Ashermans -wwyd?

[sadagain]

Hello all, I am currently having a mmc /chemical pg which due to having had a few of each - I KNOW it is not working. I will go to the hospital soon and get it confirmed but am not bleeding - dont feel pg tests very very light . I know it's a miscarriage. Anyway - I am older and recently saw a private consultant for the whole ttc thing. He told me that there was nothing he could do to help me keep the pregnancies and basically said just keep trying.

The one thing he was really really adamant about though was Ashermans syndrome. He went on and on about dont have a d and c opt for medical.

Having had both i found d and c so so so much nicer. medical was horrible and i swore never again.

Does anyone have advice- any one been given the same advice as me? The consultant is highly esteemed at big teaching hospital.

Thanks for any advice

I am sorry about your loss and I am afraid that I can offer you no advice only to say I have had 2 natural mc, one at 9 weeks and one at 12. The one at 9 weeks was, whilst horrid, shorter.

I hope someone with some knowledge comes along soon to help you out. x

hi, your post is very interesting. I am impressed he is so up to speed about Ashermans - i've found many doctors don't know much about it, if anything, so it's great that he was able to tell you about it and warn you of potential risks. i have had three D+Cs myself and got very worried about Ashermans ahead of the third procedure. someone on this board on mumsnet actually sent me a research paper that really freaked me out, with some statistics about how the risk of scarring increases each time you have the operation etc etc. however i have subsequently been told that the risk only increases because each time you have the operation, you are exposed to a certain risk (let's say 1: 5 risk of some scarring); therefore the more operations you have, the more likely is is that you'll be the unlucky 1 in 5. this is very different to the risk of scarring increasing each time as a result of the previous surgeries which is what I initially thought and understood to be the case.
this actually made me feel better about having to have a third D+C (i waited two weeks in the vain hope that nature would take its course; by then my embryo had been dead for a month or so and i was then worrying about getting an infection; so finally i gave in and had the operation).
i do think Ashermans is an interesting area for more research and information, in terms of possible link to miscarriage. despite having four miscarriages in a row, and having had a very aggressive and unpleasant D+C many years ago which i think may well have caused some scarring, not one of the many many doctors or experts i have seen has ever mentioned the condition.

i hope this is at least a little helpful.

I am so sorry to hear of your loss.

I have been treated for Asherman's Syndrome. mine was as a result of a c section with my DD. I know Asherman's is more commonly caused by a D&C, but it is still rather uncommon.

Your consultant sounds very up to date and knowledgeable. It took me several years to get a dx! I was lucky to find that my consultant once referred to the hospital (also bug teaching hospital, in Sheffield) was knowledgeable on the subject and suggested AS within the first meeting with him.

KTrace - i have also had natural which was by far my easiest -its just the 'when?' thing. I am only 4.5 weeks and the tests are gradually getting darker so i feel as though i could be in this state of limbo for weeks and weeks

sotough - you make me feel like my consultant is right - isee what you mean re the probability bit i just feel it would be so much easier to go surgical. The risk of compromising my fertility makes it a complete no no..

aaargh!

Hulababy i am so soryy that you suffered that. Is your fertility ok now - is that how you discovered you had it ttc again?

I had symptoms that lead to the dx, but it took time. I had a lot of pain, and I mean intense pain, every month but no or very little bleeding. This was since the birth of DD. We'd had problems TC with DD anyway so was expecting that but it just went on and on. I went to the GP about the lack of period but the intense pain, the TTC was almost incidental at the time as the pain was my main concern.

It is now nearly 3 years since my first op (8y snce DD was born and 6y of TTC) and a couple of years since my various treatments, inc clomid, ended. Apparently my A has been treated and the adhesions gone but I still have some symptoms (very light periods, but no pain) and still no pregnancy, despite other tests being normal.

However, i is also important to remember that AS is still very uncommon and most women who have a D&C are not affected by it.

Good luck with everything and again, sorry about this loss.

oh yes, i should have mentioned that i also have very light periods indeed, something i have specifically raised with several consultants, and still none of them mentioned the possibility of Ashermans. this is probably because i have proven fertility - in that I have a DS, now three years old - and the light periods began before he arrived, but still, you'd have thought with four consecutive miscarriages it might have been worth investigating. happily i'm now 27 weeks pregnant anyway but if i'd had a fifth miscarriage i would have gone private for Asherman's investigations. for anyone who is interested/worried about the condition, Adrian Lower is supposed to be the private expert to see in London.

