Infertility after c section

Dont mind at all. I used Mahantesh Karoshi. Really liked him. His specialist area is mainly treating irregular bleeding as opposed to secondary infertility though so he wanted me to get a second opinion from a fertility specialist before I had my resection, which I did but I stuck with Mr Karoshi for the procedure. I have just discovered there is another thread on Mumsnet called secondary infertility following emergency c section which discussed niches and resection. There are also a couple of Facebook groups on c section niches which I have just requested to join.

I had my c section resection 6 weeks ago. I’ve been searching for stories about recovery from the procedure as so far I have some improvement (no more horrible dark sludgey spotting post period) but still several days of lighter spotting so am concerned. But the official line from my consultant is it’s too early to assess the success of the procedure as it heals over time (have to wait for 3 cycles).

Hope this info helps!

I have heard of Adrian Lower. Did he have much information about the success of these procedures? This seems to be a relatively new field and there is very little information on it.

@HPriorhi, i hope you don’t mind me messaging. I feel like I could have written what you’ve said on this thread, our stories are so similar. Would you mind sharing which consultant did your resection? I saw Adrian Lower a few months ago who told me that he could do this for me, but I’ve seen various other names on other forums so trying to figure out the best option for me. Thank you 🙏

Sounds like you are getting closer to an explanation. And I think it is 100% the right path to get MRI and hysteroscopy. Once consultants start on the “unexplained” path ditch them IMO. It just means they don’t know the answer and can’t be bothered to look for one. To give some context I had multiple ultrasounds with 3 different specialists, including a saline one, before someone (the 4th person) even saw my niche. I was objectively told my scar had healed well by the other 3. Even after the niche was known about and I had my first hysteroscopy I was told it was too small to be problematic. I have told countless different medical people (multiple GPs, a gynaecologist, 3 consultants at my fertility clinic, nurses and sonographers) about my post menstrual spotting and not one knew this was a symptom of a c section niche. Then when I found the right guy he said immediately, without me even mentioning the niche, “I would be interested to take a look at your scar as post menstrual spotting is very typical of c section niche”. I’m glad you’ve stumbled across this potential sutures explanation. I have never heard of it and I expect many specialists haven’t either. Best of luck with the investigations.

Update on my end- I’ve had my c section resection now. Very straightforward day case, little pain afterwards. Have to wait a few months for it to heal now before I can TTC. Crossing everything!

@Lucy040288

I have pelvic pain around the time I am due on,it’s more pressure if anything hurts when I walk but goes after while! That only started this year hoping it’s nothing related to c section.

I wish you the best of luck and I hope you get your baby xxx

Sorry for ALL the questions 🫣

Did you have endometriosis before getting pregnant? Has your periods always been on time every month? Did you have an emergency c section also? When did these pains all start? Sorry I’ve not really read the comments so don’t feel like you have to explain yourself

@HPrior

when I seen this conversation ngl i panicked as to me that’s a lot of women on here that are struggling to get pregnant after having a c section! I just never told this could have been a risk to me!! I do have pelvic pain just before I am due on my period but think that’s just normal although I never really experienced it until probably this year and my daughter is now 19 months.

I am so sorry you’ve gone through such a hard time ☹️ it sounds heartbreaking and I wish you nothing but the best xx

C Section niches are very common - current estimates are that up to 70% have some kind of niche following a c section. However, for the majority of women, niches do not cause infertility or any other symptoms / problems. All surgery, including c sections, carries risks, as does vaginal birth, and most people that have c sections go on to have successful second pregnancies and beyond. I was also told by my consultant that I was unlucky because it is relatively unusual to have a symptomatic c section niche after only one c section. Much more common to get problems after multiple c sections. I wasn’t, however, informed about this risk before I had my c section and my experience, having gone through multiple investigations with no one flagging this as a potential cause of my problems until now, is that medical professionals are generally not alert to this as a potential cause of secondary infertility and are not aware of the symptoms. So in conclusion, don’t panic if you’ve had a c section. It’s more likely than not that it won’t affect future fertility.

hi,

just came across your post!! I had a c section with my daughter due to preeclampsia she now is 19 months and are now TTC baby number 2: I did not know this was a thing with c sections and how it can affect TTC in future pregnancies!!! Now I am worrying!!!

when you say about pelvic pain where abouts roughly is it? Does it hurt to walk?

also I hope you manage to get your second baby 👶 🤞🏻

Is this actually true??
I had no choice but to have a c section due to pre eclampsia, I was not told this at the time and surely the health professionals should mention this before?

