Pregnancy issues after D&C
Dear Dr Mitchell,
My husband and I have been trying to get pregnant for five months now without success. Each month I will have signs of pregnancy — sore breasts and nausea, and my period will be a few days late, then it arrives. I feel like my body is rejecting pregnancies because of my health history. We time intercourse around ovulation, give or take a few days, in order to be certain. Truth is, a year ago, at six weeks pregnant I had a D&C overseas, which was characterised by a few anomalies: 1. I bled just a little right after for about a day, then nothing happened for a few days. I felt fine, except for stomach issues from the antibiotics prescribed – Doxy. 2. About a week later, I had intense cramping — more horrible than childbirth, with uterine contractions. I bled profusely and passed huge clots for about four days. At the same time, the antibiotics I was prescribed made me very ill, to the point where I couldn’t keep food down. My regular cycle did not return for 10 weeks, and is just now becoming ‘normal’ again. Could the earliness of the D&C mean that much more scraping of my uterus was done than was necessary? Could it be that conception is now unable to occur because the conditions in my uterus are hostile? What can we do to rectify this problem? I was not given an ultrasound before the D&C.
I am sorry to learn about your inability to conceive despite trying for several months. The events that were associated with the termination of your pregnancy that was done overseas are significant. It would definitely seem as though the procedure could have been incomplete, and placental tissue might have been left in place, resulting in the heavy vaginal bleeding and cramping that occurred after the procedure. Inflammation in the lining of the uterus could then cause damage and scarring to the lining, resulting in adhesions and failure of the menstrual period to return, or for the flow to be scanty and irregular.
Additionally, overzealous scraping of the lining of the uterus can damage the lining and cause adhesions which can alter the normal menstrual flow, and the damaged endometrial lining will prevent implantation, thus resulting in subsequent inability to conceive. You should get an ultrasound done to check the cavity of the uterus for adhesions.
It is also possible that your Fallopian tubes could be blocked because of an infection. This is quite possible if the antibiotics prescribed were not completed after the dilation and curettage (D&C) was done. An X-ray of the Fallopian tubes (hysterosalpingogram) will help to establish whether the Fallopian tubes are blocked and also outline the endometrial cavity, thus ruling out any adhesions within the cavity.
If adhesions or scarring of the lining is present, then these can be removed by a relatively minor outpatient procedure called operative hysteroscopy. This can confirm the presence of scar tissue which can be removed at the time of the procedure with a good outcome. If extensive damage is present, this can unfortunately prevent a pregnancy from implanting in the uterus. This condition is called Asherman’s syndrome. Consult your gynaecologist who will advise you further, do the appropriate investigations, and refer you for further treatment if necessary to optimise your chances of a successful pregnancy.
However, most couples will achieve conception within one year of regular sexual activity two to three times per week, so be patient. You still stand a very good chance of becoming pregnant eventually. You should take folic acid to reduce the possibility of birth defects when you do become pregnant. Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
