CAN DILATION AND CURETTAGE CAUSE INFERTILITY?
CAN DILATION AND CURETTAGE CAUSE INFERTILITY?
Motherhood is magical, it gifts amazinginstincts, it fuels in ways that cannot be explained, to keep going no matterhow exhausted. While every woman is keen on carrying a life within, it is noteasy for some women who face difficulties due to infertility. There are anumber of conditions that can cause infertility. Infections, lifestyle,environmental conditions, health issues, and certain surgical procedures. Onesuch very commonly heard procedure is dilation and curettage. A question thatstrikes is - can dilation and curettage cause infertility?
What is dilation and curettage?
Dilation and curettage often referredto as D&C is a minor surgical procedure that is performed for the removalof tissue from the uterus. It is so named, as the procedure involves dilationof 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&Cis 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 treatmolar pregnancy (tumour formation instead of pregnancy) and remove any benignuterine or cervical polyps
How does D&C cause infertility?
Dilation and curettage can contributeto infertility to some extent if not entirely. Although the procedure is safeand has minimal complications, it does pose certain risks that can causeinfertility. Some of these risks include
Infection: A problem which is a raritythese days, a patient complains of high fever and purulent discharge buteffective treatment administered in time will not lead to any problems. But ifthe infection is not treated aggressively, it may lead to future infertility asthe infection spreads to the reproductive organs and the tubes, which in turnmay get blocked. The infection may also lead to peritonitis, adhesions. Thismay lead to a condition called frozen pelvis or blocked tubes, which may lead toinfertility.
Trauma or injury and scarring of thecervix – there is sometimes a risk of a tear of the cervix that could occurduring the procedure. Repeated D&Cs can scar the cervix, the scarred cervixbecomes weak and incompetent which may lead to mid –trimester abortions.
Perforation of the uterus - The sharpcurette used, may cause a hole in the uterus, which heals on its own most ofthe time but rarely can extend to the internal organs, like the intestines,which may need laparotomy procedures for corrections. These procedures may, inturn, lead to adhesions and to infertility
Scar tissue – A D&C could sometimesresult in the formation of scar tissue in the uterus which can result indisruption of the menstrual cycle, risk of miscarriage, and infertility.
Asherman’s Syndrome – A delayedcomplication that can happen due to the over-zealous curetting (scraping) ofthe uterine wall which leads to scarring and leads to adhesions or bands oftissue within the uterine cavity which create a way for infertility in futurepregnancies.
If one has had D&C and experiencesprofuse bleeding, runs high fever or cramps lasting more than 48 hours afterthe procedure or a purulent discharge from the vagina , she should report tothe doctor immediately so that it can be managed at the earliest and preventcomplications which may lead to infertility in the future. It is very importantto be diligent not to use tampons or resume sexual activity without properadvice. It is always better to be cautious than to end up in a precarioussituation.
If a woman has had dilation andcurettage and is planning on conceiving, one needs to be very careful andconsult a doctor on the timing to start trying and precautionary measures toadhere to, in order to result in a successful pregnancy.
D&C is a safe procedure and therisk of infertility due to D&C is very low, if done by experts and done atthe right place, for the right indications, with the right methods, steriletechniques and good antibiotics.
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