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Why I’m Here

My name is Jackie and I am from Ohio. My goal with this website is to reach women who are looking for information on dilation and curettage (D&C). I want this site to become what I wish I had found before June 19th, 2013 – the day I had my D&C for a missed miscarriage. It is true that there are no guarantees in life. But the Asherman’s Syndrome that the surgery gave me could make having a child much more difficult, if not impossible for me. The days that I was pregnant were the happiest of my life. I do not want more women to say, “I wish I had known. I never would have had the D&C.” Asherman’s Syndrome is a preventable condition.

The D&C is billed far and wide as a routine procedure that has few complications. But research shows there is a 30.9% prevalence of intrauterine adhesions, aka Asherman’s Syndrome, in cases like mine, that of a D&C after a missed miscarriage.(1) The risk is even greater for D&Cs for retained products of conception after a woman has given birth.(2)

Sadly, doctors commonly fail to warn women about the dangers of the D&C. When I spoke with my obstetrician the day before my procedure, he dismissed my concerns. “Now, maybe back in the 1930s and ’40s it was more obtuse,” I recall him saying. Even after I failed to regain my cycle two months later, he refused to acknowledge that Asherman’s was a possibility. Your doctor may have told you complications are extremely rare as well. Below, I quote the top Asherman’s Syndrome doctor, Dr. Charles March of California Fertility Partners, from his article, “Management of Asherman’s Syndrome.”

“Most physicians believe that AS occurs rarely and do not suspect the diagnosis even in the presence of clear symptoms. Table 1 details its prevalence among those with various conditions or after various uterine surgeries. It demonstrates convincingly that AS is anything but rare.”

(See the table here; please note that “spontaneous abortion” is synonymous with miscarriage.)

Safer Alternatives

Women deserve to be told that medical management (Misoprostol pill) or expectant management (natural miscarriage) are as effective as curettage in assuring complete evacuation.(3) One randomized control study suggests that Misoprostol would reduce the incidence of intrauterine adhesions.(4)

The D&C is a century-old, blind procedure on a soft organ using a sharp curette or suction, and women deserve to know the risks this entails in full before undergoing it. It is not only a fertility issue. Women with intrauterine adhesions have been found to develop high rates of endometriosis, as scar tissue often traps menstrual blood from exiting the cervix, causing blood to backflow through the Fallopian tubes.(5) It should be noted that endometriosis is another “women’s condition” similarly surrounded in lack of awareness, misconceptions and delayed diagnosis.

Why is Asherman’s Syndrome perceived as rare? It is underdiagnosed, sometimes because women still have periods after acquiring adhesions, yet are unable to conceive or keep miscarrying, and no connection with the D&C is made. It is also underdiagnosed because not all women seek to become pregnant again after their D&C, particularly if it occurs after a live birth. Doctors are known to miss even obvious symptoms of the condition, further delaying diagnosis. Trapped blood and echoes indicating adhesions can be seen on sonogram, but hysteroscopy is the gold standard for diagnosis.

A thinned uterine lining, which inhibits embryo implantation, along with serious pregnancy complications such as incompetent cervix and placenta accreta, in which the placenta embeds into the uterine wall, are linked to Asherman’s Syndrome. Lining issues can present even if women do not develop adhesions after a D&C: A 2009 study found that the endometrium of women is thinner for about 6 months after a D&C.(6)

Support Network

The good news is that Asherman’s Syndrome is treatable. A highly skilled surgeon in Asherman’s Syndrome is absolutely critical to perform corrective surgery or scarring can be made worse. Please read resources such as Ashermans.org if you are considering a D&C. If you suspect you have intrauterine scarring and want to learn about treatment options, contact one of the top Asherman’s doctors. Also feel free to join the Asherman’s Syndrome Yahoo group, or email me at any time at dandcfacts@gmail.com and I will do my very best to help you.

I have used many of the resources at Ashermans.org in my own journey, including the great women in the aforementioned Yahoo group, which was started in 1999 by Poly Spyrou of Cyprus. Poly established the Asherman’s Syndrome International Support Group at Ashermans.org, through which she has worked for many years to change the standard of care in the medical community and educate the public about the condition. Countless women have been helped due to her perseverance and diligence, including me. It was also through her group that I found my doctor and my hero, Dr. March. I cannot thank them enough for what they have done for me.

Thanks for reading.

“Let gratitude be the pillow upon which you kneel to say your nightly prayer. And let faith be the bridge you build to overcome evil and welcome good.”
Maya Angelou, Celebrations: Rituals of Peace and Prayer

References

  1. Adoni A, Palti Z, Milwidsky A, Dolberg M. The incidence of intrauterine adhesions following spontaneous abortion. Int. J. Fertil. 1982;27:117–118
  2. Westendorp ICD, Ankum WM, Mol BWJ, Vonk J. Prevalence of Asherman’s syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum. Reprod. 1998;13:3347–3350
  3. Blohm F, Hahlin M, Nielsen S, Milsim I. Fertility after a randomised trial of spontaneous abortion managed by surgical evacuation or expectant treatment. Lancet. 1997;349:995                                                                                                                                                                                                Smith LFP, Ewings PD, Quinlan C. Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial. Br. Med. J. 2009;339:3827
  4. Tam, WH, Lau, WC, Cheung, LP, Yuen, PM, and Chung, TK. Intrauterine
    adhesions after conservative and surgical management of spontaneous abortion. JAm Assoc Gynecol Laparosc 2002;9(2):182-5.
  5. Palter. SF, High Rates of Endometriosis in Patients With Intrauterine Synechiae (Asherman’s Syndrome). Fertility and Sterility 2005; 86 (null):S471-S471.
  6. Moon KS, Richter KS, Levy MJ, Widra EA. Does dilation and curettage versus expectant management for spontaneous abortion in patients undergoing in vitro fertilization affect subsequent endometrial development? Fertil Steril. 2009;92(5):1776-9. PMID 19560759
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