When Sky TV presenter Sophie Blake became pregnant with her daughter Maya, she never imagined that, just a few years later, trying to conceive a baby brother or sister for her would prove so difficult.
‘My fiancé Scott and I hadn’t been together long when I became pregnant with Maya – it was a shock,’ says Sophie, 37.
‘So when we started trying for a second baby, we assumed everything would be plain sailing.’ But as the months passed with no luck, Sophie began to worry.
‘Despite it being several months after Maya’s birth, my periods hadn’t returned. An ovulation test proved I was ovulating and doctors were insistent nothing was wrong, but something just wasn’t right.’
It took two years for Sophie to get a diagnosis – and even then it was only down to her persistence and the internet. She suffers from Asherman’s syndrome, which is treatable, yet which often goes misdiagnosed, causing recur rent miscarriage and infertility.
‘The worst thing is I now know the earlier it’s diagnosed, the more treatable it is,’ says Sophie. ‘Unfortunately, it’s too late for me.’
Asherman’s syndrome is a type of adhesion – where bands of scar-like tissue form inside the body between two surfaces, causing them to stick together. Adhesions are a common problem, affecting 93 per cent of patients who undergo surgery.
All the abdominal and pelvic organs – which are most susceptible to adhesions – are wrapped together in a clear membrane, the peritoneum. When this is traumatised either by infection or surgery, it triggers an inflammatory response, stimulating the growth of fibrous scar tissue. Asherman’s is the term given to adhesions in the womb.
The problem is triggered by a dilation and curettage (D&C), a standard procedure used to clear the womb after a miscarriage, or when the placenta is retained after childbirth or a termination, says Adrian Lower, a consultant gynaecologist and one of only a handful of Asherman’s specialists in the UK.
He says: ‘During the procedure, a spoon-shaped instrument [a curette] is used to scrape the uterus lining.
‘It’s thought that Asherman’s occurs when this is done too forcefully,’ he says. Around 100,000 procedures are carried out each year, with five per cent resulting in Asherman’s.
Despite Sophie’s first pregnancy being unplanned, Sophie and Scott were thrilled when, after a 24-hour labour, Maya was born in May 2007. But there were complications – the placenta was not going to come out naturally.
Sophie was rushed to theatre where surgeons removed it using a D&C; crucially they did not perform an ultrasound to check they’d removed all the placenta.
‘I went home after three days but felt dreadful,’ says Sophie. ‘Over the next fortnight I lost weight. Most women suffer post-partum blood loss after birth, but mine seemed heavy and my stomach was cramping like bad period pains. The midwife said my stomach muscles were tightening up after being stretched during the pregnancy.’
Then Scott, 31, former British Speedway motorcycle champion, flew to Europe for a race. ‘That night the cramps turned into strong contractions and I was losing more blood. Panicking, I rang a friend and asked her to take me to hospital while my sister looked after Maya.’
An ultrasound revealed parts of the placenta had embedded into Sophie’s womb. Left untreated, it could lead to serious infection, so she had another D&C.
‘I know now there’s a 25 per cent risk of developing Asherman’s two to four weeks after having a D&C, but no one ever mentioned this.’
Six months later, her periods hadn’t returned and she continued to have cramps. ‘Every time I went to the GP I mentioned the procedures, but was told my periods would return and I was stressed.’
When Maya turned one, Scott and Sophie decided to try for another baby. But still not having had a period, she insisted upon seeing a specialist.
Doctors gave Sophie a hysterosalpingogram, where dye is injected through the cervix into the uterus and an X-ray taken to check for any blockages in the uterus or fallopian tubes.
‘Despite several painful attempts, the dye wouldn’t pass through my cervix. Then someone suggested it could be blocked by scar tissue from my D&Cs.
‘This was the first time scar tissue had been mentioned, but the consultant dismissed it, saying I needed further investigations. Yet another appointment was made for months away.’
In the meantime, Sophie became anxious – aged 35, she was aware her body clock was ticking. Finally, in February 2009, she had another procedure – a microscopic camera was inserted through her navel to look inside the uterine cavity.
‘When I came round from the operation the consultant said the camera had shown up adhesions all over my womb. These were blocking my cervix and gluing my uterus walls together,’ she says.
‘He said he’d tried to cut them away but there were so many he’d perforated the womb wall and had stopped before he’d caused further damage. he believed the scar tissue had been caused during labour.
Then he delivered the worst news – there was no chance of me conceiving, for although my ovaries were working, my womb was next to useless as there was no longer a cavity for a baby to grow.
‘I’m pretty tough, but I found myself sobbing. And when Scott arrived we cried together.’
Back home in Ipswich, Sophie logged on to the internet and keyed in the words: ‘adhesions, scar tissue, uterus, cervix’.
This led her to the Asherman’s syndrome website. Through this she learnt about Adrian Lower and went to see him privately in March. He performed a 3D ultrasound and conf irmed that Sophie had developed the condition due to overly aggressive D&Cs.
Sophie says: ‘He said he could remove the adhesions using micro-scissors guided by a camera; this meant he would be very precise and not cut away anything other than the scar tissue. He also said that because my adhesions were so big my chances of having a baby naturally would be 50:50.
Three weeks later, Sophie underwent the two-hour operation. She was then fitted with a coil, to help keep the uterine walls apart. She was also put on a month’s course of HRT to boost oestrogen levels to help regrow the lining of her damaged womb.
Five weeks later, Sophie had her first period in more than three years, while scans revealed the lining of the womb was re-growing.
‘Mr Lower warned the adhesions were likely to grow back, which gave us a three to six-month window to conceive. We were so excited and didn’t care that our lives revolved around trying for a baby.’
Every month, Sophie secretly took endless pregnancy tests; each time hiding her disappointment when none showed that thin blue line.
Then in June, the stomach cramps returned and her periods stopped. Tests revealed the adhesions had grown back.
Sophie had another operation to remove the new adhesions. Sadly, as they grew back quickly, it became obvious she wouldn’t conceive naturally, so she started IVF.
But this didn’t work either. And after yet another operation and second failed round of IVF, Mr Lower gave her the crushing news that despite having two frozen embryos ready to implant, the speed at which the adhesions were returning meant a pregnancy was too risky because of the increased chance of premature birth, or the placenta and womb rupturing.
‘I was willing to take the chance, but Scott made me realise that the risk to my life wasn’t worth it. We are now exploring surrogacy or adoption options.’
Adrian Lower believes women should be warned of the risk of Asherman’s before undergoing a D&C. He also urges women who whose periods have stopped or become lighter after a D&C to seek urgent treatment.
Ideally, corrective surgery should be performed within six months of the adhesions forming before they get too large, as Sophie’s did.
Sophie adds. ‘I have a beautiful daughter and if we don’t have another child then she will always be enough. But I don’t want other women to go through what I have because of a lack of awareness.’