Success Stories: Hope After Ashermans

Liz's Success Story

The following is my Ashermans success story:

My husband and I began trying to conceive our first child in January 2002. I was 34, and my husband was 33. I didn’t know much about fertility issues at that time. I had a history of regular (30 day cycles), non-eventful menstruation since I was 15 years old, so didn’t think I would have many issues getting pregnant.

My husband and I were elated to find I was pregnant after our first cycle trying -- I knew enough about fertility to realize getting pregnant that quickly was a bit out of the norm. I experienced extreme fatigue, but that was my only pregnancy ‘symptom’. I was a little concerned about how good I felt – no nausea, no sensitivity to odors seemed odd – but the books and internet sites I consulted all said that a symptom-free pregnancy was normal. Unfortunately, at my 12 week check up, we found out that the pregnancy was not viable. We should have been able to hear the heartbeat through the doctor’s stethoscope – but we heard nothing. I had an ultrasound, which showed no heartbeat & a pregnancy that sized at about 8 weeks, when I was 12 weeks along. I hadn’t had any bloodwork done yet, so my beta levels were tested the day of this appointment and two days later to confirm the dropping hcg levels. My hcg levels were dropping dramatically. As I was showing no signs of miscarrying, I had a D&C. I recuperated well from this procedure, and my body cycled normally after 5 weeks.

I began researching miscarriage, and found that losing a pregnancy was much more common than I thought. I also learned about fertility charting, and began charting my cycles (keeping track of my basal body temperature, changes in cervical fluid, and changes in the cervix itself).

I got pregnant again in August 2002 – I was now 35, and was in my fourth cycle after the previous miscarriage. This time my ob tested my hcg levels during my 6th week. I had the blood work done on Wednesday, and again on Friday. I wasn’t called with the results – I figured I would hear from the ob next week, and couldn’t imagine I would again experience a miscarriage. Unfortunately, I was wrong. I began spotting brown blood on Monday morning, which turned to red spotting in a few hours. I called my doctor’s office for the hcg results, and found that my hcg levels had dropped between my two tests. I was in my 7th week of this pregnancy. I miscarried this pregnancy on my own.

It took several weeks for my hcg levels to drop back to 0, but I again resumed menstruating just about 5 weeks after that miscarriage. I continued charting, and became pregnant in December 2002 – I was still 35, and this was my third cycle after the previous miscarriage. I had my hcg and progesterone levels tested during my 6th week of pregnancy, and had an ultrasound to look for the heartbeat. We did see a heartbeat, but my bloodwork didn’t look good from one test to the next – my hcg level stayed about the same, and my progesterone dropped from 18 to 9. I had a second ultrasound, which confirmed that this pregnancy was not viable. I had a D&C.

I again resumed charting, and anticipated menstruating again in 4 or 5 weeks, as that had been my history with the two prior miscarriages. However, I never menstruated. My charting showed that my fertility symptoms were normal – my temperature fell into the same biphasic temperature shift, and my cervical fluid followed the same pattern, yet I was not menstruating. I did notice that I was experiencing extreme pain in my lower abdomen at about the time I would normally expect my period.

That first cycle, I attributed the pain to gas, and assumed that for whatever reason it was taking my body a bit longer to recuperate after the third miscarriage. After the second cycle of no period but extreme pain, I called my ob. I told my ob that I was experiencing sharp abdominal pains when I would normally expect to receive my period. She didn’t comment, and said that if I hadn’t menstruated by 3 months after my miscarriage, she would put me on progesterone for 10 days. This hormone should stimulate my body to menstruate. If the progesterone didn’t work, she would put me on birth control pills for three months. Her logic was that my hormones were still out of sync after the miscarriage, and the birth control pills would force my hormones back into a normal pattern.

I was not comfortable with my ob’s diagnosis, as my charting indicated to me that my hormones were behaving normally. If my hormones where out of sync, I would not be seeing a biphasic temperature pattern, and that pattern was coming through clear as a bell. Her suggestion of progesterone and then birth control pills meant that my husband and I would not be able to try to conceive again for at least 4 months. As I was now 35, I was well aware of the increased risk of having a chromosomally abnormal child, as well as my lowered fertility, so did not like the idea of waiting for 4 months. However, she was my ob, and therefore the expert, so I took her advice. When I reached her magic mark of 3 months of no period, she prescribed a 10 day course of progesterone.

Progesterone to encourage menstruation works as follows: the woman takes progesterone for 10 days, then waits. Within 10 days after taking her last progesterone pill, she should begin menstruating. I took progesterone for 10 days, and was on the 5th day of waiting for my period when I again experienced the excruciating pain in my lower abdomen. I went to the emergency room, and found out that (1) I had an ovarian cyst, but that cyst was not causing my pain; and (2) that I had a 1.8 cm thick endometrial lining, but was not menstruating.

I was now thoroughly baffled. The 1.8 cm thick lining meant that I had a period in my uterus waiting to come out, and I was taking a hormone that was supposed to encourage my body to release that lining, yet I was not menstruating. It seemed obvious to me that my problem was not due to my hormone levels being off. I did not call my ob – I was sure I would be told to wait 5 more days to see what happened, as I was only in the 5th day of waiting to see if the progesterone would work. At this time I was extremely disappointed in my ob for a number of reasons, and did not trust that office any longer.

