“At least there wasn’t really a baby.” I heard this phrase so often after my blighted ovum miscarriage (BO) that I actually stopped telling people what type of loss it was. I just couldn’t take it anymore. For years, I’d tried to have a baby. For more than a month, I’d dreamed of my child’s life. And then, two miserable ultrasounds sent me into the tailspin of a blighted ovum miscarrige process. This is my blighted ovum story.
What is a blighted ovum?
I’m going to answer this question two different ways. First, with a technical answer. Then, with a story.
Medically, a blighted ovum (also known as an “anembryonic pregnancy”) occurs when, according to the American Pregnancy Association, “A fertilized egg attaches itself to the uterine wall, but the embryo does not develop. Cells develop to form the pregnancy sac, but not the embryo itself.”
That’s the official explanation. In lay terms, that means the pregnancy stops growing before an embryo even develops–by the time you get your menstrual period, your chance of a healthy baby is gone, but your body may show no signs of anything being amiss.
For this reason, it’s one of the most frustrating types of miscarriage because it can take a long time to learn that your pregnant isn’t viable, and people are sometimes awful about it.
A Blighted Ovum Often Looks Like Any Other Pregnancy
But let me tell you what it really means to have a blighted ovum, from a physical and emotional perspective.
My first pregnancy was a blighted ovum, and do you know what it was? A pregnancy. Here’s how it happened.
Husband and I spent a year-and-a-half trying to conceive. As we sat on the couch one night making a list of questions to ask my GYN at my annual appointment the next day, I noticed a sharp pain in my left breast. Oh, the irony.
It suddenly hit me that the nausea I’d felt all weekend, the food aversions, and the outlandish craving for chicken sausage might not be a coincidence after all.
I rushed to the bathroom, having taken hundreds of pregnancy tests but having never seen a positive one. I knew before the second pink line showed up that I would finally see a positive pregnancy test, but after trying for what felt like so long, I couldn’t possibly believe it.
That immediate and dark second pink line still wasn’t enough to convince me. I was in shock.
Blighted ovum symptoms
I was also tremendously thankful that I already had a doctor’s appointment the next day, where we would confirm my pregnancy. I tossed my list of fertility testing questions into the recycling bin, never imagining that I could need them again.
After all, I was pregnant. I was finally going to have a baby!
My doctor confirmed my pregnancy the next day via a urine test, and we started doing blood tests and watching my human chorionic gonadotropin (HCG, aka “the pregnancy hormone”) levels rise. Once they got high enough, we would do an ultrasound.
Everything looked great. My HCG levels were doubling more than properly, and my pregnancy symptoms were through the roof.
I spent hours a day hovered around a toilet, rubbing my belly, eating nothing but bananas and chicken sausage. This sounds gross, but I didn’t really care because I was pregnant.
I had intense heartburn, so I carried a photo of my doctor’s list of pregnancy approved medicines. I downed Tums like it was candy (let’s be honest; it basically is) and always had Mylanta on hand so I could keep the nausea and reflux at bay to every extent possible.
At work, I always had Gin Gins in my mouth, hoping I could make it through teaching my classes without rushing out to the bathroom to be sick.
In that bathroom, I talked to my baby. I was in a new job after 6 years of grad school, and I felt lonely. But because of the growing baby in my belly, I knew I wasn’t really alone, and I took comfort in that. Amid the nausea, of course.
Blighted ovum miscarriage: What to expect
Here’s something I really want people to understand about a BO. The mother’s experience is just like any other pregnancy!
Some women will have morning sickness. Others won’t.
Some will have cravings. Others won’t.
Many will experience food aversions. Others won’t.
Heartburn is common in some women. It’s not in others.
These are all normal pregnancy symptoms! And there are so many more! Bloating, sensitivity to taste and smell, fatigue, sore breasts, round ligament pain, metallic taste in your mouth–all the normal and unusual early pregnancy signs can still be present with a blighted ovum.
That’s something most people don’t tell you to expect with a blighted ovum. If your body doesn’t recognize the loss, you can still have normal pregnancy symptoms.
Because hormones are still increasing.
The gestational sac is still growing.
As far as your body knows, it is growing an embryo.
The only difference is that, internally, there’s no embryo.
But unless you have a spontaneous loss, your body doesn’t recognize that, and God knows your heart doesn’t either.
