Woman With Asherman’s Syndrome May Need Surrogate

Dear Dr Edward,

I am writing you from Nigeria. I am 28 years old. In 2009, I had a miscarriage at 10 weeks of pregnancy. The doctor performed a D&C (dilatation & curretage) to evacuate the residue from the pregnancy. Since that day till today, I have been having extremely scanty and extremely irregular period. Before that day, my period is usually very full and lasts for 6 to 7 days. But now, my period doesn’t even come for months. When it eventually comes after taking progesterone and estrogen, it lasts 2 to 3 days and is very light. I have PCOS but whenever I take clomid and folliculin injections, I get up to 4 mature follicles but yet pregnancy never occurs. In march 2012, i did HSG and the result said my tubes are okay but i have a poorly demonstarted uterine cavity. I made arrangements to come to the US for a Hysteroscopy but the medical bills were too expensive. So this year October 2012, I went to India for a Laparoscopy and Hysteroscopy. The Hysteroscopy found out I had mild Asherman”s syndrome. So the doctor performed endometrial adhelyosis to cut off the adhesions. My ovaries were also drilled during laparoscopy.

But after the Hysteroscopy, I was only given estrogen tablets to take for 21 days. No ballon was inserted in my uterus to keep the walls apart. My period came but it was still scanty.  After a month of the surgery, my doctor in Nigeria stimulated ovulation again. I got four mature follicles but yet pregnancy didn’t occur. My period just came again and it is even more scanty than ever before. I am so worried and unhappy. I am scared that the adhesions have recurred since no ballon was inserted in my uterus to prevent growth of scar tissues. My husband has done a seminal analysis and everything seems to be okay with him.

Please, what can you tell me concerning my issue. Do I still stand a chance of having children? What other treatment therapy can you suggest for me?

Thank you for your anticipated response. M. from Nigeria

Answer:

Hello M. from Nigeria,

Asherman’s syndrome can be a difficult problem to solve.  Asherman’s syndrome is the formation of intrauterine adhesions (scar tissue), which typically develop after uterine surgery, in your case the D&C. Often, it can take multiple hysteroscopies and revisions/adhesiolyses to finally get the cavity cleared.  In addition, because each of these surgeries can cause adhesion formation themselves, it is important that the cavity be held apart during healing.  Your surgeon should place a foley (bladder) catheter (like a small balloon) inside the uterus for several days and prescribe estrogen therapy while the uterine lining heals. Antibiotic treatment may also be necessary if there is an infection.

At this point, you would probably need another hysteroscopy, but no laparoscopy. If this cannot be corrected, the only option left would be to use a surrogate to carry the pregnancy and this is done in conjunction with IVF (in vitro fertilization).  Hopefully, however, with proper care the problem can be resolved.  Keep in mind that the proper protocol is to do repeated hysteroscopies after the adhesiolysis to confirm that the cavity has been cleared, NOT an HSG.  In my office, this is done as an office procedure.  It would probably cost you more in plane fare than the procedure itself so is probably not worth coming to the United States. It sounds like you have a tough road ahead of you but it is not impossible to reach the end with proper medical guidance.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG