EXPERT ADVICE Can a D&C or abortion affect my fertility?

No menstrual periods and suffered repeated miscarriages following uterine surgery? You might have Asherman’s Syndrome…

Conceiving-EXPERT-ADVICE-Can-a-D&C-or-abortion-affect-my-fertility
Your womb
is a magnificent organ that is able to create and sustain life inside of your body for almost 10 months.

However, intrauterine adhesions can form in your womb for various reasons, usually after certain procedures, such as a dilatation and curettage (D&C) procedure or an abortion.

These adhesions and scarring result in a condition known as Asherman’s Syndrome. In very rare cases, Asherman’s Syndrome can also form after a bout of tuberculosis or schistosomiasis, a chronic disease caused by parasitic worms.

According to the International Asherman's Association, the front and back walls of the uterus stick to one another in many cases. Other times, adhesions only occur in a small portion of the uterus.

The extent of the adhesions determines the severity of the case and how well the womb will respond to treatment. Since the symptoms are quite mild, most patients aren’t even aware they have Asherman’s Syndrome until they can’t conceive. Scar tissue makes it more challenging for a fertilised egg to get implanted.

SmartParents expert, consultant ob-gyn Dr Christopher Chong sheds more light on this relatively unknown condition, which is easily treated. Many patients can even go on to have healthy pregnancies.

What is Asherman’s Syndrome?

It is the scarring or development of fibrosis tissue [excess connective tissue that occurs as part of a process to repair damage] in the lining of the womb. This often leads to the lining sticking together, also known as adhesions.

How and why does it happen?

Usually due to severe damage to the lining, often when curettage (the scraping of the lining) has been done excessively. Curettage is carried out for a variety of reasons, such as to assess the uterine lining for abnormal cells, in the case of abnormal menstrual or intermenstrual bleeding. Other times, the lining of the womb thickens because of a procedure after an abortion or miscarriage. You’re at higher risk for scarring if it’s been done multiple times. Infections such as tuberculosis can also cause it, but it’s very uncommon.

What are the chances of women developing Asherman’s Syndrome after a miscarriage or abortion?

In good hands, and not done recurrently, in my practice, less than 1 per cent.

How many such cases have you seen in Singapore?

Fewer than 10 cases in the last 15 years. 

A scarred lining will affect or even prevent the implantation of the fertilised egg. Even if implantation occurs, the risk of miscarriage will increase as the scarred lining does not have enough blood supply to optimally accept the growing embryo.

What are the most common symptoms?

Having little or no menses. In a normal menstrual cycle, the lining of the womb sheds as menses. In Asherman’s syndrome, the lining is scarred, so there are no cells or tissue to shed. Some only discover they have it when they do fertility tests or have recurrent miscarriages.

Can Asherman’s Syndrome affect a woman’s chances of conceiving?

Yes. A scarred lining will affect or even prevent the implantation of the fertilised egg. Even if implantation occurs, the risk of miscarriage will increase as the scarred lining does not have enough blood supply to optimally accept the growing embryo. Women with Asherman’s syndrome have very little or no menses, so trying to time your fertile period to maximise the chances of conceiving is also a challenge. 

What are the treatment options available in Singapore?

A hysteroscopy can be done to resection the scar tissue and adhesions. It involves putting a small scope through the cervix and into the womb. This is usually followed by oestrogen therapy to boost moisture in the lining, while an intrauterine device or balloon keeps the lining open.

What are a woman’s chances of conceiving after treatment?

It depends on the severity of the disease and how well it is treated. If her menses goes back to normal and scans do not show any abnormal lining, then her chances of conceiving are as good as before surgery, all other parameters being equal.

Photos: iStock

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