the formation of the icm. That again is a blinded ovum. There'even theories out there about trophectoderm overgrowth where the trophectoderm may overdevelop so much that suppresses ICM and that can cause a blind o them. But what all these factors have in common is the ICM didn't develop. Now, what's frustrating about it is you really can't prevent it. And the reason you can't prevent it is because there's multiple causes and it's not just genetics. Even though a lot of them may be, you can put back a pgt, a normal embryo, and still have a bliet ovum. Now, the good news is most people just go on and have normal pregnancies after that. Rarely do you see people come back with another blighted oval. That's not very common to have that repetitively. Now, although you can't prevent a blood Oum, 100%, there are things you can do that may reduce it. Such as if you do pgta, you're going to at least remove the chromosomal problems that can lead to that. But one of the common myths out there is that a blight ovum might be your fault. That is absolutely not true. There is no lifestyle factor that can cause it. It's essentially a biological event that happened by chance. Now, as I mentioned, because it's still making HCG and you're getting all the symptoms of pregnancy, you feel like everything's good. In reality, it's not. And so the question is, for someone going through fertility, you're going to know about it very early. But someone who's got pregnant naturally and showed up at their doctors at 12 weeks, they're going to find about it then. And then the question is, what do you do? How does it go away? And so if you're someone who, let's say is having spawning at 12 weeks at your, you could theoretically just wait and let things naturally miscarry because it's probably going to happen pretty soon. But the problem is, if you caught this early, like, a fertility ultrasound at six weeks, well, your body's not going to recognize an issue until potentially 12 weeks. And then the question is, do you wait six weeks to allow this to continue to grow until it outgrows, its blood supply and then miscarries? And so there are some other options in that situation. One of those options is a medication called Visis Arostol. And what that will do is that will get your body to realize something's wrong and will help it miscarry naturally. The other option is what's called a, dnc, which stands for dilation and curetage. And that will be able to remove the pregnancy tissue surgically. And that way you have to wait for things to happen. There is no wrong or right. You can either do the expectedant management and allow it to happen natural, the medication management, or you can do the surgical management. But what's important to understand is, unlike other type of miscarriages, where the body will recognize it soon, this is different. The placenta will keep growing. And because it will keep growing, it could take weeks, even a couple months before your body recognizes that something's wrong. Now the question is, what happens afterwards? So, depending on what you do, if you end up doing the expected management or the medical management, it's probably going to be good to follow it up. You're going to watch HCG levels go down and you're going to do a sono histogram to make sure everything did pass before you go on to other fertility treatments. Now, if it's a situation where you're doing the surgery, then you know everything was removed. And so at that point you can move forward right away. Now, as I mentioned before, for most people, they'll experience just one and then go on to have healthy pregnancies and never have another one. Now, having one also doesn't mean you're going to have more of them in the future. It doesn't mean that now there's something else wrong again. It's just usually an error in development. Now, if you are having multiple of them, then the question I would ask is one, is it being diagnosed incorrectly? I've seen many charts I review that will say they had blighted ovums. And I see a yolk sac on it, and that's not aighted ovum. That's an early miscarriage. So it's important that gets diagnosed correctly. But the other thing is, if it's happening multiple times, it could be an issue with the chromosomes. And that's where PGT may come in. Because there might be a reason you're having those very, very early miscarriages before even the am develops. Personally, I have never seen this, but I know theoretically it could happen. But most of the time when I see someone with recurrent blight ovum, when I go into the data and look at it, they weren't blight ovums. No matter when this happens, whether it's six weeks or 12 weeks, it is going to be emotionally difficult and it should be. Losing a pregnancy, even without an embryo, is still a loss. But what makes this so difficult is the confusion. Because when youe told theres no baby there but youve been feeling the pregnancy, its something you couldnt even fathom. When you see that pregnancy test and you know that everything is potentially going well, it is confusing to then be told theres no baby and you can start looking for answers thinking maybe I did something wrong. And there is a lot of frustration and a lot of times people dont even believe the diagnosis. And thats why we usually will do another ultrasound to make sure that you feel comfortable knowing that this is truly the diagnosis. I think it is important that if you do come across this, there are support groups out there, counseling and other things that can help the healing process. If you had to go through this. A blighted ovum can be a confusing and heartbreaking experience. But that is not the end of your ferity journey. As I mentioned, most women who experience one go on to have healthy pregnancies. So if you've been through this, you'not alone. You would be surprised at how many people have had blighted ovums. There are support groups out there and there are people you can talk to if you did have one. I'm sorry there is never a good miscarriage but I know this one is very difficult when people have it. I hope this episode doesnt scare you. There is concern when you get pregnant that there can be problems, but most time things go fine. Next week I actually plan on doing a podcast about when is it safe? And kind of talk about these issues. What is your chances as you keep going and how far along you get. But in the end if you are someone who had alighted of them, or know someone who did tell them about this podcast this may be helpful for them to know theyre normal, they're not alone and this can happen to people. It's not easy but then they can be reassured that most pregnancies will go on to be just fine. As always, I greatly appreciate everyone those listens to this podcast and tells everyone about it. It is because of you that we are growing and we're helping educate everyone about fertility struggles and some things that other people don't talk about. I try to bring analogies and science to these conversations, but most of all not being superficial and trying to give you the actual data and the science so that way you can be an advocate for yourself. Just like we talked about today. If someone told you had to blighted o them, but there's a yolk sack, you're going to know that that was incorrect. So like I said last week, you love this podcast. Keep telling people about it, give us a five star review on your favorite medium, but most of all, keep coming back. I look forward to talking you again next week on Talk About Fertility Tuesday.