I’m really sorry you’re struggling. I find I am ok mostly but I do get periods where I get very depressed about it. It has got easier over time but weirdly I have come to dread any new treatment as I know if it doesn’t work I’ll have to deal with the disappointment again. During the in between periods I’m ok I think because I have hope to cling onto that the next thing will work, even though I know it might not.

I think there is a real problem with the culture around infertility and the reluctance of doctor’s to investigate and treat potential structural problems.

With c section defect and secondary infertility, I think it is an area that is relatively new in its discovery and there is relatively little known about it. There are only very small studies looking at outcomes from these procedures which “fix” the niches. Definitely worth investigating for you I think but also remember to keep an open mind as to potential other causes. I expect you’ll be told that surgery is a risk - my consultant was clearly concerned about that because he was very keen for me to get a second opinion.

Yes, I have had the same advice with my niche until now, because it is small they write it off as being an issue. You may need an MRI and/or hysteroscopy to assess what procedure would be needed to repair the niche. If your myometrial thickness behind the niche is less than 3mm you have to have more major surgery to open the scar and re-sew it. It’s only if your myometrial thickness is thick enough that you can have the more minor surgery to smooth out the pocket. I would happily recommend my consultant but he did say to me it was the fact I had had euploid embryo transfers that meant he was recommending the repair - otherwise he would have put the infertility down to being bad embryos. I am seeing the second opinion consultant next week so I will let you know if he is any good.

@Lucy040288my consultant showed me this video which may be of interest:

@Lucy040288I don’t get any pain with my defect, only the spotting and heavy periods (not sure if the latter is c section related). I haven’t ever been told there is fluid in the scar, no. My understanding is that the blood collects as you are having your period, gets stuck and then leaks out, which is why I get the post menstrual spotting - so I guess I’d see fluid there if I had a scan in the first week after my period but not sure. Re CD138, no I haven’t had that. The abnormal vascularity within my niche was really obvious during the hysteroscopy though, which can cause chronic inflammation.

Do you have a retroverted uterus out of interest? I do (about 1 in 5 women have it). It is a normal thing but it makes you more at risk from c section niche.

I would say definitely get the niche investigated via hysteroscopy and possibly MRI (depending on what is recommended). The CD138 test may also help you convince doctors your secondary infertility isn’t just down to bad embryos if you can show chronic inflammation. If you’re paying for a hysteroscopy, you may as well get the biopsy for the CD138 done at the same time.

I think the reason fertility experts overlook the niche is because it is so common to have a niche and in the majority of cases it doesn’t affect fertility. So you really have to convince them you are in the minority!

Could you push for investigation on Asherman's Syndrome? I had it after a D&C and from what I learned from that experience is that it's not very well known and understood. Also, it's very difficult to diagnose if you are using standard diagnostic exams. I made some researches online and found a couple of the best consultants in the world were based in the UK and I contacted them privately.

On this, my private clinic (who are supposed to be one of the best in the U.K.) 1. Did not pick up the niche until I had done multiple scans and it was only picked up when I had a routine scan from a different doctor before my embryo transfer. He said it was small and “very unlikely” to cause problems with implantation. 2. Even after me asking for the niche to be checked when I did the hysteroscopy, don’t seem to have paid much attention to it because there were no photos of it (meaning my new consultant had to re- do the hysteroscopy) 3. Insisted after the hysteroscopy that the c section niche wasn’t causing the implantation failure and 4. Never once linked my post menstrual spotting to the niche despite me sounding like a broken record and asking what could be causing it on every appointment and despite the fact my symptoms are textbook and the new consultant upon hearing my symptoms immediately suspected a niche (I hadn’t told him I had one because I had repeatedly been told it wasn’t an issue).

The “fertility” clinics should just call themselves IVF clinics because in all honestly that’s all they want to do and all they are experts in.