- Ute's story

[Guest guest]

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I was surprised you were able to read Tammy's story but not Ute's. I wonder if anyone else is experiencing this problem. In an case, I have cut and pasted the story below for you to read:

My Fertility Journey

I am writing this while , my miracle baby, is happily snoring in hisbouncy chair. I am a single mother who decided in 1997, at the age of 33,after several years of thinking and longing for a child, to embark onmotherhood. I thought it might take three months to get pregnant and Ithought I was brave to do IUI with donor sperm.. Little did I know...

After six unsuccessful months, I had my first surgery,laparoscopy/hysteroscopy. The surgeon lysed adhesions on my tubes andtried to remove a fibroid tumor that was growing into the uterine cavity.An IUI cycle with injectibles followed in August of 1998 which ended in atubal pregnancy. Meanwhile, the fibroid had grown back. Both theseproblems were removed via mini-laparotomy in September of 1998. Anunsuccessful IVF followed in Nov./Dec. 1999. After this failure, mydoctor performed an exploratory hysteroscopy to check if the myomectomy (fibroid removal) had not left any adhesions in my uterus.

He found "minor adhesions" (hey, shouldn't he have checked *before* the IVF?) and polyps (at least that's he thought it was; two independent doctors I asked later could not see any polyps on the photographs). He removed the uterine lining and when the "polyps" were still there he performed "gentle curretting" (at least, that's what he called it, the butcher) and put me on estrogen pills for a few days. I asked him at the post-op appointment if it was possible that I'd get adhesions from the D & C and if I didn't need some sort of intrauterine device to keep the walls apart and more estrogen to prevent adhesions. He said (in his usual condescendingmanner) for sure I wouldn't. My lining was 7mm after the estrogen. Thatseemed fine. I also read in a textbook that Asherman's after D & C on anon-pregnant woman is very rare. Well, I was the exception Mytemperature dropped, but my period did not come (I have no idea where that 7mm lining every went); then after 12 days my temperature rose again. That is, I had the temperature pattern of a normal cycle, but no period. I called the doctor who found a ready-to-ovulate follicle, but no uterine lining. Asherman's! (you should have seen his face). He performed a saline ultrasound which clearly showed adhesions. Because they weredetected early, they were still filmy, not very hard, and he was able tosplit them with pressure from the saline. I have not seen this methoddescribed anywhere in the literature, and in hindsight don't think this isthe way to do it. Hysteroscopy is much more precise, but I was lucky. Adiagnostic hysteroscopy a couple of months later (by a new surgeon as Ifired the first) showed I did not have any adhesions left. My uterus wasnot the same anymore, however. What used to be 9mm linings before allthis mess was now 4.5 mm in a natural cycle at the time of ovulation.Mega-doses of estrogen injections (wow, that was fun!) brought it to 7mm.

I proceeded to IVF #2 at an out-of-state clinic (IVF not because of the Asherman history, but because of my messy tubes), reached 8mm lining on injectibles and failed the IVF. I was convinced my uterus was the issue. My IVF doctor kept saying a high-quality embryo will implant even in a suboptimal lining. He put five high-quality embryos during the next IVF cycle and it worked with 7.3mm lining! At 8 weeks pregnancy I needed emergency surgery for heterotopic pregnancy, i.e., I had one embryo in the uterus and one in the tube. I read later that a damaged uterus can contribute to ectopic pregnancy (especially when combined with messy tubes); the embryo does not find the uterus hospitable and moves to the tubes. My uterine embryo survived the surgery and we had mastered the first crisis of a high-risk pregnancy.

Pregnancy After Asherman's

Pregnancy after Asherman's is high-risk. So I signed up with aperinatologist group. The risks are placenta accreta and uterine rupture.In placenta accreta the placenta grows into the deeper layers of theuterus causing severe bleeding when they try to deliver the placenta (thebaby is already out at that point, so the risk is only to the mother). Iwas told with history of myomectomy and Asherman's my risk of placentaaccreta was 5%. Uterine rupture can occur when the uterus is very thin(can happen after Asherman's) or when a scar is present (such as after mymyomectomy). The risk is highest during labor. Most of the time rupturehas catastrophic consequences for child and mother. At this point I hadlearned to expect the worst and prepare for the worst. I made my will andchanged to another perinatologist group who worried as much as I did. helikelihood of rupture is still low with my history (a few percent), but norisk was to be taken; thus they delivered my precious baby at 37 weeks via scheduled c-section. No major complications occurred, and needless to say I cried with relief when was out and safe on July 3, 2000.

With all the fertility issues I had, Asherman's was the most distressing.You can get around messy tubes with IVF, but with a messy uterus thingsare so much harder. I carried (and still carry) so much resentmentagainst that butcher doctor. On the positive side, I will always have adeep sense of admiration and gratitude toward my child (in addition totremendous love of course). He is my hero. It was a jungle in there, andyet he implanted; he overcame my insufficiency. He truly is my miracle.And now he needs a diaper change, so I have to go.

I wish you all luck in the world, brave ladies. Hang in there, ladies andembryos. Asherman's is a tragedy, but with persistence and the skills ofan excellent Reproductive Surgeon it can often be overcome.