Asherman's Syndrome or intra-uterine adhesions is an acquired uterine condition, characterized by the formation of adhesions (scar tissue) inside a woman's uterus. It can cause miscarriage and infertility and is most commonly caused by a D&C (dilation and curettage) after a missed or incomplete miscarriage, a retained placenta or elective termination of pregnancy. It is thought that pregnancy related D&Cs account for 90% of Asherman's syndrome cases.
Adhesions (scar tissue) are more likely to occur the longer the period between fetal death and the carrying out of the D&C. I find this very interesting as for my first missed miscarriage and D&C, I was told that our baby may have died around 8 weeks (as it measured this size) but I was 13 weeks by the time I had the D&C. A woman is more likely to develop Asherman's syndrome the greater the number of D&C s she has had and adhesions are often explained by 'over-zealous' D&C.
I was diagnosed with Asherman's by accident really. It was suggested to me that due to the fact that I was infertile after two missed miscarriages and D&Cs that before I consider egg donation, I should ensure that my womb was undamaged and that the prognosis for donor conception was good. I had always assumed my premature ovarian failure - poor egg quality/number was responsibility for my infertility. A surgeon at The Rotunda Hospital was amazed to discover a thick narrow band of scar tissue in my uterus, after performing surgical hysteroscopy. He cauterized the scar tissue (surgical scissors are better). My basal layer of endometrium is very thin and failed to respond to either viagra or nitrodur during a donor cycle.....v. depressing. The surgeon said the scar tissue was caused by 'too much force being applied' during past a D&C.
I subsequently made an appointment with The Master of Holles Street to make a formal complaint, as both of my D&Cs for missed miscarriage were carried out there. He refused to accept liability (naturally) and said interuterine scarring can be caused by almost anything, including infection. I asked how infection could cause a thick narrow line of scar tissue which seemed more in keeping with injury from an instrument such as curette. I got no satisfactory answer. I formally requested that the hospital provide clear warnings to women with missed miscarriages on the consequences of D&C and explain to them that Asherman's is a potential outcome which may leave them infertile. I feel like I was not given enough information about 'conservative management' and it was implied that I would get an infection and probably have to come in eventually if I did not book in for a D&C in the first instance.....I try not to think about it too much these days otherwise I risk becoming melancholy and bitter. I do however feel strongly that women are not given enough information about this devastating consequence of D&C.
I subsequently made an appointment with The Master of Holles Street to make a formal complaint, as both of my D&Cs for missed miscarriage were carried out there. He refused to accept liability (naturally) and said interuterine scarring can be caused by almost anything, including infection. I asked how infection could cause a thick narrow line of scar tissue which seemed more in keeping with injury from an instrument such as curette. I got no satisfactory answer. I formally requested that the hospital provide clear warnings to women with missed miscarriages on the consequences of D&C and explain to them that Asherman's is a potential outcome which may leave them infertile. I feel like I was not given enough information about 'conservative management' and it was implied that I would get an infection and probably have to come in eventually if I did not book in for a D&C in the first instance.....I try not to think about it too much these days otherwise I risk becoming melancholy and bitter. I do however feel strongly that women are not given enough information about this devastating consequence of D&C.
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