Sarah Raynes had no trouble conceiving the first time around. But when, a year
after her son was born, she wanted to try for her second child, her
menstrual cycle hadn’t resumed – despite confirmation from a home ovulation
kit that she was ovulating regularly. At her GP’s advice, she gave up
breast-feeding, but several months later there was still no sign of her
periods returning, and Sarah started to get concerned.
She turned to the internet for advice: “I typed ‘ovulation without bleeding’
into a search engine and came across a condition called Asherman’s
Syndrome.” Also known as scarring of the uterus, this syndrome can result in
permanent infertility and recurrent miscarriage. It is usually caused by a D&C
(a dilation and curettage) procedure, performed to clear the uterus after a
miscarriage, to remove a retained placenta after the birth of a child or, in
a minority of cases, to abort a pregnancy.
Around 68,000 D&C procedures are performed every year. Although the exact
number of cases of Asherman’s is unknown, Adrian Lower, director of The
London Fibroid Clinic and one of only two Asherman’s specialists in the UK,
estimates that up to 5 per cent result in cases of Asherman’s. That’s nearly
3,500 people who are suffering unnecessarily every year.
For Sarah, alarm bells started ringing. She had twice undergone a D&C:
once after a miscarriage and, later, to remove a retained placenta after the
birth of her son. When she put this to her GP, he told her the condition was
incredibly rare and unlikely to be the cause of her symptoms. “Friends and
family told me that I should stop trying to self-diagnose, and that my GP
knew more than me. But the internet threw up a website dedicated to
Asherman’s, and too many symptoms matched mine. It was impossible to ignore
it.” Very soon, she says, “I knew a lot more about the condition than my
GP”.
So in January 2007, she organised a private appointment with Lower, who was
recommended on the Asherman’s site. He suggested that he carry out a
diagnostic procedure called a hysterosalpingogram, where a radioactive dye
is injected into the uterine cavity while an X-ray is taken.
The results confirmed Sarah’s suspicions. “My womb was completely shut, like a
deflated balloon that had stuck together. There was no way into my cervix
because it was so badly scarred.”
D&C procedures involve using a sharp instrument to scrape the uterine
walls to remove retained products of conception. Often, they don’t cause any
problems at all, but sometimes Asherman’s is the consequence. Damage to the
uterus can range from mild scarring, causing lighter periods, to extreme
cases, such as Sarah’s, when the uterine cavity is completely filled with
scar tissue.
The prevalent theory is that Asherman’s occurs only in cases in which the D&C
procedure is “overly aggressive” – where the doctor performing the procedure
scrapes the uterine walls with too much force. “It’s clear that in any
procedure when curettage is done more harshly there is a higher chance of
Asherman’s,” explains Professor Bill Ledger, a spokesman for the Royal
College of Obstetricians and Gynaecologists. “However, in certain
situations, this is the only way to stem excessive bleeding and may be a
necessary life-saving measure.” Ledger is slightly more conservative in his
assessment of the prevalence of Asherman’s, putting it at less than 2 per
cent of those who have D&Cs – still 1,360 unnecessary cases – and he
agrees that the condition “is significantly underdiagnosed. Asherman’s is
not common, but it is certainly not rare.”
The main reason the condition often goes undiagnosed is because it is hard to
detect using straightforward diagnostic procedures, explains Lower. “Instead
of using the 2-D ultrasound scans, the best way to diagnose Asherman’s is by
visualising the interior of the uterus, using a diagnostic hysteroscopy,
where a tiny scope is inserted through the cervix, or a hysterosalpingogram
(HSG),” as was used in Sarah’s case. HSGs cost around £300 to perform, so
why aren’t they used more widely? “The reality is that too many women with
fertility problems are thrown straight into IVF without being fully checked
out.”
Because medical professionals frequently fail to recognise the symptoms of
Asherman’s, women may undergo months or even years of inconclusive
procedures that fail to uncover the cause of their infertility. Some are
referred for IVF treatment, which stands no chance of success while
Asherman’s remains undiagnosed and untreated.
Rebecca McAra went through £1,000 of tests over a 12-month period before
discovering that she had Asherman’s, caused by a D&C carried out
after a miscarriage. “I was so traumatised when I lost my baby that when I
was offered a D&C I jumped at the chance, thinking it was the quickest
and easiest option. I wish I had been told that a snap decision made in a
hospital scanning room might irreparably compromise my fertility.
