QuestionI had history of scar tissue (Asherman Syndrome) since my Myomectory surgery in 2008. I have very light period since then and have had 4 hysterescopies to remove the scaring. The last one was done in August 2010 and since then i have not had a normal period. I had only a period in November after being on the pill for 1 month. And after that i do not have any period. I have tested and am not pregnant. I am confused and don't know what else to do to have a regular monthly period. Can you shed some lights on what i need to do to get a period? Age is not on my side am 43 years old and has been trying to conceive since 2008. My 2nd question is this, can i take Clomid without a period?
AnswerHello Olu from the U.S.,
You bring up several isues so let me see if I can give you the information that you need.
Asherman's syndrome, as you know, is the formation of scar tissue within the endometrial cavity. As has been done with you, hysteroscopic surgery is required to removed this scar tissue and open the endometrial cavity up. Without a normal endometrial cavity, you cannot become pregnant. This has nothing to do with your menstrual cycle, UNLESS the endometrial lining was scraped so intensely that there is severe scarring that prevents the endometrial lining from forming. This is usually done when a D&C is performed. If the curettage portion of the procedure is done over-vigorously, it can remove the uterine lining down to the muscle layer and causes the formation of scar tissue at the muscle layer. This then prevents new endometrial lining from developing. This is the basic concept with endometrial ablations, which is done to stop menstrual periods and bleeding.
No having periods, can be for many reasons, including the one I just described. The more common reason is due to an ovarian dysfunction. That is, the ovaries are not working correctly so do not go through their normal ovulatory cycles. Several things can cause this starting from the brain level. Testing needs to be done to evaluate for this. These tests are blood tests. If the brain hormones are working correctly but the ovaries are not responding then it is an ovarian derived problem. The most common ovarian disorder is called polycystic ovarian disease, which is basically an ovarian dysfunction disorder. The birth control pill is used to bypass the ovaries and induce a normal cycle. In that case, the ovaries are put at rest. But, this cannot be used to get pregnant. In order to get pregnant, one has to ovulate (grow an egg#. This will require the use of some form of fertility medication. Clomid is one of those medications and there are others as well.
In terms of getting pregnant, the biggest inhibiting factor that you are facing is your AGE. A woman is born with all the eggs she has for her entire life and the eggs deteriorate with time. By the time she reaches 35 years old, her fertility rate is less than 50% of what it was in her twenties. By 40 years old it is 10% of what it was. This is due mainly to the decline of egg viability. By 42 years old, the chances of natural pregnancy are only 1% per year of trying. So, in answer to your question about pregnancy, yes, you can use Clomid but a period needs to be induced before starting it, but this is the lowest level of treatment, and frankly, I would not recommend it. I think it would be a waste of your precious time. This year will probably be the last year that you will have the opportunity to get pregnant using your own eggs #if you are not already perimenopausal). For that reason, I think you need to proceed to the highest level of treatment to give you the best chances of pregnancy. That level is called IVF. You would have an approximately 43% chance of pregnancy per attempt. Past 43 years old your only option would be donor eggs and IVF.
I have written extensively about all three of these subjects on my blog. I would recommend that you go through it and give it a good read.
Good luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
