Conventional gynaecological wisdom, from short term studies in the 1970’s, suggests there are few consequences of surgical curettage procedures for miscarriage or termination of pregnancy (TOP) (1).
Many IVF patients have injuries to their uterosacral ligaments with contained uterine nerves, presumed to be due to excessive traction on the cervix during surgical procedures for miscarriage or TOP (see Fig.1, 2). Over-vigorous, sharp curettage also threatens the endometrial-myometrial nerve plexus and raises the risk of adenomyosis (3). Injuries to uterotubal innervation will have predictable effects on gamete and embryo transport, and, may cause chronic pelvic pain in due course (3).
Medical procedures during the management of first trimester pregnancy loss, may not avoid these risks since excessive uterine activity has also been implicated in uterotubal nerve injury (2). Gynaecologists might reflect on these considerations by avoiding excessive traction on the cervix, and, sharp uterine curettage where possible.