“I could have waited to see if the full miscarriage occurred naturally but was
told this could take up to a month. I wasn’t informed about medication as an
alternative to uterine surgery, nor about the risk of developing Asherman’s
if I had a D&C.” Having undergone hystero-scopic surgery to remove
uterine scar tissue, McAra is now trying to conceive again. Professor Ledger
believes that hospitals should routinely warn women that there is a risk of
developing Asherman’s if they opt for surgery. “The NHS is very hot on
producing leaflets about anything and everything but few women are informed
about Asherman’s.”
Treatment methods vary from doctor to doctor, but the most common involves
using micro-scissors to remove the adhesions. Either an intrauterine stent
or a “balloon” is left in the uterus for a short period to prevent adhesions
reforming and surgery is usually followed by a course of antibiotics, as
well as a course of hormone replacement therapy (HRT) to stimulate uterine
healing and the regrowth of the womb lining. Treatment is available on the
NHS but there are few surgeons in the UK performing hystero-scopic surgery.
According to Lower, this can result in long delays for treatment, which in
turn can compromise the chance of a successful outcome: “Over time the
adhesions become more fibrotic and much more difficult to break down than
when they are not so well established. Ideally corrective surgery should be
performed within six months of adhesions forming.”
Professor Ledger adds: “Treatment of Asherman’s involves a relatively simple
procedure that surgeons could easily be trained to perform and the equipment
required is inexpensive for hospitals to purchase. It is a question of
raising awareness, rather than funds. Doctors need to be more aware of the
condition and look harder at women with ‘unexplained’ infertility.”
As a result of the current waiting list on the NHS, Sarah, like many other
sufferers, decided to go private. “The first attempt to treat the condition
has the greatest chance of success and it can be made worse by inappropriate
surgery,” says Lower. “Some women are even told that another D&C
will clear the adhesions, but it would in fact result in further scarring.”
The success of treatment to restore fertility depends on the severity of the
scarring, the skill of the surgeon who performs the corrective surgery, the
amount of healthy endometrium still remaining in the uterus, and other
factors. Lower says: “Between 75 per cent and 80 per cent of the patients I
treat have gone on to have successful pregnancies.”
In Sarah’s case, surgery proved successful. Her periods resumed and she
quickly fell pregnant but sadly had a miscarriage at seven weeks. She was
very reluctant to have another D&C but after waiting nearly a month to
see if she would miscarry naturally she had no option. However, this time,
armed with greater knowledge about the condition, she asked to be put on a
course of HRT to help aid the healing of the uterus. Sarah doesn’t yet know
if adhesions have reformed or whether she will need to undergo further
surgery before trying to conceive again. With each surgery her chances of
having another baby are reduced, with an increased risk of pregnancy
complications.
“I am well aware of the risks, but there are a lot of success stories too and
I remain hopeful that one day I will hold my postAsherman’s baby in my
arms,” she says. “I was told that unexplained infertility is something that
you have to live with, but why should you? It’s time for this silent
syndrome to start making some noise.”
Asherman’s Syndrome: how to spot the symptoms
— The most common symptom of Asherman’s Syndrome is the reduction in volume –
or absence of – the menstrual flow, following a gynaecological surgical
procedure.
— This reduction can be accompanied by an increase in pain when menstruating,
as the uterine muscle has to work harder to get rid of the menstrual fluid
past the scar tissue. In such cases women will have trouble conceiving.
— It is quite possible that there are women who do not have any symptoms if
they have a small number of adhesions. Conception may be possible but there
is a higher risk of recurrent miscarriage, placenta previa, bleeding during
pregnancy and stillbirth.
— The same symptoms can be caused by a hormone imbalance, but if your hormone
levels are normal, it is worth discussing your concerns regarding Asherman’s
with your doctor so that it can be appropriately diagnosed or ruled out.
www.ashermans.org, www.infertilitynetworkuk.com
I too stopped menstruating after a D&C. It took months for anyone to even diagnose the problem. Had a hysteroscopy via the Public Health System, which was a total waste of time. Paid for the same operation privately and became pregnant. shortly after. God knows how many women are in the same boat?
