Dilation and Curettage (D&C) is a minor surgical procedure where the cervix is dilated and tissue is removed from the inner lining of the uterus (the endometrium). Because the procedure often follows events like pregnancy loss, patients frequently worry about its impact on future reproductive health. This article explores the standard outcomes and the specific, infrequent risks associated with a D&C procedure and its overall impact on fertility.
The Context of D&C
A D&C is performed for both diagnostic and therapeutic reasons. Therapeutically, it is most commonly used to remove retained products of conception following a miscarriage or abortion. This is often medically necessary to prevent complications like heavy bleeding or infection. The procedure may also address retained placental fragments after childbirth.
Diagnostically, a D&C allows a healthcare provider to obtain a sample of endometrial tissue. This sample is analyzed to investigate abnormal uterine bleeding and diagnose conditions like polyps, fibroids, or uterine cancer. The procedure is typically brief and performed on an outpatient basis.
General Fertility Outcomes Following D&C
For most patients, a D&C does not compromise the ability to conceive a subsequent pregnancy. The uterine lining regenerates quickly, and the procedure is designed to be minimally invasive. Data suggests that the odds of a successful pregnancy are comparable between women who have had a D&C and those who managed pregnancy loss non-surgically.
The return to normal reproductive function is signaled by the resumption of the menstrual cycle. Most patients can expect their period to return within four to six weeks, correlating with hormone levels returning to a non-pregnant state. Approximately 90% of women who underwent a D&C were able to achieve a subsequent pregnancy within one year of attempting conception.
Rare Complications that Can Affect Conception
While the outcome is favorable for most, a D&C carries a small risk of complications that can interfere with future conception. The most significant is Asherman’s Syndrome, the formation of intrauterine adhesions. This involves scar tissue within the uterine cavity that narrows the space, disrupting endometrial growth necessary for implantation.
Asherman’s Syndrome is diagnosed via hysteroscopy and may cause absent or significantly lighter menstrual periods. The risk is higher when the D&C is performed in a recently pregnant uterus, especially to remove retained placental tissue after delivery or late-stage pregnancy loss.
Other rare complications include uterine perforation or a severe pelvic infection. While minor perforations usually heal without intervention, significant injury or untreated infection can cause scarring on the outside of the uterus or in the fallopian tubes. This scarring can affect ovulation or prevent the egg from traveling to the uterus.
Timing and Monitoring for Future Pregnancy
Following a D&C, a healthcare provider typically advises waiting a specific period before attempting to conceive again. This waiting period often spans one to two normal menstrual cycles. The recommendation is primarily intended to ensure accurate dating of the next pregnancy and allow for psychological healing.
Recent research suggests that conceiving sooner than the traditional three-cycle wait may not negatively impact the subsequent pregnancy outcome. Patients should have an individualized discussion with a physician to determine the most appropriate time to resume trying, based on the reason for the D&C and personal health factors. If complications are suspected, such as absent or very light periods, a doctor may recommend follow-up monitoring, like a hysteroscopy, before planning a future pregnancy.