QuestionQUESTION: hi my name is zara ,am 27 ,went through negative icsi in october 2008 , after that my doc done hysteroscopy which says most of the cavity seen with thick adhesions ,try to break them but difficult ,after mid canal no sound or dilater passed ,cavity 7cm minimal curetings obtained for histopathology and AFB (acid fast baccilus )
The histopathology report says sections reveal small fragment of fibrinous tissue and very tiny fragment of endocervical tissue showing few benign endocervical glands .no formed endometrial tissue identified .a very small superficial fragment of benign stratified squamous epithelium is also noted .Also my AFB smear report shows negative n till today its beeb 3 weeks its still negative , my final report of AFB will cum on june 1st . also my doc has asked me to dop HSG fr clear diagnosis of adhesions .i would like to ask few Questions : what do you diagnose that what is the problem ,do you think adhesions is the hurdle that am not conceiving ? also my laproscopy was done 3 years back and it says no adhesions ?so now what is the problem ? my periods are regular ,good average flow then what is the problem ? i also got polysistic overies and taking glucophage thrice a day since last two months ? in this situation what do think are there any treatments so that i can conceive and also since i live in pakistan there is no hytroscopic surgery perform here so thats no problem fr me to go abroad but who to trust ? also do you think it could be asherman syndrome ? please answer my queries , i'll be waiting for your reply .
ANSWER: Hello,
In order to diagnose adhesions in the uterine cavity, you would need to have a hysteroscopy. You had that done correct? By definition, adhesions in the uterine cavity is Asherman's syndrome. It is a very difficult problem to solve. People have tried many things but basically an operative hysteroscopy has to be done to break up and remove the adhesions. This can be done by cutting them or scraping them. Then the cavity needs to be propped open so that new adhesions don't form. I use a bladder catheter and inflate the balloon inside the cavity. I keep it there for 4 weeks. During that time, I also treat the patient with estrogen supplementation. That has worked in some patients.
If this problem cannot be corrected, you will need to use a surrogate to carry the pregnancy since you will be unable to get pregnant with an abnormal uterus.
The ovarian problem, polycytic ovarian disease, is a separate problem. It is treated with fertility drugs to induce the ovaries to ovulate. Some of these patients have to go to IVF to get pregnant because their ovaries are too difficult to stimulate.
I hope this helps,
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.
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QUESTION: hello ,
i just wanna ask that my AFB report will come on 10 th june and my doc ask me to do HSG after 6 weeks as i hv gone through hysteroscopy , its been 4 weeks now and i got my periods today so if i go for HSG it will be my 5th week after hystroscopy but still i dont have my final report of AFB culture ,should i wait and do HSG next month? or do it now ? since my Afb smear shows negative and for hystroscopy recovery do you think 5 weeks are more than enough ? so should i wait till next month and if yes pls explain why ?
AnswerHello Again,
I see no reason why you couldn't do the HSG with this cycle.
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.