Alison Manley, Brisbane, Australia
Thank you for bringing Asherman's syndrome to light. It is a terrible thing to endure, but with persistence and the right doctors it can be overcome. My Ashermans' was first caused by hysteroscopic fibroid surgery but it was not diagnosed for 5 years. Another 5 years, 2 miscarriages, and a dozen surgeries later, I am thrilled to have been blessed with two healthy post-asherman's babies.
Sheryl Axline, Redwood City, CA, USA
Thank heavens this is coming to light. Every woman who has to go through fertility treatment should insist on a hysterosalpingogram. My fertility specialists did it before they would even consider treatment. It was part of their standard treatment. While I do not have it, it is good to know they were very through. I hope this information makes more women successful in having good fertility treatments.
Kathy, Sellersville, PA
Thank you for raising awareness of Ashermans. D&C is still too often a routine procedure after a miscarriage and women are not told about the possible consequences. Infertility is a high price to pay of doctors' uncertainty or unawareness.
Laura, Helsinki, Finland
The gynocologist's should advise they're patients of all the dangers of all the most commom procedures due to most common conditions with all the hidden consequences and specially for Asherman's Syndrome. After an agonizing decision to terminate my first pregnancy at 36 years old becuase of my baby had a chromosome disorder. Following the termination I had blood retained in the uterus wich lead to a second procedure after the D & C. Months later my periods did not return, my gyno told me that he suspected that I had a case of Asherman's Syndrome which was later confirmed by an infertility specialist.
The specialist suggested surgery. The surgery revealed that I have a severe case of the condition and that I was permenantly infertile. I am devasted and equaly destrot since the first day this nightmare began on March of 2006.
neri, Dade County, FLORIDA
I too thought that Asherman's was a rare condition. I developed Asherman's following a uterine surgery after the birth of my son. I had lighter periods for 13 years. I just had surgery to correct the Asherman's in August of this year, following 7 years of treatment for infertility. More doctors should inform their patients that this condition is a possibility before performing d&c s or uterine surgery. Even after my diagnosis my reproductive endocrinologist went on to push invasive infertility treatments of IUI and IVF. Doctors who are supposed to have experience treating women should put their egos aside and refer their patients to someone with experience to save us from years of mismanagement of the condition.
Jennifer, Warren, Michigan, USA
The medical community needs to be made aware of their limited knowledge on Asherman´s Syndrome. Not only do they NOT diagnose it when all the red flags come up, most of them treat it poorly by using another dilation and curettage, which is the cause of it all! I wonder how many women there are, who do not know that this is their cause for infertility. And I wonder if the doctors one day will reveal the risk of a dilation and curettage, since it is such an every daqy procedure, routinely done with terminations, c-sections, almost any surgical gynecological procedure uses a D&C as a "clean up"...
Many UK residents have taken their savings and seen one of the leading surgeons in the field in Germany. I love to look at the birth announcements which were then sent to me by some of them!
CM Dartenne, Lueneburg, Germany
Thankyou for printing this article. We need alot more of this available to increase awareness of the condition to potential sufferers and to show the medical profession that this condition is not rare and more knowledge is required in this area.
I have only just been diagnosed with Ashermans after 3 years of light periods after a miscarriage and d&c. I have undergone many tests and fertility treatment and was considered as having 'unexplained fertility'. I had done alot of research on the internet regarding my symptons but did not find much in terms of ashermans and sites explaining ashermans all said the condition was rare.
It was only after my consultant mentioned the possibility of ashermans that i did a search on the subject to find the forum. It was through this that i self diagnosed even though the nhs said everthing was in order, clearly there is a lack of knowledge amongst the professionals. My diagnosis was eventually made by a private consultant.
Nima, Luton, UK
Well done for printing this article! I contracted ashermans after surgery to remove fibroids in October 2004. I had two more surgeries in 2005 to treat cervical stenosis before I found the ashermans group. I was able to put the right questions to my gynae and made the decision that he was not experienced enough to treat me (as he would never had condeded). I am still fighting ashermans but in the best hands and assured in the knowledge that I'm in good company with this group.
Emma, London, UK
Thank you for printing this article! More information on Asherman's needs to be out there for women (and their doctors) to read and make better informed choices!
