to Lynnette and others about A list docs.

[Guest guest]

Hi Lynnette,

I just now am returning from a weekend away. I wanted to answer your questions.

Is IVF the only way an Asherman's patient can become pregnant?

No it isn't. It depends on how badly your uterus is scarred, how well your uterus responds to surgery and treatment, where the scarring was, how much if any scar tissue was in your tubes or near your tubes, how thick your lining gets afterwards and whether you regain the mid-cycle triple line effect on ultrasound. Many of the women have had natural conceptions after Ashermans. Unfortunately for many of us, we got Ashermans after we already had some fertility issues and for us IUI's or IVF is the only way to go. Some women had normal conceptions before Ashermans and then had to go to IVF to get pregnant afterwards. Which one of these will be the case for you is too early to tell. Going to an A list doc will give you the best shot for natural conceptions.

Did you have a scared cervix along with your uterus?

No, my bottom 60% or more of my uterus was completely scarred, but I believe my Cervix was clear. I didn't have much of a period though.

You say the A list doctors really made a difference?

For me and many others on this board, an A list doctor were the only ones that gave us any hope at all. These A list docs are GYN surgeons that specialize in Uterine surgeries and are the most skilled hysteroscopists in the country. What we have discovered in this Ashermans group is that the group of physicians that we consider to be the best in the world is a small group of physicians and they all know each other. They attend the same conferences and they publish papers in medical journals. To be an A lst doctor you have to do numerous surgeries every week and you have to be referred by another A list doc. These docs are so skilled in their craft that what may take one doctor to do in 60 minutes these A list docs can do it in 5 minutes and do it better. They can make the difference between a restored uterus and a permanently damaged or compromised uterus.

How long how you been battling with Asherman's hope you don't mind the questions.

I don't mind at all. I was diagnosed with Ashermans last September and my first surgery was in October 2000. I like many on this board thought that my RE was good and I was loyal to him. So I went with him and another OB/GYN who is very good to do my first surgery. They were very confident that they could fix me. I felt that they were very good and I was hopeful. I still feel that these docs are very good, but not for moderate to severe Ashermans. After my surgery with these docs, I was told I was inoperable, that they couldn't help me and that my case was too severe. They told me to find a surrogate or try Dr. Indman, our first A list doctor. I went to Dr. Indman and he fixed me in 1 surgery. I had 2 follow up diagnostic office hysteros and that was it. Then I got pregnant. Then I lost it at 8 weeks.

I learned a lot from Dr. Indman. He was the one that told me that there is a huge problem in the US with having enough qualified hysteroscopists for Ashermans. There are many reasons for this. One is that there isn't that many cases of Ashermans, so docs don't do the surgeries enough to become good at them. Two, there is a huge learning curve in learning how to do these surgeries and there isn't enough money to make by them so no GYN's do want to put in the time to learn how to do these surgeries. Consequently, there is only a very small group of physicians in this country that are qualified to treat severe cases. My goal was to find who all these physicians are and place them on to the A list. Dr. Indman gave me the names of the only ones he considers the best in the country. Dr. Valle is one of them, as was Dr. March and Dr. . Dr. March is considered one of the nations finest and he is in your area. The fact that someone was referred to you by someone in Stanford, .....hmmm I don't know what to say to that. Who referred him and what specialty did he or she practice? Again, these fine hysteroscopists are very few and they all know each other. So, the fact that Dr. Indman and many others referred us to Dr. March, I would think that he is worth a second opinion at the very least.

Dr. Indman told me that your first surgery may be your one best shot at restoring your uterus. If an unskilled doctor goes in there and scrapes too hard or cuts into the muscle, you may have permanent damage. And you may permenently lose your endometrium. If you have a mild case, then you don't need such a skilled physician, but when you have complete blockage then you need the best. The reason for this is that it is difficult to determine what is scar tissue and what is normal endometrium and uterine muscle. Only a very skilled surgeon can do a good job in these cases.

I hope I didn't get too long winded here, but I think this is so important. We have all made mistakes by going to the wrong doctors first. I want you and others to learn from our mistakes and go straight to the A list docs.

Good luck Lynnette, and keep us informed of your progress.