QuestionHello, I am a 36YO with two prior C-Sections. I recently conceived again but suffered from a blighted ovum. I was advised to have a D&C at 10 weeks. Everything seemed to go well during the procedure except I did not bleed for 4 days following. The next 5 days were light spotting. After that, nothing. I am now 2 months post D&C and my period has not yet returned. I would like to have another pregancy as soon as possible (esp given my advanced maternal age).
After reading some websites stating that post D&C patients have up to a 30% risk of developing asherman's, I became extremely concerned.
My questions are:
1. Are there symptoms of Asherman's Syndrome? Is there any way of knowing if the utereus is damaged without doing a hysteroscopy?
2. Should I try to conceive and run the risk of miscarrying again and having another D&C?
3. How long should I wait to see how things unfold before I begin seeing a fertility specialist? Is my age a big factor?
4. When can I expect my period following a D&C? Will my period be the same as it always has been? Up until this last D&C my period was like clockwork. Perfectly 28 days, lasting for 5 days and extremely predictable.
Any insight you can provide is greatly appreciated.
Thank you.
Writing from Sacramento, CA
AnswerHello,
Asherman's syndrome has no symptoms. It is diagnosed by either hysteroscopy or sonohysterogram. I think that hysteroscopy is best because I can do it in the office and it is more sensitive. If the sonohysterogram is abnormal, then you need to have a hysteroscopy to confirm.
You should definitely try to conceive again. Do not worry about miscarriage and/or D&C. The risk of Asherman's is low, and miscarriages occur with increasing frequency with increasing age. However, most patients will be ultimately successful.
You are at that point now, based on your age. We recommend waiting no longer than 6 months to see a fertility specialist after the age of 35. Your age has an impact on your ability to become pregnant, as well as, you miscarriage rate. You fertility chances are decreasing with time and age, so you should take advantage of your young age at this point.
Following a D&C, it will take 6-8 weeks for the ovary to reset and begin ovulating again. It can sometimes take longer if there was some pregnancy tissue left behind and the HCG levels have not returned to 0. It will take 4-6 weeks from the zeroing of the BHCG to have your first period. I would recommend that you wait a little longer (2 weeks) to see if you will have a spontaneous period. If none by that point, then you should see your doctor to check things out.
Sincerely,
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.
Check out my blog at http://womenshealthandfertility.blogspot.com and twitter with me @montereybayivf.