Catherine White, Leland, NC
Good to see this article printed. I was diagnosed this year with severe Asherman after an emergency c-section 3 years ago. It took me three months and several doctor's visits and a lot of self diagnosing to get around this and find the best treatment at Hammersmith Hospital in London, as I was lucky to find the Asherman support group in UK when I did.
L Andersen, Oxted, Surrey, UK
Thank you for printing this information about Asherman's. I am fighting against this problem and will be having another, and hopefully last , surgery in Jan. 2008. I aquired Asherman's after the birth of my son in July, 2006. I had RPOC after the umbilical cord was broken and then had over aggressive D&C x 2 to remove the placenta and severe infection. Again, thanks for getting this information out.
Della, Gainesville, Florida
Thanks you for publishing such an article to create awareness among women and gynes who aren't aware of such an implication on D&C. Although, it may not be intentional to be 'overly aggressive' during a D&C, gynes should be aware of ashermans and take utmost care not to cause scarring. I was also diagnosed with ashermans and treated. Now i have a cutie and she is of 10 months old. The journey through ashermans is very tragic and i underwent an unimaginable trauma. Thanks to the ashermans support group and poly.
Viji, Singapore,
While I appreciate that you have published this very important article about Asherman’s Syndrome, I would like to make a clarification. Yes, Asherman’s CAN result from a D&C. However, it is not necessarily true that all of these D&C’s
performed have been “overly aggressive.†I was diagnosed with AS in late 2006 after having two early miscarriages followed by routine D&C’s. Prior to my surgery, I had my surgeon, Asherman’s specialist Dr. Charles March,
examine the pathology reports from the D&C’s and he found no uterine muscle in the samples. As I understand it, this proves that there is no evidence to support that either D&C I received was overly aggressive. Despite this fact, my uterus was 35% filled with scar tissue, which was completely blocking my cervix. It caused intense monthly pain and prevented me from achieving a successful pregnancy. It is shocking to me that I have learned more about this syndrome through the Asherman’s support group than through most of my doctors.
Liz Hillen, Castro Valley, California
Thanks for this article, and I really hope awareness about Asherman's will be raised.
I battled for 2 years to get my official diagnosis, and had to a lot of my own research. Doctors and consultants seemed to treat my lack of periods as unimportant. They also seemed complately unaware, or determined not to acknowledge, that I could have scarring caused by postpartum infection followed by a D+C.
I am just about to have expensive corrective surgery in Germany, but because my scarring has been getting worse over time, I am unsure whether i dare to hope for another child. At least i hope the monthly pain will be lessened. If only i had known sooner.
I probably still would not know what was wrong with me had it not been for the AS support groups. I certainly would not be having treatment as I was told by my consultant that nothing could be done.
I feel that Asherman's will be caused less often and diagnosed more swiftly, if awareness was raised. The condition is not THAT rare.
Louise 'Piesmore' Davey, Torquay, Devon
Thank you very much for this article, it’s very important to aware women (and doctors too) that the D&C, a procedure commonly done every day in all the world, can affect in such way the fertility and the femininity of a woman.
I live in Italy and I developed Asherman’s syndrome after the birth of my son, due to 3 post partum D&Cs, and no one advise me that they could have led to infertility and didn’t take me seriously when my periods didn’t come back.
After the diagnosis, a very hard time has began for me and my family. Dealing with Asherman is a very difficult journey: economically, physically and not last emotionally and psychologically.
Alessandra Boria, Ancona, Italy
Alessandra Boria, Ancona, Italy
I totally agree that it is a hidden threat as I had Ashermans since 1986 and never diagnosed until 2 years ago. I had no symptoms at all. The most important, is not only to diagnose but to treat. Many doctors around the world, unfortunately, do not know how to treat properly causing more Ashermans to the patients, like my situation. Still battling with this syndrome, hoping some day I will have my own baby in my arms. Thanks for writing this article and hope that doctors will learn something out of this.
Helena, Nicosia, Cyprus
Thank you for publishing such an informative article in order to get Asherman's out there in the spotlight. There are so many that consider this so rare, however, it happens to more and more people everyday. I have been suffering Asherman's for over a year now following a postpartum D&C after the birth of my son - and NEVER was I given the possibility that Asherman's was a complication that could arise from a D&C. I have been through several surgeries, a miscarriage, and alot of heartache as a result of this horrible disorder. I don't want other women to go through what I have, along with the countless other women in the world are going through - THANK YOU for creating awareness!!!!
