What is the reason for no obvious gestational sac in early intrauterine pregnancy?

Patient's question:

Uterine position, retroversion, enlarged uterine body; anechoic area measuring 5x3x4 mm was observed in the uterine cavity, with no embryonic sac or fetal heartbeat detected. Both ovaries are of normal size and shape. Liquid was detected in the pelvis, measuring approximately 19 mm in depth. The blood clot is still as large as a fingernail. Could you please ask the doctor, how many more days do I need to wait for a painless abortion, and what is the exact date? First follow-up question: I have been experiencing a 45-day menstrual delay. On November 19th and November 23rd, I had ultrasound examinations, but nothing was found; no obvious gestational sac was observed either inside or outside the uterus. It was only detected on November 26th, which was yesterday. Because November 24th and 25th were my menstrual days.

Doctor's answer:

The earliest it was December 5th. You are now about 40 days pregnant, and generally it can be done around 50 days. Based on your ultrasound, the size of the gestational sac is only about 40 days, which is smaller than your missed menstrual period. There are two possibilities: one is that you conceived later, and the other is that the embryo has stopped developing. A week later, if the ultrasound shows the gestational sac has grown and a heartbeat is detected, it means you conceived later. If the gestational sac has not grown and the fetal bud is still not visible, it seems the embryo has stopped developing.

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