Friday, January 05, 2018

Unnecessary D&C after a miscarriage can reduce your fertility

It's not uncommon for women who get pregnant after IVF to have a miscarriage. After all, the miscarriage rate is about 15% in all pregnancies, and IVF does not protect against a miscarriage. While this can cause a lot of heartache, doctors often add insult to injury by suggesting that patients  do a D&C ( dilatation and curettage) to surgically evacuate the pregnancy. They justify this by saying that the surgery is a quick and simply minor procedure; and that they can send the pregnancy tissue ( aka POC, or products of conception ) for genetic testing, so they can find out why the miscarriage occurred. However, not only is this testing expensive, it's quite pointless, because it doesn't really change treatment options for the next IVF cycle, since these genetic errors are random in the vast majority of cases. However, if the result is abnormal, the IVF doctors will use this opportunity to up-sell their services, by suggesting that the patient do PGS when doing IVF in the next cycle, to reduce the risk of recurrence of another abnormality in the next pregnancy !

However, PGS reduces pregnancy rates, and you can read more about why it does this at

However, what's much worse is that  the uterine scraping which the doctor needs to do at the time of the D&C actually reduces your fertility, because the curettage causes scarring and intrauterine adhesions. This is why we tell patients to always have their pregnancy terminated with medical therapy, using anti-progestins and prostaglandins, because this is much safer, as it avoids any surgical interference. It's a natural process, so there is no risk of creating intrauterine scarring.  The success rates of successfully evacuating the uterus is better than 97 %, which means it's very effective. Yes, it's more painful , and takes a bit longer, but it's much safer , and the uterus heals and goes back to normal in two periods.

Patients need to do a vaginal ultrasound scan one  week after the miscarriage , to make sure that the uterus is empty, because there is a small chance ( less than 3%) that the drugs may not work as expected. Interestingly, this scan will always show there is something in the uterine cavity, because the thickened endometrium ( uterine lining) of the pregnancy is still present. However, radiologists and sonographers will report this finding as retained products of conception , and scare the patient that the evacuation is incomplete. When the gynecologist sees this report, they advice the patient that they need a D&C, because the medical termination has "failed" ! However, this surgical intervention is completely unnecessary because the lining will naturally shed by itself when you get your next period.

I wish doctors would learn to be a little kinder and more conservative !

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