That’s part of what makes a blighted ovum so hard to emotionally grasp. For so many women, the problem with their pregnancy is absolutely symptomless.
I did not bleed, or even spot, or have any indication of an issue until I walked into the most miserable ultrasound of my life.
My blighted ovum story
Husband and I prepared for our first ultrasound with nothing but sheer excitement. I had told him he wasn’t allowed to tell anyone about our pregnancy because it was “too early” to tell friends and family (I no longer believe in that concept, by the way), but I didn’t actually think anything would go wrong.
Ever practical, Husband was more realistic about the possibility of miscarriage than I was. But watching my morning sickness and insane food aversions, he also thought everything was fine.
We sat in the waiting room at my doctor’s office filling out paperwork, and we looked over to see another couple sitting together excitedly, nervously, too early to show.
We knew they were there for the same reason we were. I silently thought I should befriend this girl. After all, our babies would be about the same age.
To this day, I don’t know what held me back. But something did. Thank God something did.
I should’ve found out that day
My doctor wasn’t in the office that day, but since it was a routine ultrasound test, no one was concerned by her absence.
When we were ushered into the ultrasound room, Husband’s reaction was hilarious. Apparently (and understandably), he really had no reason to know what women experience at the gynecologist.
He would learn far too well over the coming years of recurrent miscarriage.
The ultrasound technician told me to empty my bladder and put on a paper skirt. I followed her instructions with equal parts elation and nerves. Then, I plopped onto the table and put my legs up in the stirrups.
The color drained from Husband’s face. “What is she about to do to you?” he asked.
I chuckled at him. How could I not?
“I’ve never done this before,” I said, “But I’m pretty sure she’s going to stick a probe in my vagina and look around to show us the heartbeat.”
I’ve never seen his eyes so big. I could see exactly what he was thinking. “Dear God, I’m so glad I’m not a woman.”
He didn’t say it out loud, but I could see that it was there. All I could think was, “I hope this isn’t the first time you’ve realized how many ways a woman’s life is harder than yours.”
There should’ve been a heartbeat
Based on my last menstrual cycle and likely ovulatin date, I was supposed to be about 7 weeks.
There was supposed to be a heartbeat.
The ultrasound tech was supposed to put the probe in my vagina, move it around uncomfortably a little, and then turn the screen in my direction and turn up the volume so I could hear that beautiful sound. Buh-bum. Buh-bum. Buh-bum.
She was supposed to show me the flicker on the monitor and tell us it was our baby’s heart. Husband would take my hand, and we would look at each other and smile, teary-eyed.
That’s how this moment looks in the movies. That’s what I expected.
When the ultrasound technician got up to leave the room without turning up the volume or showing me the screen, I felt my heart drop way down to the bottom of my gut.
“You can get dressed,” she told me. “A doctor will be in shortly.”
I started shaking. The room was suddenly very cold, and it was spinning a little. I got up, but I didn’t feel quite stable on my feet. Was I feeling lightheaded, or were we having a small earthquake? I couldn’t look at Husband to find out. I didn’t want to see him.
If I had looked at him, I’d have seen that he had no idea what was happening. He didn’t know the protocol or what was supposed to happen. He still thought everything was fine.
I should’ve asked for my ultrasound to be medically reviewed
A few minutes later, the ultrasound technician returned.
She hadn’t been able to find an available doctor, so she was going to do what she wasn’t supposed to do. She was going to give us the news herself. Sort of.
“There’s no heartbeat yet,” she told us. “Your gestational sac looks good, but there’s not a yolk sac or fetal pole.” (I later learned that the yolk sac develops inside the gestational sac and is where the embryo grows. The fetal pole is the flicker that is the earliest sign of a heartbeat.)
Shaking even more, and with the weight of this reality hitting Husband for the first time, I asked if there was any chance of viability.
I fume to this day when I recall her answer. Because it was utter bullshit.
“It could really go either way at this point,” she told me. I might be earlier than we thought, or the pregnancy might not be viable. The only way to be sure was to wait a week and follow up with another ultrasound. She told me the chance was about 50/50.
I should’ve waited for a doctor. A doctor would’ve been able to diagnose a blighted ovum as the likely scenario, even though I’d have still been told to come back a week later to confirm.
Questions to ask when you have a suspected blighted ovum
There are times when the ultrasound tech’s words would’ve been true. But they weren’t true in my case, and I know that now because I know what questions I should’ve asked.
But at the time, I took her word for it and spent the next week in fear, waffling between predicting impending doom, and assuring myself everything was fine because I wasn’t bleeding or cramping and my signs of pregnancy were intensifying.
Had my doctor been there, she probably would’ve used words like “threatened miscarriage” and “possible blighted ovum.” She also would have prepared me for the fact that this was almost definitely a blighted ovum.
If you find yourself in this situation, first, I’m terribly, terribly sorry. And second, please ask this important question:
“What is my gestational sac measuring?”
Had I known to ask this question, I could’ve processed my pregnancy loss earlier. I would’ve known that my empty gestational sac was measuring 7 ½ weeks, and that no heartbeat, not even a yolk sac at that point in pregnancy meant that my pregnancy was VERY likely not viable. I say very likely because measurements can be off for women with a tilted uterus (which I don’t have.)
[Editorial note: if you would like to know more about gestational sac measurements, we found this scientific article to be very helpful, and this article to be helpful for a general audience. The second article includes a gestational sac measurement chart reproduced from a medical study.]
I would’ve known that my follow-up appointment a week later was to confirm a loss, not to check on my pregnancy.
But I didn’t know these things.
Blighted ovum treatment options
The following week was absolute Hell. Husband’s uncle passed away, so we flew to Ohio for his funeral. Surrounded by family with small children, I continued to imagine my life with one of my own.
I conspicuously tried to hide my refusal to eat deli meat, and I wore maternity clothes to hide the incredibly bloated belly that made me look 18 weeks pregnant, not 8. For all these reasons, along with the lack of bleeding and cramping, I convinced myself all was fine.
Despite what should’ve been a warning, I was completely blindsided the next week at the doctor when it was confirmed: my pregnancy was not viable.
My doctor explained that are three primary blighted ovum treatment options:
- Take cytotec (also called misoprostol), a drug that induces miscarriage when your body isn’t recognizing your loss and expelling it naturally. (We have an article about the misoprostol experience we recommend that you read before considering this option. But keep in mind that all experiences are different.)
- Have a dilation and curettage (D&C), a surgical procedure where the doctor expels the “contents of pregnancy” (don’t even get my started on that phrase) from your uterus
- Wait to miscarry naturally
My doctor strongly advised against waiting to miscarry naturally. Some doctors recommend that you wait in case you’re earlier in your pregnancy than you think, but we knew that wasnt my case.
With a gestational sac measuring 8 ½ weeks and HCG numbers still rising, there was no sign that my body would recognize the loss anytime soon.
She also pointed out the physical and emotional toll such a decision would take on me.
Carrying a nonviable pregnancy can lead to infection and even sepsis, and knowing you’re carrying a nonviable pregnancy is extremely emotionally difficult.
Despite her urging, I initially wanted to wait to miscarry naturally.
Until I spent that night on a towel on the floor, hovered around a toilet, and fully realized it was all for nothing.
I had read far too many horror stories about cytotec, stories like Arden’s misoprostol experience, and I knew I couldn’t handle the uncertainty of taking that medicine.
So, I opted for a D&C because it felt like the most controlled option to me.
(I should mention that it was freakishly expensive, but that many other miscarriage management options can be, as well. You can read more about that in an article I wrote on the financial and emotional cost of miscarriage for Romper.)
Questions to ask your doctor when they suspect a blighted ovum
If you suspect a blighted ovum, the primary question to ask your doctor is about the measurement of your gestational sac. This will give you a good idea as to whether you should hold on to hope or prepare to relinquish it. Because there are times to hope.
A friend of mine had a similar experience, only she was measuring 5 ½ weeks at an appointment that looked like mine at 7 ½.
Based on her last missed period, she should’ve been 8 weeks along. But because her sac was only measuring 5 ½ weeks, there was a definite chance of miscarriage, but also a chance that she simply ovulated very late that cycle.
She’s due any day now. According to my GYN, most women have an “off” cycle 1-2 times per year.
By asking what her gestational sac was measuring, we didn’t know that everything was okay. But we did know that it truly could go either way; whereas if I had asked, I could’ve accepted my reality a week earlier and seen the follow-up as a confirmation scan. I would’ve been much more prepared.
If a blighted ovum is confirmed, here are other questions I would ask my doctor, if I were doing it all over again.
