Motherhood is magical, it gifts amazing instincts, it fuels in ways that cannot be explained, to keep going no matter how exhausted. While every woman is keen on carrying a life within, it is not easy for some women who face difficulties due to infertility. There are a number of conditions that can cause infertility. Infections, lifestyle, environmental conditions, health issues, and certain surgical procedures. One such very commonly heard procedure is dilation and curettage. A question that strikes is - can dilation and curettage cause infertility?
What is dilation and curettage?
Dilation and curettage often referred to as D&C is a minor surgical procedure that is performed for the removal of tissue from the uterus. It is so named, as the procedure involves dilation of the cervix with the help of a thin instrument and then inserting a curette, a small instrument that resembles a scoop, designed to scrape tissue. A D&C is usually performed for women who have suffered miscarriages, unexplained bleeding between menstrual cycles, or residual tissue from an abortion. Apart from these, it is also done to treat molar pregnancy (tumour formation instead of pregnancy) and remove any benign uterine or cervical polyps
How does D&C cause infertility?
Dilation and curettage can contribute to infertility to some extent if not entirely. Although the procedure is safe and has minimal complications, it does pose certain risks that can cause infertility. Some of these risks include
Infection: A problem which is a rarity these days, a patient complains of high fever and purulent discharge but effective treatment administered in time will not lead to any problems. But if the infection is not treated aggressively, it may lead to future infertility as the infection spreads to the reproductive organs and the tubes, which in turn may get blocked. The infection may also lead to peritonitis, adhesions. This may lead to a condition called frozen pelvis or blocked tubes, which may lead to infertility.
Trauma or injury and scarring of the cervix – there is sometimes a risk of a tear of the cervix that could occur during the procedure. Repeated D&Cs can scar the cervix, the scarred cervix becomes weak and incompetent which may lead to mid –trimester abortions.
Perforation of the uterus - The sharp curette used, may cause a hole in the uterus, which heals on its own most of the time but rarely can extend to the internal organs, like the intestines, which may need laparotomy procedures for corrections. These procedures may, in turn, lead to adhesions and to infertility
Scar tissue – A D&C could sometimes result in the formation of scar tissue in the uterus which can result in disruption of the menstrual cycle, risk of miscarriage, and infertility.
Asherman’s Syndrome – A delayed complication that can happen due to the over-zealous curetting (scraping) of the uterine wall which leads to scarring and leads to adhesions or bands of tissue within the uterine cavity which create a way for infertility in future pregnancies.
If one has had D&C and experiences profuse bleeding, runs high fever or cramps lasting more than 48 hours after the procedure or a purulent discharge from the vagina , she should report to the doctor immediately so that it can be managed at the earliest and prevent complications which may lead to infertility in the future. It is very important to be diligent not to use tampons or resume sexual activity without proper advice. It is always better to be cautious than to end up in a precarious situation.
If a woman has had dilation and curettage and is planning on conceiving, one needs to be very careful and consult a doctor on the timing to start trying and precautionary measures to adhere to, in order to result in a successful pregnancy.
D&C is a safe procedure and the risk of infertility due to D&C is very low, if done by experts and done at the right place, for the right indications, with the right methods, sterile techniques and good antibiotics.
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