When I began charting, I became a member of the Ovusoft website – a website that is based on the book “Taking Charge of Your Fertility”. At that website, I posted my question: “my charts appear normal, but I am not menstruating. I do experience pain when my charts indicate I should be menstruating. Does anyone have any ideas for what could be wrong with me?” Someone responded: my symptoms sounded like I had Asherman’s syndrome, and referred me to the Asherman’s group on Yahoo.

I applied for membership to the Asherman’s group. While I had not yet been diagnosed with Asherman’s, the group agreed that my symptoms sounded like I had AS. The Asherman’s group on Yahoo was a fabulous source of information. I learned a great deal from the articles and information posted – most importantly, I learned how critical it was to have a qualified physician treat AS. Fortunately, two of the A list physicians were within an hour of where I live. I chose one of the A listers, and made an appointment in May 2003.

The doctor reviewed the ultrasound photos I brought from my emergency room experience, and confirmed my self-diagnosis. The doctor explained that scarring was sealing my cervix shut, so when I was menstruating, the blood had nowhere to go. The blood was backing up through the Fallopian tubes, which was causing my pain. The doctor couldn’t know the extent of the scarring within my uterine cavity, and diagnosed the severity of my A/S as ‘medium’. We planned for surgery at the end of June. As my cervix was sealed shut, the doctor would have to perform laparoscopic surgery (incision would be made through my navel, for the insertion of the laparoscopic camera; and two incisions in my lower abdomen for the surgical instruments). Were my cervix open, the doctor could have performed hysteroscopic surgery, in which all tools are inserted vaginally, through the cervix.

On a side note, the doctor expressed interest in my history of miscarriage, and began discussing treatment options once the A/S was cleared up. To clarify: I believe that my A/S was caused by the second D&C, so was not a factor in any of my miscarriages.

Prior to the June 2003 surgery, I did menstruate. The doctor downgraded the severity of my AS to mild, but recommended that I still have the surgery as we did not know what scarring remained in my cervix, nor what scarring could be in the uterine cavity. The AS surgery was therefore done hysteroscopically, as my cervix was now open, but the doctor performed laparoscopic surgery at the same time to remove the ovarian cyst. The hysteroscopy revealed that I did have mild to medium scarring in my uterine cavity.

My post-op recovery plan was to have a balloon splint in my uterus for one week post surgery, and be on estrogen for 30 days after the surgery. I also took progesterone during the last 5 days of being on estrogen. My post-op appointments went well, and I recuperated well. I had an hsg in July 2003, which confirmed that all scarring had been removed.

The doctor recommended that my husband and I wait to try to conceive for 3 months. The 3 months would allow my body time to completely eliminate the extra hormones I took during my post-op period. At the end of the 3 months, the doctor would do a few more blood tests to look for causes for my miscarriages.

In September, the doctor did the blood tests. The doctor found nothing – no reason for my three miscarriages. (Again, I do not believe AS was a factor in my miscarriages, as I believe the AS was caused by the D&C after my last miscarriage.) The doctor said that when I became pregnant, I would be put on progesterone supplements. The doctor had a theory that perhaps my body was not creating enough progesterone early on to sustain the pregnancy. Not all REs agree that low progesterone is a cause for miscarriage, but taking progesterone is not harmful to a pregnant woman. In December 04, I became pregnant. This was the 6th cycle after my AS surgery. I was 36 years old. The doctor prescribed progesterone suppositories at 200 mg (? I’m not sure of the dosage) 3 times a day. At 6 weeks, we saw a heartbeat, and my hcg and progesterone levels looked good. At 12 weeks, all looked good, and I was released to my new ob. The rest of my pregnancy was uneventful, and I delivered a healthy, 9lb, 1oz daughter on August 27, 2004. Her name is McKenna Elizabeth, and she is the light of my and my husband’s lives!

The doctor said that we’ll never know if the progesterone helped sustain this pregnancy, or if this pregnancy was destined to succeed without intervention. Regardless, I am eternally grateful to this A list doctor’s caring approach, excellent bedside manner, and expertise in treating AS.

McKenna would not be here were it not for the Asherman’s group on Yahoo. If this group did not educate me about Asherman’s, I would have gone along with my original ob’s treatment of taking birth control pills to resume normal menstruation. Because I happened to menstruate in June, it would have appeared that the birth control pills worked. I would have had the scarring that went undetected, plus that cyst that had never before been brought to my attention. (It was evident after surgery that the cyst was old, as it contained black blood. This cyst had to have appeared in the ultrasounds I had for pregnancies 2 & 3, but was never disclosed to me. The cyst could have played a part in my miscarriages – there is no way to know for sure.) I have no way of knowing how the scarring nor the cyst would have impacted my fertility, but it is likely that I would have had troubles getting and or/staying pregnant. As I am in the older range for fertility, I did not have precious months to lose in getting diagnosed – and I do not know that my scarring ever would have been diagnosed had I not found the Asherman’s Yahoo group.

Thank you to all of the wonderful women who participate on the Asherman’s group, contributing information, advice, and support. My family is eternally grateful!

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