Written By: Meredith Jung
The Case of the Missing Embryo
Shortly after midnight on a Wednesday last September, my husband and three-year-old dropped me off at the local ER. I had tested positive for COVID the Friday before and was struggling to breathe.
We did the usual dance of the ER.
The blood pressure cuff and thermometer.
Questions like “What brings you in tonight?” and “When was your last period?”
Bloodwork and orders for more tests.
When the results came back, the ER doc came back in and asked again “When was your last period?” I replied, "August," and asked why. He said, “Well, your HCG levels are high like you’ve been pregnant for a couple of months.”
Shit.
Don’t get me wrong, I wanted another baby. We were trying.
But I’d had an ectopic before. A ruptured, lost two liters of blood, ER docs were amazed I didn’t die ectopic. Given that having an ectopic increases your chance of having another from 2% to 15% and I had what appeared to be a period in August, it was likely an ectopic.
Fun fact! Ectopics sometimes don’t register in your uterus as pregnancies, resulting in what appears to be a normal period. Be sure to take a monthly pregnancy test if you’ve had an ectopic before and are having unprotected sex–regardless of what Aunt Flo says. Sure wish someone had told me that after my first ectopic . . .
Pee tests confirmed I was pregnant and I was checked into a bed to wait for the ultrasound tech.
When she arrived, she spent at least fifteen minutes poking and prodding to find the embryo. Nothing. It wasn’t in the uterus. Or my remaining right fallopian tube. Or the scar tissue of my removed left fallopian tube. My right ovary looked a little weird, but she couldn’t see an embryo there. She left to find the ER doctor so he could share the results.
Gaslighting from the ER doc and OBGYN
The ER doc diagnosed me with a molar pregnancy.
“No no,” I protested. “It has to be an ectopic. I’ve had one before, and the odds are high that I have one again. We just need to do more tests to find it.”
“Sweetie, there’s nothing there,” he said condescendingly. “Just a thicker lining of the uterus. Nothing urgent. I’ll refer you to the OBGYN associated with the hospital for follow-up after I discharge you.”
“Ok,” I replied meekly. “What about the COVID?”
“Oh, your numbers and tests look fine. Just rest up and you’ll get better.”
Ugh, not helpful.
The OBGYN’s office called that afternoon to arrange a follow-up appointment. They insisted I get additional blood work first and then come in for an ultrasound–delaying my appointment until the following Monday.
If you know ectopics, you know that every day increases the odds of a rupture. But I wasn’t worried. This was the practice that had saved me as I bled out from my first. If they weren’t worried, why should I be?
Maybe because the OBGYN who would be seeing me was not the one who had operated on me the year before?
This doctor was as dismissive of an ectopic as the ER doc. My HCG had dropped slightly. There was nothing in my uterus, intact fallopian or scar tissue. My right ovary looked a little weird, but she couldn’t see an embryo there.
“It’s just a miscarriage that hasn’t fully evacuated,” she stated confidently. “We’ll do another blood test to make sure the HCG levels are continuing to drop, but otherwise don’t worry about it.”
However, I was worried about it. Something didn’t add up.
Finally Finding (and Removing) My Ectopic
On Wednesday when the bloodwork came back with a higher HCG level, I immediately called my regular OBGYN’s office for an appointment. They got me the first available appointment with my usual doctor for an ultrasound.
After a pee test, we once again did the ultrasound song and dance. Thankfully, my regular OBGYN believed me even though we still couldn’t find the embryo. The question now was not “Do I have an ectopic?”, but “How do we abort an ectopic we can’t find?” We decided to wait on the results of the pee test as that number would determine if medicated abortion was even a possibility.
The next morning I got an urgent call from my OBGYN. My HCG levels were a lot higher and medicated abortion was no longer a possibility. She asked me to check in to the ER immediately at the hospital where she had admitting privileges for a surgical abortion. On the longer ride to this hospital, I found the embryo. I had an immense burst of pain on my right side during the drive. That was all the information my OBGYN needed to know it was hiding behind my right ovary. She removed the embryo before it ruptured, saving my ovary. We had made it just in time. It was ready to pop.
However, my right fallopian tube did not survive the ectopic. Tubeless, I went home. Had we found the embryo a week and a half earlier when I went to the ER, my tube might have been able to be saved. By the time we got to surgery, it was a lost cause.
What I’d Do Differently Next Time
In many ways, I tried to advocate for myself and failed. But here are two things I would have done differently in retrospect.
I would have insisted on additional testing at the ER and not let the doctor discharge me until it was done.
As I mentioned earlier, people who’ve had an ectopic are nearly eight times more likely to have another. So if you’ve had an ectopic before, insist on additional testing if they can’t find an embryo, like a laparoscopy. A laparoscopy is invasive, but it can see things that an ultrasound can’t. And if the doctor finds the embryo while they’re in there, they can quickly remove it during the procedure.
Support from a third party, like my husband or mother, might have helped here. But that wasn’t an option with the COVID protocols in place at my local ER.
I would have called my regular OBGYN after the ER visit instead of taking the referral to the OBGYN associated with the hospital.
Assuming you have a regular doctor you trust, you should follow up with them after an ER visit. Especially if the ER doc didn’t believe you on something. Your regular doctor will know your history better and be able to provide a more reliable diagnosis.
Whatever happens, trust your gut. It saved my life during my first rupture, and I should have trusted it when it told me not to get discharged from that hospital. Lesson learned.
Meet the Author
Meredith Jung
Meredith Jung is a founder and mom of one who wishes she had one more. A strong believer that, "The future is already here - it's just not equally distributed", Meredith takes pride in advocating for those who have not yet benefited from society's advances through petitions, letter writing, fundraising, and blog posts.