oh honey, I'm sorry you've had a poor response. Are there no other treatment options?
AFM: I've just had a hysteroscopy today along with a lipoidol flush, my specialist (Dr Warren DeAmbrosis) diagnosed Asherman's Syndrome.
What is Asherman's Syndrome?
Asherman's Syndrome, or intrauterine adhesions/scarring or synechiae, is an acquired uterine condition, characterized by the formation of adhesions (scar tissue) inside the uterus. In many cases the front and back walls of the uterus stick to one another. In other cases, adhesions only occur in a small portion of the uterus. The extent of the adhesions defines whether the case is mild, moderate, or severe. The adhesions can be thin or thick, spotty in location, or confluent. They are usually not vascular, which is an important attribute that helps in treatment. Click here for more on Asherman's Syndrome grades.
Most patients with Asherman's Syndrome have scanty or absent periods (amenorrhea) but some have normal periods. Some patients have no periods but feel pain at the time that their period would normally arrive each month. This pain may indicate that menstruation is occurring but the blood cannot exit the uterus because the cervix is blocked by adhesions. Recurrent miscarriage and infertility could also be symptoms (1).
Asherman's syndrome occurs when trauma to the endometrial lining triggers the normal wound-healing process, which causes the damaged areas to fuse together. Most commonly, intrauterine adhesions occur after a dilation and curettage (D&C) that was performed because of a missed or incomplete miscarriage, retained placenta with or without hemorrhage after a delivery, or elective abortion. Pregnancy-related D&Cs have been shown to account for 90% of Asherman's Syndrome cases(2). Sometimes adhesions also occur following other pelvic surgeries such as Cesarean section, surgery to remove fibroids or polyps, or in the developing world, as a result of infections such as genital tuberculosis(3) and schistosomiasis(4).
There is a 25% risk of developing Asherman's Syndrome from a D&C that is performed 2 to 4 weeks after delivery(5-8). Dilation and Curettages may also lead to Asherman's Syndrome in 30.9% of procedures for missed miscarriages(17) and 6.4% of procedures for incomplete miscarriages(2). The risk of Asherman's Syndrome increases with the number of D&Cs performed; after a single termination the risk is 16%, however, after 3 or more D&Cs, the risk increases to 32%(9). Each case of Asherman's Syndrome is different, and the cause must be determined on a case-by-case basis. In some cases, Asherman's Syndrome may have been caused by an "overly aggressive" D&C. However, this is not often considered to be the case. The placenta may have attached very deeply in the endometrium or fibrotic activity of retained products of conception could have occurred, both of which make it difficult to remove retained tissue. For the most comprehensive information about D&Cs and Asherman's Syndrome, please click here to visit DandCnow.info.
There is a variant of Asherman's Syndrome called "Unstuck Asherman's or endometrial sclerosis that is more difficult to treat. In this condition, which may coexist with the presence of adhesions, the uterine walls are not stuck together. Instead, the endometrium has been denuded. Although curettage can cause this condition, it is more likely after uterine surgery, such as myomectomy. In these cases the endometrium, or at least its basal layer, has been removed or destroyed.
It's seems to be on the right side of my uterus as the left was completely clear. He removed all the adhesions, and that there is only a small amount of residual scar tissue with no blood supply. The before and after photos from the scope are very different. We are going straight into my next antagonist cycle, but he's also said that he'd happy to refer me to a specialist in Sydney who specialises specifically in Asherman's Syndrome. I asked if he felt that we should do that now before trying again, but he said that 75-80% of my uterus was clear and that i have a decent chance of falling pregnant. I trust Warren implicitly and know that if he felt that we had little chance of it working, he'd not go through with a cycle and that if treatment with the doctor in Sydney was the only way to go, i'd be referred immediately. He'll take a look at my lining during the cycle and i'm guessing that if it's not good, we'll look at other options.
I had a D&C when i was 21 and have had laparoscopies since then, but no hysteroscopy - i'm guessing that this was the cause of this condition (D&Cs are the general cause of Asherman's). I know that Asherman's is not a great diagnosis, but i am so relieved that i finally have a definitive reason for not being able to conceive a)naturally, and b) 2 BFN IVF cycles. Our embryos aren't the best quality, but up until today they had little to no chance of implantation. I'm really hoping that by removing the adhesions this will give me a better chance at having a baby.
For those interested to read about Asherman's, there is a great sticky thread here on the IVF forum: