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  1. #51
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    Default Poor Responders Using Luveris, DHEA etc #11

    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.

    Symptoms

    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).

    Causes

    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:

    http://www.bubhub.com.au/community/f...05#post6812105

  2. #52
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    Thanks KandP. Hopefully I'm just having a bad month and I can bounce back but I have no illusions, my FS made it pretty clear that I'm not likely to get good outcomes with IVF but since we got DS we're not willing to just roll over and not try. Sometimes life just sucks.

    So glad you got some answers - now you can move forward and hopefully get that BFP on your next cycle!

  3. #53
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    Default Poor Responders Using Luveris, DHEA etc #11

    So sorry hoping4more it's unfair I agree.

    You are young and this is not your fault it's a cruel twist of nature that this has happened to you.

    KandP, Asherman's that's tough. It's good that you have a diagnosis but tough that this has happened. Hopefully they can treat it and you can fall pregnant.

    Afm - my sister is doing silly things and is putting her three kids at risk. I told her so in probably a confronting way, warning her about paedophiles and she threw back in my face I was obsessed with Ivf and should just adopt. I am still crying about it. We can't adopt in australia as i am too old at 39 but also there aren't any Australian children to adopt. China has a five year waiting list, and I don't think we could wait that long. That's why we will consider egg donation next. The crazy thing is that I have only done one cycle.

    It's so hurtful I cried all morning. I don't want to be thought of as a crazy woman

  4. #54
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    Thanks Luckyme1 - Sorry about your sister, it is so hard for fertiles to understand. You're not crazy you're just hurting and in an incredibly unfair position. I've spent many a day crying over insensitive comments/pregnancy announcements from friends etc. - this situation really does your head in.

    I don't know what I'd do without DS but like you I really want to give him a sibling. Donor eggs and adoption are not very likely for us (no good candidates for donors, only one we know who would help is too old and my DH is opposed to adoption). I guess we'll just keep trying and hope something gets better, maybe a second opinion if this happens again.

    Stay strong and maybe the next cycle will be the one!

  5. #55
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    kandP - I am glad you found this out, this kind of news is shocking at first but hopefully you are now much more likely to fall pregnant and you have the option of seeing this specialist in Sydney. GIve it a few more goes yourself but there may also be the option of a surrogate if you have a good embryo but they believe it may not implant ....like Nicole Kidman with#2
    Hopingformore- I am sorry about your ****ty cycle but remember you have only had your DS this year and they say it takes about 18 months to recover from a pregnancy so try not to put too much pressure on yourself, my FS says that eggs come in waves so you have a few bad months and the next wave may be better.

    Luckyme1-your sister sounds so insensitive. I hate it when people say I am obsessed about falling PG when it has come so easily to them, when they have not had to go through the disappointment of trying month after month with no success or the heartbreak of M/C. I just want to say, " What the f--- would you know!"

    AfM, looking better than last cycle. I have about 9! After last time of only having 3, I was amazed, it will probably be less for EPU because so far one may get too big and one too small. Will let you know how many are for EPU scheduled probably for Mon. ALso you can get follies with no eggs, not sure how many of those there are!

  6. #56
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    Thanks TTCno2. I'm trying to put it into perspective it's just hard as although I've always had ****ty cycles this was the absolute worst - I think I'm just dealing with the shock.

    That's great news about the number of follies hopefully they will all have wonderful mature eggies inside. Did you do anything different for this cycle or have you just miraculously gone from three to nine from one cycle to the next?

  7. #57
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    HI Hoping4more,

    I don't know if you had seen the aussieeggdonors website, if you don't know of anyone for egg donation, you can advertise on here to find one, and there is lot's of helpful people who post here, who have been through egg donation and may be able to help you.

    Here is the link if you're interested. It may not be an option that your interested in but I thought it can't hurt to let you know.

    http://www.aussieeggdonors.com/

  8. The Following User Says Thank You to Luckyme1 For This Useful Post:

    HopingForMore  (12-09-2012)

  9. #58
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    Thanks Luckyme1. Not sure how I feel about egg donation but do know that I'd take it over no more children. At least I know my body is capable of carrying a baby just need the right egg. If we have no luck in the next year or so I think an egg donor is definitely something we'll have to go for. The nice thing about egg donation is that at least as women we get to carry the baby and help give it life, while men are quite apart from the process until the baby's born (if a sperm donor was used). How seriously have you looked into egg donation?

  10. #59
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    Hopingformore I didn't do anything different I had DHEA about six weeks before 1st cycle but only took 25 to 50mg daily, they recommend 75 mg but I don't like hormones so Just took a lower dose but I stopped it at end of July....don't know if there is some remnant effect! Also am taking coenzyme Q10 100mg daily and VitaminD and fish oil but plus elevit and zinc. My protocol is same and except for stopping DHea nothing has changed but egg numbers do not matter, it's quality. You seemed to have fallen pregnant with just One embryo transfer so don't worry it Wil happen again

  11. The Following User Says Thank You to TTCno2 For This Useful Post:

    HopingForMore  (13-09-2012)

  12. #60
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    An update on me, So there may be some more follicles maybe 10 or 11 but time will tell on quality. EPU on Monday so we will see how many eggs are in these follicles and how many fertilize.
    Hopingformore, I forgot to write last time I allso have wheatgrass once a day.
    Last edited by TTCno2; 15-09-2012 at 16:12.


 

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