- Is there any chance of viability? Should we do another ultrasound in a week? (You never want to risk intervening in a pregnancy if you aren’t fully convinced it’s nonviable, even if your doctor is sure. It’s not fair to ever have to question your decision.)
- If you (the doctor) had to choose an intervention right now, what would you choose and why?
- How many of your patients who choose to wait to miscarry naturally or who take cytotec still end up needing a D&C?
- How many of those patients end up in the ER during their physical loss?
- Do I have any physical restrictions right now?
- What are the restrictions on my daily life if I choose a D&C? For example, when can I exercise again, when can I take a bath, etc? What about if I choose a medically managed miscarriage (cytotec)?
- What is the financial cost of a D&C? An ER visit if it’s necessary during miscarriage? (You may have to call your insurance company to answer these questions, U.S. mamas, but some hospitals and clinics have set pricing.)
- If you choose a D&C, should we do genetic testing? (You have the option of testing the “products of conception.” If this is your first miscarriage, most doctors will urge you not to pay for the testing. They’re probably right, as your risk of miscarrying again is low, and most BOs are caused by chromosomal abnormalities. BUT, as someone who went on to have 3 subsequent losses and never again had the chance to test (because 2 losses were spontaneous and one was ectopic), I wish we had tested my BO. If we’d discovered a normal chromosomal structure, we might’ve known to look for physiological causes of my losses sooner, which ended up providing answers and a healthy pregnancy. You can read more about my success after recurrent miscarriage here.)
- Do you have the contact information for a good therapist who can support me through this time?
What I want you to know
Oh mama, if you’re in this position right now, I am so sorry. And there are a few things I want you to know:
- First, you’re not alone. Blighted ovums are among the most common type of early miscarriage. So many of us have been there.
- Second, YES, YOU WERE PREGNANT! Your body produced all the hormones and went through all the motions. You imagined your pregnancy, your birth, and the life of the your child. The fact that you learned at an ultrasound that those hopes would not become reality does NOT take away your experience.
- Third, people will say hurtful things, even more so if they know your loss was a blighted ovum. Ignore those people! Also, send them this link so they can learn what not to say to someone who had a miscarriage, which again, includes you!
What do you wish you’d known about the blighted ovum miscarriage process?
At what stage do blighted ovums usually miscarry?
Blighted ovums miscarry at different stages. Some occur as spontaneous losses very early. Others are not discovered until a first ultrasound, which can occur as late as 12-14 weeks gestation. They most commonly expel naturally between 7 and 12 weeks.
While you don’t want to carry too long due to risk of infection, research suggests waiting until 9 weeks of pregnancy to intervene on a blighted ovum.
A blighted ovum may miscarry spontaneously, with bleeding and cramping like many other miscarriages. However, a BO can also be asymptomatic and feel like a normal pregnancy, requiring medical intervention after an ultrasound proves nonviability.
YES! When a blighted ovum occurs, a sperm and egg still come together, but a problem occurs as it develops into an embryo. A gestational sac implants into the uterine wall, and women produce pregnancy hormones and grow a sac. Early pregnancy with a BO feels just like traditional early pregnancy.
Blighted ovum miscarriages are relatively common. Up to 1 in 4 pregnancies is believed to end in miscarriage, and up to 50% of early pregnancy loss results from blighted ovum.
More miscarriage articles
- What to expect when you miscarry
- After miscarriage, what to do
- Fathers dealing with miscarriage
- Why you don’t have to attend a baby shower after miscarriage
- Recurrent miscarriage testing
- Pregnancy & Infant Loss Awareness Month
- International Wave of Light
Healing from miscarriage
- Coping with miscarriage grief
- Creating a miscarriage memorial
- Books about miscarriage
- Miscarriage tattoos
More miscarriage stories
Katy Huie Harrison, PhD, is an author, mom, recurrent miscarriage survivor, & owner of Undefining Motherhood. She lives in Atlanta with her husband (affectionately known on the internet as “Husband,”) son (Jack), and dog (Charlotte). She believes our society puts too many expectations on women that make womanhood and motherhood restrictive. Her goal is to shift the paradigm about what it means to be a woman and mother, giving all women a greater sense of agency over their own lives. You can find Katy and her work featured in places like CNN’s Headline News, Romper, Scary Mommy, Demeter Press’s Motherhood and Social Exclusion, & more.