Jill, Illinois, USA
Thank you for publishing this article and bringing attention to Asherman's Syndrome. I had my first baby in 2006 and during the delivery by c-section placenta accreta was discovered in a small area of 5%. This was removed manually. I never had a D&C or anything like that - but yet, I still developed Asherman's Syndrome.
Thankfully, I found the Ashermans.org website and was able to educate myself about this horrible condition, as there isn't much literature available out there. My family doctor had never even heard of such a thing.
Fortunately, I was able to have surgery last month by an excellent surgeon who is very experienced in treating Asherman's patients. I am praying for a successful recovery and remain hopeful that I will go on to have more children.
Melanie Evans, Ottawa, Canada
You could replace my name with Sarah's, our stories are so similar. Thank you for publishing this article in such a public venue. It is a subject that is little known even in the medical world. My family doctor, knowing my medical history, thought that a brain tumour might be causing my problems, rather than scarring from a D&C. Once I saw a specialist I was diagnosed almost on the spot, but it took 1.5 years to get there. Now, 8 months, two surgeries, countless invasive procedures, ultrasounds, and drugs and I am almost at a point where I can try to give my child a sibling. In between I have gone through an emotional rollercoaster: why-me, what-if, tears, anger, hope. Asherman's, like all infertility problems, is not an obvious medical problem that everyone can see and sympathize with, so most women suffer in silence, having had the most basic biological need taken from them.
Michelle, Ottawa, Canada
I have suffered from AS for almost three years now, have had three surgeries and am still not done. I am determined not to give up! Thanks to the AS support group/website I have become more informed and knowledgeable about this issue and it has helped me to find an appropriate doctor. I only hope more women will read articles such as this one and that doctors will also educate their patients about the risks of aggressive D&C's and Asherman's.
Allison, Salinas, CA., USA
THANK YOU for bringing this issue to the forefront & to publication!! So many of us have heard that Asherman's is "too rare" to really be the diagnosis we have had...yet there are so many international women that form an amazing, educated & supportive group on-line. Unfortunately, AS receives little time in the US medical school training (& the world?), so doctors "can't believe" it's AS because it's so rare, or that the procedures they have been trained to do for years could possibly be the cause of AS.
Removal of a large fibroid caused my AS - another cause of AS. Thankfully, we were aware surgery might cause infertility. We were still unprepared for approximately 30 surgeries & procedures & numerous, very costly fertility treatments in 5 years. We are still not able to get pregnant & are now pursuing adoption. If nothing else, though, I am thankful to no longer be experiencing debilitating pain every month & to not have had a hysterectomy at age 30 for pain relief.
Allison, Saint Peters, PA, USA
I was diagnosed with Asherman's in 2004. Since that time it has consumed my life. After the birth of my daughter I had a D&C due to retained placenta. At that time I had no knowledge of the consequences that this D&C would cause. If I had the knowledge then that I have now my decision to have the D&C would definitely be different. After many years and 4 surgeries later my adhesions are gone but so is my fertility. During the years of trying to get rid of the adhesions I have turned older and watched my biological clock tick. It has now come to pass that I can no longer have another genetic child. Hopefully by bringing this syndrome to the attention of doctors and the public some other lady's fertility is not stolen.
Karen O'Hagan, Atlanta, GA, United States
Thank you so much for printing this article and spreading the word about Asherman's Syndrome. I, too, was diagnosed with Asherman's after a post-partum D&C to remove retained placenta after the birth of my daughter. It's such a shame that even those in the medical community are not well educated on this topic. Good work bringing it to a wider audience!
