Success Stories: Hope After Ashermans

Ute's Success Story

How Daniel Came to Be

My Fertility Journey

I am writing this while Daniel, my miracle baby, is happily snoring in his bouncy chair. I am a single mother who decided in 1997, at the age of 33, after several years of thinking and longing for a child, to embark on motherhood. I thought it might take three months to get pregnant and I thought I was brave to do IUI with donor sperm.. Little did I know...

After six unsuccessful months, I had my first surgery, laparoscopy/hysteroscopy. The surgeon lysed adhesions on my tubes and tried to remove a fibroid tumor that was growing into the uterine cavity. An IUI cycle with injectibles followed in August of 1998 which ended in a tubal pregnancy. Meanwhile, the fibroid had grown back. Both these
problems were removed via mini-laparotomy in September of 1998. An unsuccessful IVF followed in Nov./Dec. 1999. After this failure, my doctor performed an exploratory hysteroscopy to check if the myomectomy (fibroid removal) had not left any adhesions in my uterus.

He found "minor adhesions" (hey, shouldn't he have checked *before* the IVF?) and polyps (at least that's he thought it was; two independent doctors I asked later could not see any polyps on the photographs). He removed the uterine lining and when the "polyps" were still there he performed "gentle curretting" (at least, that's what he called it, the butcher) and put me on estrogen pills for a few days. I asked him at the post-op appointment if it was possible that I'd get adhesions from the D&C and if I didn't need some sort of intrauterine device to keep the walls apart and more estrogen to prevent adhesions. He said (in his usual condescending manner) for sure I wouldn't. My lining was 7mm after the estrogen. That seemed fine. I also read in a textbook that Asherman's after D&C on a non-pregnant woman is very rare. Well, I was the exception My temperature dropped, but my period did not come (I have no idea where that 7mm lining every went); then after 12 days my temperature rose again. That is, I had the temperature pattern of a normal cycle, but no period. I called the doctor who found a ready-to-ovulate follicle, but no uterine lining. Asherman's! (you should have seen his face). He performed a saline ultrasound which clearly showed adhesions. Because they were detected early, they were still filmy, not very hard, and he was able to split them with pressure from the saline. I have not seen this method described anywhere in the literature, and in hindsight don't think this is the way to do it. Hysteroscopy is much more precise, but I was lucky. A diagnostic hysteroscopy a couple of months later (by a new surgeon as I fired the first) showed I did not have any adhesions left. My uterus was not the same anymore, however. What used to be 9mm linings before all this mess was now 4.5 mm in a natural cycle at the time of ovulation. Mega-doses of estrogen injections (wow, that was fun!) brought it to 7mm.

I proceeded to IVF #2 at an out-of-state clinic (IVF not because of the Asherman history, but because of my messy tubes), reached 8mm lining on injectibles and failed the IVF. I was convinced my uterus was the issue. My IVF doctor kept saying a high-quality embryo will implant even in a suboptimal lining. He put five high-quality embryos during the next IVF cycle and it worked with 7.3mm lining! At 8 weeks pregnancy I needed emergency surgery for heterotopic pregnancy, i.e., I had one embryo in the uterus and one in the tube. I read later that a damaged uterus can contribute to ectopic pregnancy (especially when combined with messy tubes); the embryo does not find the uterus hospitable and moves to the tubes. My uterine embryo survived the surgery and we had mastered the first crisis of a high-risk pregnancy.

Pregnancy After Asherman's

Pregnancy after Asherman's is high-risk. So I signed up with a perinatologist group. The risks are placenta accreta and uterine rupture. In placenta accreta the placenta grows into the deeper layers of the uterus causing severe bleeding when they try to deliver the placenta (the baby is already out at that point, so the risk is only to the mother). I was told with history of myomectomy and Asherman's my risk of placenta accreta was 5%. Uterine rupture can occur when the uterus is very thin (can happen after Asherman's) or when a scar is present (such as after my myomectomy). The risk is highest during labor. Most of the time rupture has catastrophic consequences for child and mother. At this point I had learned to expect the worst and prepare for the worst. I made my will and changed to another perinatologist group who worried as much as I did. he likelihood of rupture is still low with my history (a few percent), but no risk was to be taken; thus they  delivered my precious baby at 37 weeks via scheduled c-section. No major complications occurred, and needless to say I cried with relief when Daniel was out and safe on July 3, 2000.

With all the fertility issues I had, Asherman's was the most distressing. You can get around messy tubes with IVF, but with a messy uterus things are so much harder. I carried (and still carry) so much resentment against that butcher doctor. On the positive side, I will always have a deep sense of admiration and gratitude toward my child (in addition to tremendous love of course). He is my hero. It was a jungle in there, and yet he implanted; he overcame my insufficiency. He truly is my miracle. And now he needs a diaper change, so I have to go. 

I wish you all luck in the world, brave ladies. Hang in there, ladies and embryos. Asherman's is a tragedy, but with persistence and the skills of an excellent Reproductive Surgeon it can often be overcome.

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