My question is about a gestational and yolk sac with no fetal pole. I am about 4 weeks pregnant. My hcg level was at 7,000. Ive had 2 ultrasounds because they thought with the first one I had an ectopic pregnancy, she could only see the yolk sac. But that was ruled out. My question is, when should I start to get concerned about there not being a fetal pole or heart beat. Some women have said wait until at least the 8th week. If nothing is found then, my pregnancy is probably not viable. I am just to early to see anything? Is my hcg level where it should be? When should I hear a heart beat? With no fetal pole should I be concerned about a miscarraige?Also before I took a pregnancy test or missed my period I was already having symptoms such as fatigue, queasy stomach and very tender swollen breast, that's how I knew personally I was pregnant. I just don't know if Im actually 4 weeks, if I was already having symptoms.I feel further along. My stomach is already poping out and I was very active, very fit, so my stomach was FLAT! This will be my first pregnancy, so Im a little worried and confused about everything. I hope someone can help me with as much information as possible. Thanks.

5 ½ to 6 ½ weeks is usually a very good time to detect either a fetal pole or even a fetal heart beat by vaginal ultrasound. The fetal pole is the first visible sign of a developing embryo. This pole structure actually has some curve to it with the embryo's head at one end and what looks like a tail at the other end. The fetal pole now allows for crown to rump measurements (CRL) to be taken, so that pregnancy dating can be a bit more accurate. The fetal pole may be seen at a crown-rump length (CRL) of 2-4mm, and the heartbeat may be seen as a regular flutter when the CRL has reached 5mm.

If a vaginal ultrasound is done and no fetal pole or cardiac activity is seen, another ultrasound scan should be done in 3-7 days. Because pregnancy dating can be wrong, it would be much too early at this point to make a clear diagnosis on the outcome of the pregnancy.

Even in the most athletic and tight tummied woman, you would not be beginning to show yet at 4 weeks. This is most likely due to increased urinary retention or just generalized excitement about your pregnancy.

Your hCG level is great for the gestational age, which should range from 1,000 - 30,000 at 4 weeks.

Here is the table for the rest of the pregnancy. Notice that the levels begin to decline in the second trimester.

Pregnant females by week of gestation
Less than 1 week 5-50 mlU/mL
2 week 50-500 mlU/mL
3 week 100-10,000 mlU/mL
4 week 1,000-30,000mlU/mL
5 week 3,500-115,000 mlU/mL
6-8 week 12,000-270,000 mlU/mL
12 week 15,000-220,000 mlU/ML

Here is the HCG level that J9 always puts on here
Less than 1 week pregnant = 5-50
2 weeks = 50 - 500
3 weeks 100 - 10,000
4 weeks 1,000 - 30,000
5 weeks 3,500 - 115,000
6 - 8 weeks 12,000 - 270,000
12 weeks 15,000 - 220,000

Each woman and each pregnancy varies on what is normal for their levels. A you can see, at week 4 you are still within normal ranges. 1,000-30,000 is a large range. As you are only 4 weeks pregnant, that means that your babies conceptual age is actually 2 weeks.
Fetal development - 4 weeks pregnant
"The ball of cells -- now called an embryo -- growing inside your uterus is the size of an apple seed. It's divided into three layers that will later form organs and tissues. Low on the sides of the head are two folds of tissue that will become the ears.fetal development at 4 weeks...The neural tube -- from which the brain, backbone, and spinal cord and nerves will sprout -- develops in the top layer. The heart and the circulatory system begin to appear in the middle layer. The third layer starts to house the lungs, intestines, and beginnings of the urinary system. In the meantime, the early version of the placenta, the chorionic villi, and the umbilical cord, which delivers nourishment and oxygen to your baby, are already working. "

If you go to that link I gave you, you will see a picture of what your baby would look like at this point... which is... not much. If your doctor is not worried, neither should you be. It sounds like they are keeping a close eye on things, so don't worry yourself yet. Good luck and congrats on your pregnancy.