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How a Simple D+C Robbed One Woman of Her Fertility

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Dilation and curettage (D+C) is when the lining of the uterus is scrapped out. This is carried out to remove uterine fibroids or polyps, to remove retained pieces of placenta after childbirth and control heavy bleeding, during termination of pregnancy and after miscarriage.

D+C is often routinely carried out after miscarriage even when not medically needed (the majority of first trimester miscarriages occur naturally and expel completely without medical assistance). Doctors say that a managed miscarriage limits the risk of excessive bleeding and reduces the risk of infection from retained products of conception.

Although there is a slightly increased risk of heavy bleeding after a natural miscarriage (around 2 in 100 women), there are anesthetic risks, risks of perforating the uterus and emergency surgery, risks of post-operative infection, scarring and infertility after a D+C.

Asherman’s syndrome can develop. This is when the lining of the womb becomes so scarred that it scars shut or becomes solid due to being filled with scar tissue and this makes it impossible for an embryo to attach to the wall of the womb. Without corrective surgery and medications, most affected women will be unable to get pregnant.

6.4% of women who have a D+C will develop Asherman’s syndrome and subsequent infertility, yet the majority are not warned of the risk when they consent to the procedure. If you elect to terminate a pregnancy, your chance of post-termination infertility is 13% and the risk increases for each subsequent termination you have.

Shari had a D+C after a miscarriage and did not imagine that this simple procedure, recommended to her by her doctor, would steal her fertility and plummet her into a world of assisted reproduction.

“I was completely in shock when I learned that the D & C caused scarring. I will never forget that moment during the painful HSG test. I was dreading the test because I am a wimp when it comes to that sort of thing but I was focused on the pain; never imagining I would get bad news.

The technician asked if I ever had uterine surgery during the procedure and I immediately said no. But then she probed further, and said, “What about a D & C?”

So I said oh yeah, I had that.

Right away, I saw a concerned look on her face. Immediately, my fear for the pain transferred into fear. I asked what was wrong and she said there was scarring on my uterus. When she saw my face, she immediately said, “Oh no worries, it can be fixed with a simple surgery and they will put you out so you won’t feel it.”

What she didn’t know was that I had a fear of getting an IV. I had to get an IV for the first time during the D & C and it was horrible. So I immediately started tearing up, knowing that meant another IV.

My husband was waiting for me in the waiting room and as soon as I came out, he knew something was wrong by the look on my face. I told him we had a problem and burst into tears on the car ride home.

He had to leave for a business trip after our appt. so it was bad timing. For the rest of the day, I googled uterine scarring on the internet and learned that it was called Asherman’s syndrome. When we went for the follow up appointment with my infertility doctor at shady grove, he confirmed that it was indeed Asherman’s since that was the first question I had asked.

After receiving the news, I learned that my friend Shannon was going through the same thing. She connected with some other friends of friends and we started our own intimate infertility support group. It was six of us. Out of the six, three of us had Asherman’s. It was so helpful to have the support of my new friends.

I also had a fear of doing IVF, I was so petrified of ending up in that situation. I just couldn’t believe that I was able to get pregnant naturally but then the D & C caused me to no longer be able to get pregnant on my own. It was a sick irony and I had a hard time accepting it.

After several months of infertility, trying unmedicated IUI cycles, going for a 2nd opinion and even attending a fertility conference in Florida, I finally had decided that I would eventually have to move on to the IVF as hard as it was to face. Luckily, my doctor at shady grove thought it was worth trying one cycle of IUI before the IVF even though the doctor in NYC said to skip right to the IVF. Well I will be forever grateful to my doctor who said to try the IUI. Even though I was so scared of getting those injectible shots with the IUI cycle, it was much better than doing the intramuscular shots that you have to do with the IVF.

After my cycle I took my own home pregnancy test because I started to have some spotting. It was negative. I was crushed and knew I would have to do the IVF. On the morning when I went back to shady grove for the blood test, I was unusually calm. I remember thinking I had just finished off my school year (I was a teacher), it was a beautiful summer day in early June and I thought it would have been such a good day to get good news. Instead, I knew I wasn’t. I went for a walk outside after the blood test and scheduled a manicure for myself so that I would be distracted upon hearing the bad news.

My cell phone rang during my manicure and when I saw it was shady grove calling, I ignored it because I knew they were calling to give me the bad news; that I wasn’t pregnant. It rang again; shady grove a second time. I ignored it. Then my husband was calling. I finally picked up his call and said I was getting my nails done (which he should have known) and he told me to step outside. I said I couldn’t and tried to hang up. He kept insisting and then he finally burst out that I WAS PREGNANT! I was in utter shock.

I called back shady grove when I got home and said it must have been a mistake.

My son was born 9 months later. I felt such a sigh of relief; like I finally won! I was SO happy and felt SO lucky.”

Shari now has a lovely four year old boy but has not managed to conceive naturally. She doesn’t think that she can go through IUI again and hopes that her son won’t mind being an only child.

How to Reduce the Risk of Secondary Infertility

• D+C does not necessarily have to be done for a first trimester miscarriage, the body is efficient at expelling products of conception. If you are worried that you might have an incomplete miscarriage, you can have ultrasound scans to check if there are any retained products.
• Consider adoption instead of termination.
• Retained placenta can be removed with the medication misoprostol instead of being manually scrapped away. The same medication can be used to control post-birth hemorrhage.
• If you have no choice but to have a D+C (for instance, to remove fibroids or tumors), it can be done with ultrasound so that the doctor only treats the affected area and doesn’t scrape away an excessive amount of tissue.

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