Kelly, Scottsdale, Arizona/USA
Thank you for printing this article. It is so important that society becomes more aware of Ashermans Syndrome. I was diagnosed with Ashermans 20 years after terminating a pregnancy in my youth. It was only through the Ashermans website that I could educate myself about it. All my information came from there. I chose to fly to Australia for surgery because my specialist in New Zealand did not want to try and remove my scarring. Now, at the age of forty, I have the chance of having a family. Once again thank you for reporting on such an important topic.
camilla browne, wellington, new zealand
Thank you for helping to educate the public about a condition that can permanently affect fertility. I was diagnosed with Asherman's Syndrome in 2002, four years after my D&C due to retained placenta after the birth of my only child. My OB-GYN did not even diagnose me with AS. After many confusing doctor appointments and fertility tests, I started searching the internet for my own answers. I was lucky to find the AS Support Group. The women there gave me insight, advice and knowledge as well as pointed me in the right direction to find a specialist who could try to help me. Even though I was not able to have any more children, due to the severity of my scarring and the damage to my endometrium, I felt I was doing everything possible to improve my chances. I cannot say enough about the unity these women have provided. They come from all parts of the world and support each other for a common goal. I am happy to have had the chance to get to know all of them
Nancy, Georgia, USA
I'm proud to say I developed, fought and defeated Asherman's in 2006, but had never heard of it before I got it. Luckily, I had a GYN who diagnosed the problem right away, but I think a lot of people, even some GYN's , don't know anything about this condition. I found out about AS through the online support group (www.ashermans.org), and without them, I'm sure I would have never found a good surgeon or a cure. The support group strives to raise awareness and knowledge about AS and how to battle it. They strive to be accurate as well as a supportive sounding board.
Beth Neel, Raleigh, NC?USA
Dear Catherine,
Bravo! Finally an article on Asherman's Syndrome in a world renowned newspaper. This disease needs to be exposed; it causes so much pain, loss and unanswered questions for many families. I was diagnosed with Asherman's Syndrome 23 years ago. By the time I found out what was going on with my body I had lost 4 precious healthy babies to Asherman's Syndrome. I felt lost in a medical world that had no answers. It was a physical and emotional time of distress for my husband and I. Finally I found a doctor in Pittsburgh, PA that was treating women with Asherman's Syndrome; Dr. Shaffer did all he could at the time but nothing helped. I almost died during the 4th miscarriage and from that time on I was too afraid to try again. It altered my life. Hopefully bringing more attention to this disease will help other women avoid this life sentence. Women and doctors need to become more aware. So many of these cases were preventable including mine!
Pamela Parks-Westberg, Bonner, MT (previously PA), 59823
This article is excellent. I am so glad that it will bring awareness to the public about this difficult condition. I have been in treatment for Ashermans Syndrome during 2007. I have undergone 2 surgeries and 2 diagnostic HSG's. I have been cleared to try and conceive. I attribute alot of my support and understanding of my condition to the Asherman's support group and website. My OBGYN did not refer me to a specialist, I decided to do this on my own after researching all of the information available. Women must educate and empower themselves to obtain the best specialists and treatment possible to have the best chance for having a child. I am currenlty praying for my second child and I know that the information that was made available to me helped me to get to this point alot more quickly. Women need to know what questions to ask and what to expect when being treated for this difficult syndrome. There is hope and I am proof that education and support lead to good treatment and healing!
Melanie Miall Allen, Northport, USA- Alabama
Thank you so much for bringing attention to such an underpublicized and underdiagnosed syndrome. Asherman's has stolen so much from so many women --- time, money, failed diagnoses, fertility, and can also be painful and lead to other issues, such as endometriosis.
More attention needs to be paid to this syndrome so that women are informed of the risks of D&C, and so that others who contract the syndrome as a result of infection understand and seek correct diagnosis. More physicians, especially OB-GYN's need to be educated on this subject so they know what to look for and so they know that this 'rare' syndrome may very well NOT be so rare.
Thank you again for your highly informed and informative article.
Shayann, NY, USA,
What a wonderful article. This syndrome is not as rare as many doctors think. It is amazing how many doctors are oblivious to this condition in their patients. Many women, including myself were given a D&C and not told of any complications that may occur. Thank you for helping to raise awareness.
EN, Chicago, IL, USA
Thankyou for publishing this incredible article, I am a 31 year old woman from Melbourne, Australia. I was diagnosed with Ashermans Syndrome in March of 2005. It is great to finally see some information on this sometimes delibitating condition that is often underdiagnosed, and causes so much more grief and sadness than understood.
So many people do not see the effects of the condition because it is a "hidden" problem as infertility can be. Unlike a visible disabillitysuch as a limp or someone wearing glasses.
