<s>[INST] Last menstrual period start January first having abdominal pain and lower rob pain went to ER yesterday, ChatDoctor level of 276 had vaginal and abdominal ultrasound that showed cysts on ovaries and small amount of fluid in cul de sac no intrauterine pregnancy I have had no bleeding should I be concerned that it is ectopic still? [/INST] Hi and welcome to Chat Doctor. Thanks for the query. This is very unlikely since Chat Doctor levels would be much higher and embryo would already be detectable with ultrasound. Your pain can be caused by cysts and especially ruptured cyst which could explain fluid in cul-de-sac. So this is the first thing to think of. But if pain persist you should visit gynecologist again. Wish you good health. Regards </s>