The Fertility Podcast
What is Ashermans syndrome?
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Episode notes
This week, we hear from our guest presenter Katy Linderman in conversation with Emilie Jones-Ransley. We asked Katy to have this conversation for us as both ladies have had thinks thin lining issues and talk about being members of 'The Thin Lining Brigade'
Missed Miscarriage
Emilie talks about her experience of missed miscarriage and the surgery she had to had, to remove it ( ERPC )and how after that she didn’t feel right two months later and she had to have further treatment. She explains how traumatic this period of time was for her. Katy shares her experience of also having to have an ERPC and the issues around her hormones levels being high, 5 weeks later and how awful the experience was as your body still thinks you are pregnant.
Hysteroscopy
Medical procedures can cause scaring and Emile talks about how she only found out by chance after haveing further fertility investigations by chance. A conversation with her doctor about her periods being regular saw Emilie being booked in for a hysteroscopy, a procedure to look at your uterus with a tiny camera to check your lining. This was seven months after her second ERPC.
Ashermans Syndrome
Emilile found out that half her Uterus was full of scars which means there is a layer of scaring on the endometrium meaning it doesn’t shed properly. Both Katy and Emile talk in details about the types of blood changes in your period and how important it is to realise that if it has changed significantly as it could be a sign of Ashermans. Scaring almost makes it very difficult for an embryo to impact and it can also be dangerous and could cause a miscarriage. The scaring can be removed with a lazer, however in Emilie’s case they punctured her uterus.
The A listers
Specific Doctors who specialise in these procedures. Medical insurance does cover miscarriage and gynaecology - as these surgeries can be covered. The Ashermans Facebook group shares a list of these people.
Knicker Watch and IVF
Permanently wanting your period and wanting ‘red blood’ when you are having treatment for Ashermans or thin lining treatment. Emilie had three unsuccessful rounds of funded IVF and then they moved onto having further private rounds with PGS testing. After her fourth round, Emilie had the summer off and talks about the importance of having a break during treatment. They then attempted frozen embryo transfers but Emile was still struggling with lining issues.
‘Decent Lining’
We're talking thickness and appearance as the ladies discuss that 'Triple' means - three layers, so it looks white and the thickest part should be measured and ideally, for IVF it should preferably be 8 mm or above. Normal is 13 or 14mm. Both Katy and Emilie talk about feeling like they couldn’t get off the starting line due to their lining issues and how difficult that is. Feeling like your body isn’t working and the feelings of anger towards your body.
Deciding to use a surrogate
After 10 failed IVF rounds, Emilie and her husband decided to go down the surrogacy route with a Ukrainian Surrogacy and hope to bring their baby girl home in August.
Dr Adrian Lower - Asherman’s expert explains
Adrian explains how Ashermans is caused and how it impacts on the endometrium. We discuss the number of women who are diagnosed and undiagnosed and Adrian explains how and why Asherman's is largely unrecognised. It could be up to 5% or more of people who have surgical procedures and then have scarring. The problem is that people question if it exists and Adrian says he sees four or five people a week with the condition and how it is important that people look for it.
Saline infusion scan or Hysteroscopy.
Adrian explains how by pumping saline into the womb to dilate it helps to see the scaring or tissue as does a hysteroscopy. Women don’t realise as they might find their periods become lighter after a period or a termination and if they aren’t actively trying to conceive it might be seen as a benefit. If women are still trying to conceive, if part of the cavity is obliterated it has a profound effect on their fertility and it can be treated.
How do your periods change?
This is the first sign and consultants needs to listen to patients more and should be investigated further to see if there is a physical cause. Sometimes the scaring is because the uterus is an abnormal shape, there might be a false passage from the DNC. Unless it is being looked for it can be increased, and create more difficulty and more damage which is a major concern for women. We spoke about how there needs to be more awareness for people before they have medical procedures.
Advice
Keep an eye on your periods, it’s not unusual for a month or two after they are lighter. However, after that, if there is an issue with bleeding, people should seek professional help. The least expensive is the saline infusion sonogram and it should be mandatory for anyone going into IVF if they have had medical procedures beforehand. Hysteroscopy should be done if there has been a diagnosis to divide the adhesions.
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