My Story & Letter to Doctor

The intent of this letter is to let you know the outcome of a D&C I received under your care that has led to my current diagnosis and treatment for Asherman's Syndrome and to the loss of my fertility. What I have to say also forms the basis of my decision never to return to Group Health Associates for future obstetric care.

Dr. ____ was my OB/GYN. I had only seen her twice, once for my yearly exam, and to confirm my recent positive home pregnancy test; and once at my 8 week appointment. I was new to this practice at the time I found out I was pregnant. These appointments were in August & September of 2008.

At 11 weeks, I began spotting. I wasn't alarmed at first since I knew this could be normal. On the 3rd day of spotting, I asked my husband to take me to the ER. I was concerned something was wrong. It was a Sunday. October 5th, 2008. You were the physician from my OB/GYN group that was in the ER that day. It was concluded that there was no cardiac activity and that the fetal pole only measured approximately 7 weeks. Therefore, I had a missed miscarriage. You wanted to see me in your Springdale office the following day for another ultrasound to be certain, before proceeding. At that appointment, the miscarriage was confirmed. You explained my options which were simple. I could either do "expectant management" or have the D&C. You indicated the surgery had normal risk of anesthesia and was very routine & low risk. We discussed the benefit of emotional closure with D&C versus expectant management. Also, because I had a missed miscarriage, the expectant management option may have taken longer and I could have been at a higher risk for infection. The decision to have the D&C seemed simple and was not difficult for me to make. We then discussed whether or not I wanted my regular OB/GYN, Dr. _____ to perform the procedure, or you. My husband and I chose you. We felt comfortable with you since we hadn't been seeing Dr. _____ long, and you were so appropriate in such a delicate situation. You handled the ER visit and the follow-up the next day, so it just made sense to proceed with you. My D&C was performed on Tuesday, October 7th, 2008.

Everything seemed to go just fine with the procedure and my physical recovery. We had our one-month post-op appointment and everything seemed okay. When my monthly cycle had not yet returned at 6 weeks, I began growing concerned. When I called you for advice, you assured me this is normal and to wait patiently. At 2 months, I called again and you suggested I stop stressing about it, that it would come in due time. You assured me that we were still within a normal time frame. I called your office just before Christmas to let you know that my cycle still had not returned. We made an appointment for Dec. 31st. We were now 3 months post-op. You ordered blood work and I had an ultrasound. You explained that my lining was very thin and that you suspected my stress levels being the cause of my cycle not yet returning. You said that I "could win an oscar for anxiety". If my blood work came back okay (which it did) and my cycle still had not yet returned, your plan was to see me at 4 months post-op. You would then just put me on birth control to return my cycle. I left your office feeling a sense of guilt, as though I was causing my own grief through stress, and feeling helpless and uneasy. Your plan did not sit well with me. I immediately decided to pursue a consultation with a specialist.

I had my first appointment with Dr. Sherif Awadalla of the Institute for Reproductive Health at the beginning of February, 2009. After a detailed conference and ultrasound, Dr. Awadalla suspected Asherman's Syndrome. He started me on hormone replacement therapy immediately to begin building my lining, and explained that we would do an HSG to officially diagnose my case and determine the severity. A hysteroscopy and laparoscopy would then be done to remove the scarring. He explained that this would be a process and I would have to be patient. I did the hormone replacement therapy for a total of 6 months. My surgery was at Christ Hospital on May 29th, 2009. A balloon stent was placed in my uterus for three days to ensure that my uterine walls would not re-adhere. My case was concluded moderate with approximately 60% scarring in my uterus and one tube blocked. The surgery was successful. At my 2 month post-op appointment (beginning of August), we were given the "green light" to try again to conceive. Dr. Awadalla suggested Follicular Stimulation & IUI for better results, but we decided to try on our own for a couple of months, taking a break from drugs.

I had a mid-cycle scan on Monday, October 12th which determined that my follicles were not developing, therefore I was not successfully ovulating. Dr. Awadalla explained that it may take us a long time to conceive naturally. With it already being a year since the miscarriage, and with my upcoming 35th birthday, we do not feel we have time on our side. We are eager to begin our family. So we have (reluctantly) decided to opt for the Follicular Stimulation & IUI for four cycles. After that, we are unsure of our next steps. We are looking at adoption just in case.

Many OB/GYNs would say they haven't caused Asherman’s in any of their patients. I realize unless I write you, you will not know that the D&C you performed caused Asherman’s in me, one of your patients. It is a lot more common then the obstetric community believes. I ask that you please be aware of the ramifications of your actions and the catastrophic consequences that they can create. I suggest you educate yourself on this syndrome and the rate of adhesions forming post D&C and what different circumstances increase the rate of Asherman's Syndrome post D&C. You should give your patients the real statistics on intrauterine scarring and let them know what this could mean to their future fertility. If I knew the real risks I may have made a different choice. I, as do all women, deserve to know the real risks as well as the long term ramifications of the surgery. I did not know this was a risk, and that I could lose my fertility through the surgery.

There are studies that conclude that a missed miscarriage can place a woman at a higher risk for scarring if a D&C is performed. The longer the deceased fetus is in the uterus before the D&C is performed, the higher the risk. Therefore, that should have been included in the risks that were not explained to me pre-op; having had the knowledge that my fetus stopped living at approximately 7 weeks, and we were- at that point- 11.5 weeks along.

There have been several studies looking at the prevalence of Asherman’s after D&C's. I have listed a few of them at the end of this letter for your reference. I have also enclosed articles for your review that will further educate you on the statistics.

It remains to be seen whether or not I will ever be able to conceive again. Even if I am successful in this endeavor, I will face a very high-risk pregnancy, and risk of conditions like placenta accreta.

This process has been time consuming, costly, and emotionally taxing. The cost of the procedures with mediocre insurance is upwards of $5,000 to date. I have had to withdraw indefinitely from my Master's Program because this year-long ordeal has consumed me. I cannot focus beyond my daily activities. I used to be so driven and energetic. I find myself overly sensitized and fearful of any procedure dealing with my uterus, even diagnostic ones. I find myself very untrusting of the health care industry.

So here I sit, a year out from my miscarriage, still battling for my fertility. Making monthly payments because I can't afford the treatment. Living each day with regret and heartbreak. Wishing I hadn't had the D&C that caused this, and more importantly, wishing I had been better informed and a better advocate for myself.