From an infertility management point of view, checking for Ashermann’s following any kind of intervention inside the uterine cavity should be a standard procedure because ultimate success lies in attention to detail. An Ashermann’s usually develops following rigorous DD & C’s or evacuations following miscarriages, especially if an underlying infection was present. 

- Week 21 answers kindly provided by Dr. Stephan Volschenk -

I am sad to hear about your unfortunate outcome. I can assure you that the two episodes of infection had absolutely nothing to do with the embryo transfers. Common things occur commonly, and the most logical explanation would be an ascending infection upwards through an incompetent cervix, hence the negative culture on the swab. Should a cervical stitch have been inserted for the cervical incompetence, this in its own right could have lead to chorioamnionitis as this is a well documented complication which ultimately means that one ends up between a rock and a hard place as a stitch would be the correct management for cervical incompetence.  

Because of the fact that you had an episode of infection inside the uterine cavity, the correct thing to do BEFORE attempting to do another IVF/ICSI cycle, would be to confirm that the cavity is not scarred in any way by performing either an HSG or office hysteroscopy procedure.

- Week 21 answers kindly provided by Dr. Stephan Volschenk -

This refers to the blood flow in the uterus and more specifically to the endometrial lining. It is a very difficult parameter to evaluate and the best method is Doppler ultrasound measurements of the blood flow in the uterus and endometrium. This is not practical on a day to day basis and only of any value in a research setting. Clinically a thin endometrium may be an indication of sub optimal blood flow in that region and can be extremely difficult to manage. Studies using Viagra or exogenous estrogen supplementation were very disappointing and generally are of no value.

Clomiphene is a very potent anti estrogen and can have a negative impact on the lining and also the cervical mucus. This obviously can effect conception but  should not have an effect on an established pregnancy.

- Week 15 answers kindly provided by Dr. Stephan Volschenk -

Retroverted uteri is a normal finding in 20% of the general reproductive population and therefore has no significance to conception, pregnancy or labour. The only issue is to probably turn onto the stomach for 20 minutes following intercourse instead of lying on the back. This however is also a point of controversy. But as a whole – no significance.

- Week 9 answers kindly provided by Dr. Stephan Volschenk -

Retroverted uteri is a normal finding in 20% of the general reproductive population and therefore has no significance to conception, pregnancy or labour. The only issue is to probably turn onto the stomach for 20 minutes following intercourse instead of lying on the back. This however is also a point of controversy. But as a whole – no significance.

- Week 8 answers kindly provided by Dr. Stephan Volschenk -

Uterine septae are a documented reason for recurrent miscarriages and preterm labour. In order to manage recurrent miscarriages successfully, one has to exclude ALL possible causes systematically , one by one and correct any abnormality that might be present. The prevalence of uterine septae is around 3 % in the general population and there are many patients, unaware about the fact that they have a septum in the uterus that go on and have one successful pregnancy after another. However, there is also the group that have one bad outcome after another, and after having the septum resected and all other causes excluded that then go on and have a successful pregnancy – difficult to put an approximate number to this though. I guess that what I am trying to get across is the fact that ALL possible reasons should be dealt with BEFORE attempting another pregnancy.

- Week 5 answers kindly provided by Dr. Stephan Volschenk -