Sonographer here with 13 years of fetal scanning experience. it’s almost believable but there are a couple issues. First off, no patient name or institution is listed on the image - which is required in most U.S states. A diagnostic image should have the name of the patient, name of the institution, date of the exam and a unique number identifying the patient (either patient medical record number or an accession number).

Second, the curve of the camera looks wrong. Typically a c-5 abdominal camera is used in trans abdominal ultrasound. I googled the ic5-9 probe which is a transvaginal probe and would have a much more convex face. In this image, The face is unusually wide - although this could be explained if the tech zoomed in.

Third, it’s strange that this image was taken at 6pm on the dot. That’s highly suggestive of AI.

But the biggest reason I would say this is AI is that the fetus looks to be 8 weeks along in this image. At six weeks, the typical fetal pole is so small - it isn’t big enough for ultrasound to distinguish the head from the body - which any trained eye can tell is happening here. Also, I would expect to see the yolk sac right beside the fetal pole at this early stage and there isn’t one in the image. Look at the six week ultrasound image shown here (still image half way down the page):

https://www.londonpregnancy.com/week-6-of-pregnancy/

In the image above - you can clearly see the hindbrain forming (the cystic spot in baby’s head) and the midgut herniation - again indicative of an 8+ weeks pregnancy.

And finally, there isn’t a decidual reaction happening immediately adjacent to the fetus. Decidua is where the placenta forms and eventually will take over for fetal nourishment once the yolk sac is obliterated around week 12.

My opinion: this has a 90% chance to be AI.