Had my first ultrasound today. Is there any hope?

CW: pregnancy loss

UPDATE (11/24): My doctor asked me to get a formal ultrasound 2 days ago. The radiologist told me to go straight to the ER because they suspected I had an ectopic pregnancy. I didn't have any severe pain or bleeding. The only symptoms were my high hCG levels (15,000+) and a 4mm mass found in the right fallopian tube. ER nurse and on-call OB confirmed it's ectopic and gave me two choices: 1) methotrexate and go home with the , or 2) surgery to terminate the pregnancy and lose my fallopian tube. I ended up choosing the latter bc it meant being proactive and treating the ectopic pregnancy before a ruptured could happen. Since I was super stable and not presenting with any pain or bleeding, the OB scheduled my surgery for the following morning. I was admitted to the hospital overnight. Around 8 am, I thought I was having gassy cramps so I went to the restroom. While cleaning up, I got super dizzy and started to blackout and lose my balance. I was able to walk back to my bed, but the abdominal pain was making me go into a cold sweat and almost pass out. I was pale and my blood pressure dropped to 86/59. My tube had ruptured and I was bleeding internally. My surgery was bumped ahead of the others. OB said I lost about a liter of blood and my right fallopian tube was removed. I'm still in the hospital but hopefully getting discharged today. The recovery has been painful physically and emotionally. I had to receive 1 unit of blood transfusion. But, all things considered, I was in the right place at the right time for all this to take place. Of course I'm sad about losing my baby, but I was also mentally prepared in case something like this happened in the first trimester. If anything, I'm traumatized and unsure if I want to ttc again. • • • Let me start by providing context. I'm 31 years old, have PCOS and irregular periods, and have been off birth control since March. On 11/4, I took a home pregnancy test that was positive. Wanting to be absolutely sure, I took two more the following day that were also positive. No faint lines, just very clear and solid lines. Doc sent in an order for hCG quantitative labs and my levels were at 2044 mIU/mL.

Husband and I had our first prenatal appointment with a nurse on 11/11 and discussed all the things to expect. We have been actively TTC since March and were so excited to find out I'm pregnant. However, we were also cautiously optimistic because we didn't want to be disappointed in case (God forbid) a miscarriage, chemical pregnancy, etc. happens. Still, we began to dream and plan together.

Today, I had my first transvaginal ultrasound. If my last period was truly on 10/19 ("truly" bc not sure if it was implantation bleeding or period), then the gestational age is currently 4w3d. OB is a resident and couldn't find a gestational sac. My bladder was full, which she said was a good thing but still couldn't see anything. She called in her advising physician, who also was unable to see anything except a cyst on one of my ovaries. They ended up telling me that this is concerning bc they should be able to see something by now. The two doctors were also only talking to each other during the ultrasound and said something about thickness not as thick as they would hope? Not sure what that was in regards to. Advising OB told resident OB to order another hCG lab stat and left. Resident OB said "sorry" and that she'll call me with the results of the new test and left. No info about what could be potentially happening or anything like that.

Husband and I are gutted. We were so looking forward to hopefully seeing a small glimpse of our little nugget. I already got the second hCG test back; its only a qualitative test but it says "positive" for pregnancy. Is it possible that it's just too early to see a gestational sac? Is it possible that my bladder was too full and made the ultrasound hard to read? Should I hold onto hope that I'm still pregnant??