Well, this is what happened to me: We had planned our first child and she arrived exactly on the day she was due. We wanted a home birth and it started as an easy confinement with her being born in our living room three hours after the first labour-pains. Till today no one understands why my placenta did not come out properly. My midwife said she had never seen such a torn piece and it was clear that I needed to go into hospital for a minor operation. Not knowing what would happen I was only happy that my child was healthy (well, I still am).
When we arrived the midwife showed the placenta pieces that had come out so far to the doctor, but she was not at all interested. A week after this D & C I went home and immediately developed high fever. I was told by the midwife and the gynaecologist that this could happen during breast-feeding, but when it did not stop after a week and reached 41° C I went back to the same hospital nearby (wrong, wrong, wrong, never go to a hospital for the same thing twice, they will not think about them maybe having made a mistake at the beginning!).
Within the next week they checked every pore of my body BUT NOT my uterus with ultrasound! They did not find a thing that was wrong with me, but I still had high fever. Therefore they suggested a strong dose of antibiotics, which would have meant to stop breast-feeding my child. I refused this as I did not like the idea of not knowing what was wrong but taking heavy stuff nevertheless. Luckily the fever stopped for three days and I was allowed to go home without any further treatment.
Well, it started again. This time I looked for an internal specialist. I found a good one because he (not being a gynaecologist at all!) was the one to say that if I was still bleeding (and I was, but the hospital staff had not taken it serious), I needed to go to a big hospital for an ultrasound. And so I did. Once it was done there, they suggested another D & C for still retained placenta, four weeks after the first one. To cut a long story a little shorter: the operation seemed to be successful (nearly two years later one of the doctors said they should have told me about the likeliness of Asherman’s, well, many shoulds and woulds).
I breast-fed my daughter for half a year and did not expect to have a period. But when it did not reappear three months thereafter I went to my gynaecologist. She made an ultrasound and said it was due to nature that it sometimes takes longer. She repeated this opinion twice when I consulted her three and six months later. At this point I felt I had to go to someone else. The next gynaecologist suggested a hormone therapy before going for a hysteroscopy. As it was negative I had the first hysto in April 2000. Already when I talked to the doctor at the clinic (specialized on female minimal invasive surgery) before (!) the operation he said: „You have Asherman’s“.As if it was the most normal thing to happen and know about ….
During this first hysteroscopy he opened the cervix which had been totally blocked and found that two thirds of the cavity were full of adhesions including one tube’s entrance therefore blocked. I had severe Asherman’s. With the operation report in my hands I then talked to my gynaecologist who said that I would never be able to have children again. I was devastated and somehow got back home. Then it struck me that the operating surgeon had suggested another hyst/lap to open the cavity. Why would he do so if there was no chance at all? In Germany you are not supposed to ask any more questions to the operating team once the operation is over. But this was my only chance. So imagine me driving to the clinic and again with new knowledge (it was worthwhile trying to open the rest of the uterus, they said) back to my gyn, only because they would not talk to each other about my case!
After the first hysteroscopy luckily a friend of mine (make sure you have a doctor among your friends …) told me about medline. What a surprise to find more than 100 articles on Asherman’s! I ordered the most important ones and now was sure to be right when planning the second hysteroscopy, which took place in August. It went well, and they did not even have to do a laparoscopy. After this operation they said everything was as before I had developed Asherman’s and I should only one more month take an estrogen/gestagen combination (2 mg per day estrogen, after 11 days combined with 0,5 mg gestagen, I had taken this also after the first operation. At both operations they did not use any IUD, balloon etc.). After the first normal cycle I could become pregnant without any problems in sight.
My gyn though said that according to the operation report they had damaged at least part of the remaining endometrium with the YAG laser. I should take the hormones three months. And in order to know whether adhesions have reformed I should go for a third „control“ hysto. So there I was again: They couldn’t have said anything more different. What was I to do?
This was my situation when I joined the Asherman’s support group. And it has made such a big difference. With all that wealth of information and emotional support I was able to decide rather easily. First I started to look for THE specialist for Asherman’s. Someone in the group knew a specialist in the USA, I emailed him asking for one in Germany, got an immediate answer, talked to this doctor, got an appointment, drove three hours, talked to him for more than one hour, and found out that my surgeon (who had been responsible for the second hysteroscopy) is indeed one of the best surgeons for Asherman’s! I was so relieved to hear that!
Unfortunately my period got weaker within the next two months. Since this can be a sign of adhesions reforming, I got really worried. Finally I asked my surgeon for a second-look hysteroscopy. He considered it not necessary but was willing to do so. He even suggested an endometrium receptors biopsy along with it. This was done at the beginning of November and showed NO SCARRING HAD RETURNED, lucky me! Meanwhile I also have the results of the biopsy and it states clearly that my estrogen and progesterone receptors work fine. This was just done to rule out any further problems. So the problem left is the endometrium’s thickness and quality. But I am confident that I will somehow be able to manage this, too. For the time being I am having nice periods (but still a little weak) and my lining (without hormones) is a little over 6 mm on cycle day 14. I stopped taking anymore hormones to see what my body does without them (I have taken them for seven months now!). I feel I have gone a long winding road with lots of stones that needed to be taken away. But I know that there will be a chance of another full term pregnancy in future. And I no longer consider myself absolutely infertile! And this proves that you should not believe any doctor who says you could never have another child on your own, unless you have asked for a second opinion!