I cannot profess to have any formal medical knowledge whatsoever. However, anecdotally I can tell you that I have had 6 D&C procedures and subsequently had my 4th child last year with no uterine problems. Additionally, I have had one medical treatment of a MMC which resulted in retained products of conception and a severe infection (leading to life threatening septicaemia) that once cleared up saw me under GA having yet another D&C. So, personally, I don't feel avoidance of the syndrome is as cut and dried as not having surgical treatment of MC. However, statistics may paint a different picture from what I've read briefly.

I am very sorry that you are in the position to be thinking about this and though your OP sounds wearily resigned to the reality (I was like this with MMC no.2), I wish you strength and I hope a successful and strong pregnancy soon.

Hello

Sorry you are going through this sadagain, it sounds like you have been through a lot already.

I'm very interested in this thread as I am awaiting testing to see if I have Ashermans. and am just learning all about it.

I found this video with doctor Lower speaking in it. He says that if you are worried about repeat ERPC's that you could ask for the procedure to be performed under ultrasound control so that they are not performing "blind"

I cant remember if he mentions it or I read it elsewhere but I also learned that there is more risk when an ERPC is done after the birth of a full term baby because the uterus is more stretched and sensitive at this time, so presumably the earlier the mc the less risk of getting AS? Also, having a natural/medically managed mc doesnt guarantee you zero risk of Ashermans as retained tissue can get stuck and cause an infection which is another cause of AS.

I hope things turn out allright in the end and you dont have to face the awful decision of how to manage an mc, but if you do then I believe its best to base it on what you feel you can cope with at the moment and what will help you recover best rather than whether you may or may not get a rare complication from the ERPC

best wishes xxx

PS hobgobblin - I cant believe how much you have been through. Do you mind me asking did you always get your periods back after the ERPC's?

Oh, mummyabroad, I'm okay about it. I had so many for various reasons. Some were after pregnancy, some miscarriage. I have 4 healthy children all of whom were born after at least one D&C/ERPC procedure.

And yes, my periods all came back normally. I have a very strongly consistent cycle and it has never wavered. The only change now is that I get dark brown bleeding before the bright red whereas it used to be the other way around. I don't think too much of this and don't reckon it is a problem at all.

Thanks for your reply. I was kind of hoping you would say "oh it always took about 6 months for them to come back but in the end they always did" I have got no periods at the moment and that is the most worrying sign for me that it might be Ashermans.

Guess I will have to wait for my test results. xxx

MA, how regular are they normally? I think mine are spookily regular so bear that in mind if it helps.

I'm sorry that you fear the outcome may be looking bleak but sincerely hope this isn't the case. There are, afterall a myriad of reasons why periods can become muddled up following complications of pregnancy, that is not to make light of your situation at all. I am sorry to hear that you haven't had a period yet. :(

mummyabroad - hope you getyour testing soon and the results are ok.

Hi hobgoblin,

Well they were really regular until DS was born, a month after the birth I had an emergency ERPC for retained placenta and then no periods for 6 months, they were eventually kick started with progesterone, then I went on the pill for a year, came off to TTC number 2, but suffered a very very long mmc, spent 3 months trying to get tissues out and then had another ERPC and have not had periods since. This was 15 weeks ago. I'm ovulating and getting cyclical period pain, so its not looking good but then again you I cant really say for sure until I have an HSG, will have to be patient and wait I guess.

mummyabroad and hobbgoblin so sorry for all you have been through - yes hobbgoblin i do feel weary - i think i was happy for about 12 hours before the doubt set it...

thanks for all the replies you are all so well informed I love mumsnet

daren't even go to gp
am just living in some weird state of denial that this is even happening

I do think the ultrasound thing sounds the way to go

Really sorry you are going through this sadagain. Just wanted to echo what has already been said by hobgoblin. I have 3 children and have also had a scary number of ERPC's (8 i think!!) for miscarriage and also for retained placenta. These were all done under ultrasound guidance as i have a bicornuate uterus. For me the ERPC route caused me less emotional pain as in all my miscarriages I never start to miscarry natrually. No one has ever mentioned Ashermans to me and my periods have always returned within 4 weeks of ERPC (they are quite light though so maybe i should be worried??)