Can Dilation And Curettage Cause Infertility?Dr Chaithra S.K

Motherhood is magical. It gifts incredible instincts and 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. Several conditions can cause infertility. Infections, lifestyle, environmental conditions, health issues, and specific surgical procedures. One such very commonly heard procedure is dilation and curettage.

A question that strikes is – can dilation and curettage cause infertility?

Dilation and curettage, often referred to as D&C, is a minor surgical procedure performed to remove tissue from the uterus. It involves dilation of the cervix with the help of a thin instrument and then inserting a curette, a small device 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. It also treats molar pregnancy (tumor formation instead of pregnancy) and removes any benign uterine or cervical polyps.

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.

A problem that is a rarity these days, a patient complains of high fever and purulent discharge, but effective treatment will not lead to any issues. 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 may get blocked. The condition 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 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 can happen due to the over-zealous curetting (scraping) of the uterine wall, which leads to scarring and adhesions or bands of tissue within the uterine cavity, creating a way for infertility in the 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 essential to be diligent not to use tampons or resume sexual activity without proper advice. It is always better to be cautious than in a precarious situation. Suppose a woman has had dilation and curettage and is planning on conceiving. She needs to be very careful and consult a doctor to try preventive measures to adhere to 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 correct indications, with the proper methods, sterile techniques, and good antibiotics.