It is great to see, this get out into the open and to allow women who may be suffering from some of the symptoms to be able to put a name and understanding to their problem.
Sometimes this can be the first major step of knowing that what you have is not in the mind nor is it normal as some will have been told.
Appreciation from Australia.
Belinda Timmins, Melbourne, , Australia
Thank you for printing this article. After I was diagnosed with Asherman's my doctor told me I could never have another baby. Fortunately I found the Asherman's website and was able to learn more about this condition, found a doctor who could cure it, and went on to have a successful post-Asherman's pregnancy.
Jenny, California, USA
Thank you for covering this very important topic. I was diagnosed with Asherman's Syndrome in 2003 after having had a d&c following a miscarriage. The scarring the procedure left in my uterus was so severe that my doctor at the time felt my odds of having a child biologically were slim. When I searched for information on the condition, I was amazed at the dearth of coverage in the media and in medical literature. Thankfully, I was able to connect with an online support group, found a specialist, and was successfully treated (and now have two children). But more coverage of this problem and more research is most certainly needed, not only to inform women who are at risk for the condition, but also to inform their doctors--many of whom are not adequately educated about Asherman's Syndrome and its proper treatment.
Terry McKiernan, Long Beach, California
Thank you for publishing this article to bring Asherman's Syndrome into the limelight. It is not nearly as rare as many doctors believe it to be, and hopefully this article will make people realize that. I have been diagnosed with severe Asherman's Syndrome following an emergency d&c two weeks after we lost our baby at 27 weeks. I have no living children and am hoping that my recent surgery to remove my adhesions will be the answer to my prayers. The more people who are aware that routine uterine surgery can cause this problem the better. Kudos for a great article!
Jodi DiFilippo, Indiana, PA, USA
I hope this article will help bring awareness about Asherman's or intrauterine adhesions to doctors and sufferers alike. It is important to highlight that D&Cs are a major cause of the condition because women are not given a CHOICE despite safer methods such as hysteroscopy, ultra-sound guided D&Cs, or even misprostyl, a chemical substitute, which is banned in many countries including Australia for 'moral' reasons. There are ways to prevent stds and other diseases, and no doubt these need to be publicized as causes of the condition, but women have no control over preventing undergoing a D&C. It's about time doctors use direct visualization when scraping away at delicate tissue. Also, we hear about stem cell research for just about every condition, but where is the research for regenerating damaged endometrium? If doctors didn't cause this condition , albeit inadvertantly, there would be so much more interest in it. Instead it's been swept under the carpet for far too long.
CS, Sydney, Australia
Thank you for printing this article. Asherman's is certainly not rare and its about time someone spoke up about it. It is unthinkable that doctors perform a procedure where they CANNOT SEE WHAT THEY ARE DOING - namely a D&C. The technology exists for doctors to perform a hysterscopy to remove retained products of conception to save unneccesary trauma to the uterus. Why dont they use this? Equally appalling is the fact that so many obstetricians do not recognise the signs of Ashermans and refuse to consider this as a diagnosis. Obstetricians need to be more aware of the risk of Ashermans when performing a D&C and also need to be aware of the warning signs when diagnosing infertility.
Melanie Wolfhart, Sydney, Australia
Thanks for this very informative article. Unlike most women, I did not get Asherman's from any surgery. I never had any surgery. A few months back I was diagnosed of severe Asherman's. I was treated for Abdominal Tuberculosis 10 years back. No Dr. ever suspected that the infection could have caused so much damage to my reproductive system. After trying to conceive for 1.5 yrs, I went for an HSG that diagnosed that I am now left with both my tubes badly scarred/blocked and my uterine cavity badly deformed. I need to go for surgery for removal of adhesions and restoration of a normal uterine cavity. My Dr. told that Asherman's syndrome caused by Tuberculosis is one of the worst cases of Asherman's and in many cases, the damage caused is irreversible. This cause is more common in Asia than in other parts of the world. I wish we were more educated about this rare syndrome. Awareness could have helped me stay fertile and complete!
