Our expert says:
In the first instance the diagnosis of ovulatory dysfunction is extremely likely, but the underlying cause is yet to be established. It is occasionally possible to diagnose PCOS without any physical attributes, but purely on the basis of ultrasound examination. I find it difficult to correlate a negative HCG blood test with the ultrasound findings of twin gestational sacs. As a general rule if a single gestational sac is seen even in an impeding miscarriage situation one would still expect an HCG level in excess of 3000 and therefore I can only presume that what was seen on ultrasound was a pseudo sac. Such a pseudo sac may be due to fluid accumulating in the endometrium or the presence of blood clots some of which may have haemolysed within the endometrium (uterine cavity). This will correlate strongly with the increased heavy bleeding that followed and it is often the shedding of a decidual cast. I would therefore consider a review of the entire process and diagnosis before embarking on further treatment.
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