scarring & Ashermans

scarring & Ashermans

Dee
Dee

November 30th, 2011, 2:39 am #1

If you had a saline sonogram and the RE told you there was no scarring, does that mean you don't have Asherman's?
Quote
Share

Joined: August 17th, 2005, 11:44 pm

November 30th, 2011, 3:01 am #2

it can detect but not in all cases, as it does not give as much clarity and specificity provided by an HSG.

4. How can I be sure that I actually have Asherman's Syndrome?

The best way to diagnose Asherman's Syndrome is by visualizing the interior of the uterus. This can be accomplished using a diagnostic hysteroscopy or through the performance of a hysterosalpingogram ("HSG"). A diagnostic hysteroscopy involves the dilation of the cervix and the insertion of a tiny scope that enables the doctor to see inside the uterus directly. An HSG is a more indirect method of diagnosis and is performed by inserting a small catheter about the width of a ballpoint pen into the cervix and then injecting radioactive dye through the catheter and up into the uterine cavity while performing an x-ray. Using this procedure, the doctor can get a very detailed picture of the interior of your uterus and can note any areas of scarring. In some cases, however, the scarring is so severe that the dye simply will not flow into the uterus at all because it is blocked with scar tissue. It is also not uncommon for a woman with Asherman's Syndrome to have a cervix that is so scarred that the catheter is not able to be inserted at all in which case a diagnostic hysteroscopy is recommended. Some doctors have suggested the use of sonohystograms (an ultrasound that is performed after sterile saline has been flushed up into the uterus similar to an HSG) but the general consensus seems to be that although this method can certainly reveal the presence of scar tissue in a general manner, it lacks the clarity and specificity provided by an HSG.
Quote
Like
Share

Joined: September 13th, 2008, 5:13 pm

November 30th, 2011, 4:28 am #3

If you had a saline sonogram and the RE told you there was no scarring, does that mean you don't have Asherman's?
She has severe Asherman's, and it went undetected through several procedures, if I'm remembering correctly. My AS was detected through a saline hysterosonogram, but it was mostly banding, a mild case. Do you have a particular reason to be concerned? Have you had a D&C or pg termination or difficult delivery of the placenta, etc.? Ninety percent of AS in the US is due to pg-related D&C's. Take care, Maggie (in VA)
Quote
Like
Share

Dee
Dee

November 30th, 2011, 4:40 am #4

I had a saline sonogram a few months ago, and the RE said no scars were detected. It was a test where they inject dye into the uterus and watch it on a sonogram. When I had the IVF, I had pain during the transfer, and the doctor said I had very mild cervical scars from the D&C. She said it was nothing to worry about, though.
Quote
Share

Dee
Dee

November 30th, 2011, 4:41 am #5

it can detect but not in all cases, as it does not give as much clarity and specificity provided by an HSG.

4. How can I be sure that I actually have Asherman's Syndrome?

The best way to diagnose Asherman's Syndrome is by visualizing the interior of the uterus. This can be accomplished using a diagnostic hysteroscopy or through the performance of a hysterosalpingogram ("HSG"). A diagnostic hysteroscopy involves the dilation of the cervix and the insertion of a tiny scope that enables the doctor to see inside the uterus directly. An HSG is a more indirect method of diagnosis and is performed by inserting a small catheter about the width of a ballpoint pen into the cervix and then injecting radioactive dye through the catheter and up into the uterine cavity while performing an x-ray. Using this procedure, the doctor can get a very detailed picture of the interior of your uterus and can note any areas of scarring. In some cases, however, the scarring is so severe that the dye simply will not flow into the uterus at all because it is blocked with scar tissue. It is also not uncommon for a woman with Asherman's Syndrome to have a cervix that is so scarred that the catheter is not able to be inserted at all in which case a diagnostic hysteroscopy is recommended. Some doctors have suggested the use of sonohystograms (an ultrasound that is performed after sterile saline has been flushed up into the uterus similar to an HSG) but the general consensus seems to be that although this method can certainly reveal the presence of scar tissue in a general manner, it lacks the clarity and specificity provided by an HSG.
that's what I had, an HSG test.

