Conceiving After a D&C: What to Expect & When to Try Again

Question
Dr. Ramirez, I am a 31-year-old woman in Washington, D.C. I have had two pregnancies. The first was a surprise pregnancy; we conceived in May 2006, my pregnancy had no complications, and I delivered a healthy baby girl on her due date. We conceived again in January 2009 a month before we were gearing up to "try" to get pregnant. At a routine sonogram at 8 weeks, 5 days, no heartbeat was detected in the embryo, and development appeared to have stopped at 7 weeks, 5 days. We had a second sonogram done two days later, and then I underwent a D&C four days after the initial sonogram. I had no complications with the D&C and got a period on April 10 -- 28 days after the procedure . Since then, I have had 29-day cycles save one month (August) when it was a 33-day cycle (I took a pregnancy test and it was negative). My periods are exactly as they have always been in terms of flow (moderate to heavy), duration (five to six days) and severity of cramps, etc. My husband and I have been trying to conceive again since June and have been unsuccessful. After the one longer cycle in August, my OB/GYN ran an anovulatory panel on me and my FSH, prolactin and thyroid levels were all normal. I have charted my BBT the last two months and used OPK last month, and both methods indicate ovulation occurred. I am concerned that after conceiving so easily twice before, my failure to conceive thus far might be due to damage caused by the D&C to my uterus or tubes. My OB/GYN thinks it was luck that led me to conceive quickly before and wants me to keep trying a little longer. How likely is Asherman's Syndrome in a woman with regular, normal periods? How long would I have to try to conceive before an OB/GYN would order an HSG or similar procedure? Thank you for your time.

Answer
Hello Ashley from the U.S.,

Asherman's syndrome is definitely a possible complication from D%26C but usually rather rare.  However, considering how things have become a little more difficult, it cannot be ruled out without some testing, either an HSG or diagnostic hysteroscopy.  If this is a concern for you, there is no reason that your doc can't order this at any time.  There is no prescribed "waiting period" yet (there will be if health care reform is passed).  Just ask your doctor for it and tell her you want if for your peace of mind.

The waiting period that your doctor is prescribing is for an infertility evaluation.  It takes most women 8-12 months to conceive naturally, and for that reason, we usually will not recommend an infertility evaluation until a woman has gone past that point.  That would be one year from your last pregnancy.  Since you have only been trying since April 6 months, that has not been sufficient time to worry yet.

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 facebook and twitter with me at @montereybayivf