Richa Sharma , New Jersey, USA
Richa Sharma, Randolph, NJ, USA
Many thanks for highlighting this important syndrome. I was diagnosed with Ashermans after a D&C for a miscarriage babk in 2005. Thankfully with the help of the internet group and a fantastic consultant I gave birth three weeks ago to a health baby boy.
Juliette, Birmingham,
I just want to say thank for you writing this article. I have been diagnosed with Asherman's Syndrome for over a year now. I have been misdiagnosed all of 3 times before learning about AS. I got it from a removal of a small fibriod. If I had known a year ago that I could develop AS from removing a small fibriod, I would have opted out. Now I am battling with infertility. Asherman's Syndrome can occur from any trauma to the uterus, not just D and C. STD's like chlamidya effect fertility, infection, and any type of surgery on the uterus. No longer is "unexplained infertility" acceptable. Women like me have a right to get a proper diagnosis and treatment. I refuse to pay my health care provide tons of money to get an answer like unexplained infertility.
Vanessa, New York, NY
I was diagnosed with Ashermans in 2003 after several months of tests. I wish there had been more articles like this one printed then because at that time I had never even heard of Ashermans.
Thank you for printing this.
Sam, Stevenage, Herts
I too was diagnosed with Ashermans Syndrome this year & I thank you for printing this article. Its effects are devastating to those of us that have it. Often I hear it described as "rare" by Doctors who shrug it off as a possible diagnosis without proper investigation or knowledge.
It seems often it is left to the patient to prove her case.
Publishing information like this will alert women what to look for & hopefully Doctors to reconsider the facts.
Well done!
Tamzin Kaymaz. Antalya, Turkey.
Tamzin Kaymaz, Antalya, Turkey
A huge thank-you for printing this article. I had no trouble conceiving my first child, who is now 6. Ater 17 month of trying to conceive for a second child, and many doctors appointments later, I was diagnosed with Asherman's syndrome. My regular OB/GYN basically ignored all my symptoms and did 4 IUI's without even a
simple HSG. I have had 3 surgeries with the Reproductive Endocrinologist who diagnosed me and now am almost back to normal. I am so thankful for ashermans.org; as I have "met" many wonderful women there. The advice and support fromt this group is amazing.
Melanie Sain, Clemmons, USA/North Carolina
I too was diagnosed with Ashermans Syndrome this year & I thank you for printing this article. Its effects are devastating to those of us that have it. Often I hear it described as "rare" by Doctors who shrug it off as a possible diagnosis without proper investigation or knowledge.
It seems often it is left to the patient to prove her case.
Publishing information like this will alert women what to look for & hopefully Doctors to reconsider the facts.
Well done!
Tamzin Kaymaz. Antalya, Turkey.
Tamzin Kaymaz, Antalya, Turkey
This is terriffic that this topic has been brought in the spotlight. I have had Ashermans for 5 years now and have had 10 surgeries in hope to have another baby. I am now near the end of the road and will accept that my body will only continue to grow adhesions. I can only hope that the more publicity this disease gets, the more drug compnaies will seriously look at ways to prevent and treat this disease.
Susan Hill, Apex, USA / NC
I just wanted to say thank you for writing this article. I was diagnosed with Stage 4 Asherman's 3 years ago after a D&C and was told I would never be able to have anymore children. I did not settle for that answer and went looking for another one. That is when I found ashermans.org. I found such valuable information there and a group of supportive women who were going through the same thing I was. I also found the incredible doctor who I fully credit with the birth of our second child. It is important that women have this information, so again, thank you.
Ann Whitten Bourne, Atlanta, Georgia/United States
My daughter, who gave brith and lives in London was diagnosed and treated for severe Asherman earlier this year. She never had a D&C, or any health nor fertility problems, but an emergency c-section. I believe she was told, that developing intra uterine scarring is perceived as rare, but perhaps "just" underdiagnosed in many women and can be caused by any uterine surgery in special circumstances and not only a D&C
Brigitte Becker, Denmark
Brigitte Becker, Copenhagen, Denmark
I am very grateful that this article has been published. I live in the United States and we have been suffering in silence for many years. No one wants to talk about it, no one wants to do anything about it because the procedure is done by doctors. There are millons of women out there who will never have children because of this syndrome. It has brought untold and uncessary pain to many lives.
Thank you for publicising this!
Debra Gibson- Welch, Somerset, New Jersey, USA