Perhaps I have scars that aren't detectable, who knows.
Quote
Share

Joined: August 17th, 2005, 11:44 pm

November 30th, 2011, 4:16 pm #6

nt
Quote
Like
Share

Joined: September 13th, 2008, 5:13 pm

November 30th, 2011, 4:40 pm #7

I had a saline sonogram a few months ago, and the RE said no scars were detected. It was a test where they inject dye into the uterus and watch it on a sonogram. When I had the IVF, I had pain during the transfer, and the doctor said I had very mild cervical scars from the D&C. She said it was nothing to worry about, though.
But that is more intensive than what they did for me. I, too, had some cervical adhesions when I had my 2nd transfer, which I am guessing were probably caused by the saline hysterosonogram I had before my second cycle to make sure the scarring hadn't recurred after the surgery to correct it (or my first ET). Yeah, the doctor said not to worry, and I got pg w/twins from that cycle. Anyway, I hope BBG will chime in soon. Have you joined the Asherman's list on Yahoo? I guess that's a bit hard as you're just concerned, quite justifiably, but not actually diagnosed. I know that's nerve racking not feeling sure it's OK to put money down on another cycle, b/c I've been there. Take care, Maggie (in VA)

ETA: I just noticed something, and my comment speculating that my cervical adhesions might have been caused by my first ET was idiotic: if they had been caused by my first ET, the doctor who did the follow-up saline hysterosonogram would have seen them, b/c the doctor for my second ET had to clear them to get the catheter in. Duh!
Last edited by maggie1961 on December 1st, 2011, 6:50 pm, edited 1 time in total.
Quote
Like
Share

Joined: November 10th, 2004, 4:12 am

November 30th, 2011, 5:48 pm #8

If you had a saline sonogram and the RE told you there was no scarring, does that mean you don't have Asherman's?
Let me give you my story -- Asherman's is a condition where there is scar tissue and/or adhesions in your uterus. I was misdiagnosed with it at one point but, later, turned out I did have scar tissue in my uterus -- when it wsa removed, I got pregnant on my first cycle. However, it wasn't necessarily considered Asherman's -- Asherman's (the term) is more about the amount of scarring and/or its genesis (from what I gathered during the several months I thought I had it).

I had NUMEROUS saline scans and hsgs following my multiple failed cycles. I was told by top REs that IF I had scar tissue it would show up on these scans because the shape of the uterus would be different. The scans came back clear.

I then had 2 or 3 MORE failed DE cycles and these same top REs just scratched their heads. I finally went to a new RE (the famous Dr. K) who insisted I have a lap with a hysteroscopy. Guess what...loads of scar tissue in my uterus. It was removed, I cycled and my son just had his 1st b-day.

There is such a thing as scar tissue that does not adhere the portions of the uterus together. This is really all that hsgs or saline scans will show. Whether or not it is considered "Asherman's" is another question but, in some ways, irrelevant b/c scar tissue is scar tissue.

I wasted well over 100K on cycles that could NOT have worked because I was told from hsgs and saline scans that there was no scar tissue. INSIST on a hysteroscopy and make sure a qualified RE does the hysteroscopy.

sas
Last edited by sangelas on November 30th, 2011, 5:51 pm, edited 1 time in total.
Quote
Like
Share

Dee
Dee

November 30th, 2011, 6:27 pm #9

so, I need to ask for a lap with hysteroscopy? And if I get one, and it is clear, then I probably don't have scarring? Would I need any further tests?
Quote
Share

Joined: September 13th, 2008, 5:13 pm

November 30th, 2011, 7:04 pm #10

Let me give you my story -- Asherman's is a condition where there is scar tissue and/or adhesions in your uterus. I was misdiagnosed with it at one point but, later, turned out I did have scar tissue in my uterus -- when it wsa removed, I got pregnant on my first cycle. However, it wasn't necessarily considered Asherman's -- Asherman's (the term) is more about the amount of scarring and/or its genesis (from what I gathered during the several months I thought I had it).

I had NUMEROUS saline scans and hsgs following my multiple failed cycles. I was told by top REs that IF I had scar tissue it would show up on these scans because the shape of the uterus would be different. The scans came back clear.

I then had 2 or 3 MORE failed DE cycles and these same top REs just scratched their heads. I finally went to a new RE (the famous Dr. K) who insisted I have a lap with a hysteroscopy. Guess what...loads of scar tissue in my uterus. It was removed, I cycled and my son just had his 1st b-day.

There is such a thing as scar tissue that does not adhere the portions of the uterus together. This is really all that hsgs or saline scans will show. Whether or not it is considered "Asherman's" is another question but, in some ways, irrelevant b/c scar tissue is scar tissue.

I wasted well over 100K on cycles that could NOT have worked because I was told from hsgs and saline scans that there was no scar tissue. INSIST on a hysteroscopy and make sure a qualified RE does the hysteroscopy.

sas
Am so glad you were able to have your kids despite that level of problem. Anyway, Dee, here is an explanation of different grades of Asherman's.

http://www.ashermans.org/information/as-grades/

The saline hysterosonogram showed mine (which would only have been a grade I-II), because the saline wouldn't flow into the right horn of my uterus, despite several attempts. I think any money you spend to make sure you have a sound uterus for ttc will be well spent.

Take care,

Maggie (in VA)
Quote
Like
Share