This is the rest of my story having turned into a success story. And it is the story of my three girls born after Asherman’s.
November 2001: It didn’t take long: I am now 33 wks pregnant with a little girl and hope to be delivering early January. Up to today everything went smoothly, this pregnancy is no different to the first one, though this time I won’t be able to deliver at home and instead go into a big clinic where they do have a little experiment in high risk pregnancies post Asherman’s. In March 2001 I started a law suit against the hospital that missed out on diagnosing retained placenta. In October of this year we settled the matter out of court. They paid app. US$ 6.000,- for all my expenses (an amount which meets German standards, not to be compared what is usually paid in the States for cases like mine!). Most important was the fact that they did actually admit that something went wrong!
January 2002: I have given birth to our little girl on December 20th, 2001, via a secondary c-section. The surgery did reveal that after the manual removal of the placenta again two small placenta pieces were sticking to the uterus walls (called placenta adherens) but there was no placenta accreta nor increta. The c-section went normal, my baby girl weighed 3,2 kg and was 49 cm long. I would have been given the chance to delivery vaginally if the baby had turned head down properly which she hadn’t. So she decided for a c-section herself and in respect of the placenta problem it was a wise decision: with a vaginal delivery I would have had to have a blind D&C afterwards. And we all know that with a surgeon who is not experienced this could have been the beginning of another Asherman’s nightmare! I am now mother of two wonderful little girls. And just today I sent a birth announcement card to the gynaecologist who once said I could never ever have a second child.
February 2005: After the birth of my second daughter, my period returned and Asherman seemed to be a problem of the past. I fell pregnant again and had an uneventful third pregnancy till week 30. Then in December 2004, I suddenly felt less fetal movements. I waited one day and when I still couldn’t feel the usual vivid movements and instead only light ones, I went to the clinic nearby to have her heartbeat checked (we knew it would be another girl). This was the beginning of a real drama for us both, the baby and me: the heartbeat was definitely not okay, but the doctors could not find any reason why. It took only one hour from the time I stepped inside the hospital for them to suggest an emergency c-section! I could not believe that what was supposed to be a simple routine heartbeat check, was supposed to turn into a dramatic premature surgical delivery at 30+6 weeks. I will never forget how desperate I was to understand what had happened and how much responsibility I felt towards the child. It took all my strength to give my consent to this c-section. Well, our third girl was born 9 weeks ahead of her due date. She was immediately given to the pediatricians because they discovered that she had almost lost all her blood, her hemoglobin level 1,6! A few hours later and she would have died in utero. Till today no doctor consulted has been able to give me an explanation as to why and how this happened, I had every possible test done. Her blood loss was so severe that for the first 4 days in her life the doctors weren’t sure if she would survive. She was put into an artificial coma, was given oxygen etc. etc., the whole NICU ordeal. But since her blood loss was her ‚only‘ problem, she gradually did better every day and at day 5 we knew she would make it. She spent 5 weeks at the NICU and 3 weeks before her due date I took her home. She then weighed 2000 grams. From then on, she gained weight without any problems and I am even able to breastfeed her.
September 2005: I decided to have another hysteroscopy to check yet another possibility to determine the cause of her premature delivery. And I wanted to make sure that my uterus was in a state to carry another child, especially since I had been given a D&C during the last c-section when my placenta could not be delivered easily. The specialist who already had performed such great job back in 2000 did another hysteroscopy on my request and was absolutely surprised to find another case of Asherman’s! My uterus was 40% filled with scarring AGAIN. This was even more astonishing since there had been no indication of any problems, no lack of periods, no unusual ultrasound etc. Well, he removed these as careful as he had done five years earlier. This case of Asherman’s was a lot easier to handle psychologically because I knew enough about Asherman’s by then through the support group, I knew whom to turn to and what to do after surgery. My endometrium looked good hereafter and in February 2006 I knew that we were expecting child no. 4.
February 2007: My fourth girl is sound asleep, she is now 3 months old. My pregnancy with her was more than closely monitored, I was constantly aware of what could happen, but nothing, absolutely nothing went wrong. She was born at week 41+1 via secondary c-section and weighed 3.500 grams with a size of 49 cm. I am fully breastfeeding her and feel totally blessed to have been given the experience of one more uneventful pregnancy. BTW: Our third girl is now two years old and shows no signs of having been a preemie, she is strong willed and very healthy.
* When I was around 20 years old, I dreamed of being a mother of four girls. Ten years later, the diagnosis of Asherman’s seemed to hinder my dream come true once and for all. Now, another ten years later, I am living my dream: I am the mother of four girls. *