Asherman's Syndrome: A Complication of Dilation and Curettage

Dilation and Curettage (D+C) is a procedure which has become routine for many women.  The womb is opened and the contents are removed.  It is performed after miscarriage, elective termination of pregnancy, and sometimes after childbirth in the case of retained placenta.
Doctors will tell you it’s a simple procedure that will reduce your risk of infection.  What they don’t tell you is, this ‘simple procedure’ could cause Asherman’s Syndrome, an extensive scarring of the womb, which can render you infertile.
If you are pregnant and considering an elective caesarean you are also risking infertility.  Cuts to the womb can result in scarring, making it impossible or difficult for you to get pregnant again. Depending on the severity, the uterine walls can actually stick together.  Scar tissue can prevent an embryo from implanting, can obstruct your cervix and prevent sperm from even reaching your egg.  In many cases there aren’t any noticeable symptoms so a woman would not  know she had Asherman’s Syndrome until she tried to have a child. 

According to research carried out by Dr. Charles March at California Fertility Partners, USA:
·    If a D+C is done early after foetal death, 6.4% of women get Ashermans Syndrome
·    If D+C is done long after foetal death, 30.9% get Ashermans Syndrome
·    If D+C is done after elective termination, 22% of women get Ashermans Syndrome
·    If a D+C is performed after childbirth, 25% of women get Asherman’s Syndrome.

‘I went in for a D+C and got sick with an infection that almost killed me.’

Debra tragically lost her son in 1999 and went on to lose her fertility to Asherman’s Syndrome.
‘I got pregnant very easily in 1999 and had no problems at the start. I had two small fibroids and the team of doctors I visited assured me that they should not be a problem. However due to the hormones one of them started growing... fast. We expressed fear about it bothering the baby but they stressed that it was normal.
The fibroid was sucking whatever I had, whatever I eat and I think fighting with the baby. I had some light bleeding we went in and one of the doctors told us that if something happened that there was nothing we could do, it was nature. I just felt as if they were very callous in the bedside manner. My doctors decided that I should have a high grade ultra sound.  On December 18th, I felt some lower pelvic discomfort, we went to the doctor for the usual check and he shrugged and did not make any major comments. We were so naive and trusting we took it to mean that this was all a part of the process.

On Dec 23rd, I started to have what was similar to a period pain, by the 24th it became much worse. We called the doctors and the on call doctor told me to take a pain killer and relax. The pain became unbearable and we decided to go to the emergency room, by this point, I was rolling on the floor. We later found out I was actually in pre mature labour. By the time we got there, it was too late, the baby was coming and there was nothing to do. We were told that the child would not live, too early and that I would have to deliver.

Baby Matthew

I delivered a baby boy on Christmas Day. We held him until his heart stopped beating, he had no proper lungs and could not survive. It was and will always be the most surreal moment of my life. The doctor who treated us so badly when we called her so many times, came to the hospital and did the delivery and told us how sorry she was. At the time we were so shocked and traumatised to even think.
 My husband was pacing the room, just bawling and I just lay there wondering what I did wrong to pay for my sins this way. We left the hospital that night, we could not take the pain being there. We decided to take our child who we named Matthew Ivan Benjamin to a local funeral home for cremation. We got our child cremated, the second worst day of our life and place the box under the Christmas tree at home, we could not bear to part with him.

. After everything happened, I received one call from the doctors office from the primary doctor, who told me to come into the office and see them when I was ready. At this point we hated them, for their lack of caring, their incompetence and carelessness of care. I could not stop crying and my husband tried to put on a brave face for us, but was crying inside. I decided I wanted them to pay for what they did and what they could do to other women. We went to an attorney who told me that I did not cry enough and that a jury would not buy the case and that I would get pregnant again no problem.
 Through all of this, I was having problems every time I went to the bathroom and realized that maybe there was something going on. I found another doctor and visited him and went through my history. I was having bleeding issues and he asked if I had a D and C, I said no. I went in for the D and C and came out and got sick a week later with an infection that almost killed me. I recovered and then went for surgery to remove the large fibroid from my uterus. I had to have a blood transfusion due to extremely low iron levels, I had to be given something. I had the fibroid removed and my life continued to never be the same anymore. I never got pregnant again, and tried for the next 8 years without success.
 My husband was in a lot of pain, I saw it when we decided to take Matthew's ashes to the shore to scatter. We did it on a cold Sunday in February, my mother told us we must make this move in order to move on. He cried like a baby after we scattered the ashes, his life had changed forever, we had changed forever. We were tougher, harder, stronger. We have to be aware of what we are being told and ask questions and never, ever trust any medical professional. We became consumed with the Asherman’s Syndrome so I had to stop crying and try to find solutions. We did for 8 years.
I do not have any lasting pain physically, but mentally i still feel traumatised, I remember everything as if it was yesterday. I watched friends have families three times since then, and that is very painful. I try to be brave, but it hurts that I would never be able to do it. It really hurts. I still think about Matthew a lot, my husband pretends he has moved on but I know the pain is still there.’
Find out about the history of your doctor with D+C, it is too delicate to be messed with or your life hangs in the balance, a bad one can kill you from the infection.
We tried surgeries, IVF, I had lots of embryo’s and they took for few days and then died after implantation, the lining could not hold up. Adoption is my last chance.’

