Could tugging too hard on placenta during birth cause secondary infertility?

[dot1]

Just wondered if anyone's heard of this causing scarring, and subsequent difficulty with implantation?  Had post partum hemorrhage (but also had an induced labour with high amounts of syntocinen and had very high blood pressure which were thought to be the cause). 

[Jane]

I don't think so.  I can't even think of any possible mechanism.  The placental bed has to detach no matter what.  Being rushed shouldn't matter a bit.  Even partial detachment for a few minutes before full detach is not going to scar any more than a complete quick detachment. 

[dot1]

Thank for replying :)  Just trying to figure out my problem with implantation.

[soso-lynn]

It could cause some scar tissue to form. I have seen some women with scars after a previous birth but it is unclear what exactly caused it. No one studies this stuff but I do think it's possible that your uterus might have been damaged. Did they do a manual extraction of the placenta or a D&C afterwards? Have you had an ultrasound or HSG to see your uterine cavity?

I also wonder what you mean by 'implantation problem'. There seems to be a general misconception going around about repeated chemical pregnancies or early miscarriage being related to an unspecified implantation issue. In most cases, there really is a problem with poor quality eggs or sperm that don't produce a viable embryo, poor quality eggs that don't leave a functioning corpus luteum or things like clotting disorders. I don't know if any of this applies to you but more info on your condition could help.

[dot1]

Thanks for replying soso-lynn.  I wondered about this because of a comment my doula making in how it seemed to her that the physician tugged really hard when helping deliver my placenta.  And then, when I was hemorrhaging afterwards, he had to take a look inside to see if there was any retained placenta (which there wasn't).  I'm not sure if that's called a d and c (basically he had to go in with a metal tool, open the cervix and look inside the uterus.

I had an hsg that didn't show any obvious abnormality (they thought that my PP hemmorhage could potentially have damaged my tubes).  I don't think an hsg could detect scar tissue on the uterine wall, could it?  I've also been on clomid the past 2 cycles to address the possibility of old eggs not supporting luteal phase (suspicion of poor corpus luteum quality)...but it's had the unfortunate side effect of lightening my menstrual cycle which makes me think it has thinned the lining.  Ultrasound to check the lining isn't an option here unfortunately (I'd have to pay for it in a private clinic several hours drive away).

Would ultrasound be able to detect scar tissue on the uterine wall?  Or would one need some sort of scope?  Even if there was scar tissue, is there anything that can be done about it?

I'm frustrated with my OB/GYN (too focussed on the obstretrics side of things) but we really have no other option here :( 

[LessTraveledBy]

Hi,

I afraid I don't know the answer.... I am wondering, though, why you have been told that the problem is with implantation rather than, say something earlier in the game.

[dot1]

We don't know yet whether it's a problem with conception vs. implantation yet.  DH had SA and passed with flying colours and is now getting antibody testing done now too (no results yet) since he has a history of testicular torsion that was corrected right away with surgery.  The hsg I had done doesn't detect smaller embedded fibroids nor minor uterus surface scarring/irregularities nor endometriosis....so we might be looking at laparoscopy for me too.  Just trying to decide how far to go in the diagnostics (many of which cost me money out of pocket) and reaching for all the possible ideas that might help explain this "unexplained" infertility thing.  I ovulate still it seems... and tried clomid unsuccessfully already. 

Am moving to Letrozole (Femera) now that I've seen an RE who is actually comfortable prescribing it here in Canada. (fyi, Health Canada hasn't yet approved its use for infertility purposes - even though studies have since proven it's probably safer than clomid with less side effects).