‘The Surgeon Sewed My Uterine Walls Together’

Jennifer got Asherman’s Syndrome after a botched Caesarean.

I had an emergency c-section so I did not have a lot of choice in the matter.  And the "complication" that caused the Asherman's was that my obstetrician had a scheduled c-section after mine and was obviously in a hurry.  She actually sutured the front of my uterine wall to the back when she was closing.   And over the next year the walls grew together, completely sealing the uterus.
 
It was two more years before I was diagnosed. 

Women who have Asherman’s Syndrome have a higher rate of cervical incompetent due to previous cervical procedures done.

The placenta can attach to scar tissue and create placenta accreta.   As it results in haemorrhaging and the placenta can't be removed so they generally have to do a hysterectomy at that point.
 
It's appalling to me how many people schedule c-sections for convenience or other unnecessary reasons.   It is major surgery and things can happen.   I have told young women who are considering c-sections because they are worried about the pain of childbirth or because they like the idea of convenience that my very routine c-section left me infertile.  Most people don't realize that can happen.  I can't imagine why someone would want to repeat my journey for convenience -- it was anything but that!
 
I had lots of pain when I got home from the hospital and some fever as well.  I'd never had a surgery before and didn't really know what to expect.   I called the doctor and was told the fever was from engorgement because of the breast feeding.  I finally got an appointment with the nurse and she thought all of my complaints sounded normal and sent me home.  I thought it was odd that my periods never resumed, but everyone said it was from the nursing.  After I stopped, I was told it could take 6 months before my periods would resume -- which of course they didn't.  I went to a new OB at that point and he ran a course of fertility tests on me.  They all came back very normal.  So he scheduled an HSG test -- where they inject dye into the uterus and take x-rays of the cavity.  But the dye couldn't enter my uterus because it was solid at that point.   

I had three surgeries last year. My local OB also suggested that he'd never seen success with such a severe case.  But I did fly to Los Angeles to see Dr. Charles March, a leader in Asherman's treatment.   So after four years of infertility -- and about a 35 percent success rate for women with severe AS I was able to conceive naturally in January.

I really focused on being healed and would not let myself dwell in anger for the doctor who did this.  Not easy, but we felt that being angry and defeated just created negativity about the process.  So we meditated on being healed, visualized our new baby -- along with tons of holistic medicine including acupuncture, Mayan uterine massages, herbs, vitamins, teas... Of course I was delighted when I got the positive pregnancy test, but honestly, even though we had been told by medical professionals that it wouldn't happen, I just always knew that it would work out for us in the end.  Even if it wasn't the journey I expected!’

Treatments

Medical treatment involves surgery to remove excess scar tissue.  A small balloon is placed into the uterus to hold it open and allow the walls to heal.  This can prevent re-scarring.  The hormone oestrogen encourages the growth of womb lining so some women are given oestrogen supplements.  Up to 80% of women can go on to achieve a pregnancy after these treatments.

Alternative therapy

Fertility guru Zita West uses acupuncture to help her patients with Asherman’s Syndrome.  Stimulating the energy points in relation to the uterus can increase blood flow to the area and aid healing.

Eating foods that increase oestrogen levels may also help, for instance, soya beans.

Massages can also relax you and increase blood flow to the uterus.

Raspberry leaf tea is a uterine tonic known for strengthening the uterus.

Try a hot caster oil pack on your abdomen.  Castor oil may break down scar tissue.

If you are having surgery, Arnica 200 homeopathy can help ease pain and facilitate faster healing.