Infertility after c section

@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.

The MRI I had a couple of weeks ago showed it was 5/5/8mm. I had a repeat hysteroscopy following the MRI so have now seen it for myself on camera as well. Mine was not picked up until I had had several ultrasounds either (including when I had a saline scan). They are obviously very difficult to see and perhaps only visible on ultrasound at certain times of the month.

My MRI showed no adenomyosis so that is now ruled out.

I am pretty much certain the niche is what’s caused my spotting as my symptoms are textbook. I can’t believe no one at the fertility clinic linked the two when I was constantly going on about the spotting! I also believe this is what is causing my infertility.

Whether or not it can be fixed is less certain but I think there is hope. There are two procedures to fix a niche - one is more straightforward where they go in via hysteroscopy and shave away the edges of the niche to stop blood getting trapped. You can only have this if your uterus by the niche is at least 3mm think (mine is 6mm). The alternative is to re-open the scar and mend it properly via laparoscopy. This is more major surgery with a longer recovery period but your uterine wall is thicker at the end so better to support a pregnancy. For minor surgery you can TTC after 2-3 months but for more major surgery you have to wait around 6 months). I am in theory a good candidate for the more minor hysteroscopy surgery, but my new consultant is extra cautious and wants me to get a second opinion as to whether this is the best way to protect my future fertility. So I am seeing someone he recommended in a couple of weeks to discuss.

One thing I would note (I’ve said the same before) is my consultant said he wouldn’t be recommending getting the operation if I hadn’t had the euploid embryo transfers because of the risk of surgery and his belief that for the vast majority of cases it is the embryos that are the problem. So just to warn you you’ll probably have a fight on your hands to get the niche taken seriously (sounds like it is small like mine). I don’t really agree with him that it’s most likely to be the embryos that are the reason for failure but that does seem to be the accepted medical opinion across the board, which is extremely frustrating! Just in my group of friends I have two people who had multiple attempts and failed at IVF and later found out they had structural issues (one stage 4 silent endo and the other asherman syndrome). I believe the doctors are wrong to assume aneuploid embryos without investigating the uterine environment - I don’t care if that sounds arrogant for a non medical professional to say!

Hi - sorry to join this thread randomly but I am experiencing the exact same thing as you. Had a c section early 2022, one year later I developed right side abdominal/pelvic pain and I was sent for an ultrasound but they reported nothing. Now I’ve been ttc for 13 months and no joy and I’m convinced the pain is causing my infertility. Going to try and get tests from the GP as they have been extremely unhelpful so far, basically telling me to go for private IVF because they will not do anything. So frustrating isn’t it.

Have the hysteroscopy, and have ultrasound to confirm how thick your endrometrial lining gets during your cycle and whether it takes on the right format (triple line visible on ultrasound) to support implantation of a fertilized egg. If your lining doesn’t grow thick enough after adhesions have been removed it is incredibly difficult to have a successful pregnancy. Get these tests before you go through the hormonal and emotional rollercoaster of IVF.
My experience is of ashermans after emergency c section, but I also had ablation to stop bleeding post c section as the uterus wouldn’t contract. I was left infertile, and although the surgery to remove the adhesions (and unblock a fallopian tube) was successful, my endometrial lining never recovered.
I wish you every success OP, find a doctor prepared to listen to your concerns.

The first section affected my fertility a bit, but because I lost an ovary. 1 month to get pregnant with first and 5 months with second.

I have had 2 planned C-sections and a sterilisation. All within 6 years. Then the left abdominal pain started! Nothing showing up on ultrasound or CT scans. They have put it down to excessive scarring and adhesions, which can only be properly investigated with laparoscopy. Which I have refused to have!

I've had many pains and niggles since having a c section, dreadful ovulation pain I can feel in my rectum even, so worry I have adhesion after an emergency section to get a 10lb back to back baby out. I had ivf to have my son and havent tried again so can't comment on that. Just wanted to add my experience with pain too as its clearly an issue.

My friend has severe endo and was told she'd never concieve, she got pregnant naturally after a short time, had a section, and then got pregnant again with her 2nd too. So it isn't always the case.

Hi @Lucy040288sorry you are still having a rough time of it. When I lost my first tube post c section I did a lot of research - I find it really frustrating that doctors parrot out the whole “no effect on fertility” from blockage/loss of one tube….. what I read indicated that most women have a dominant ovary - usually the right one and so loss of right/blockage to right tube does reduce chances of a natural conception especially if you have adhesions/scar tissue etc which might effect the left tube moving over to pick an egg up - if everything else was perfect then maybe there would be no impact but generally women who have lost/blocked tubes have something else going on which reduces the ability of the other one to step up .

in terms of dna fragmentation…. I looked into this after multiple miscarriages and failed IVF rounds ….my IVF doctor said that the treatment for dna fragmentation is actually largely found in Proceive max for men so since my (ex) husband had been taking that for a while he said not to waste money on the test - so maybe put your husband on those? (Boots and Holland and Barratt usually have discount days when I would stock up as it isn’t cheap if buying men and women’s ones)

in terms of loss of fertility between age 33 and 36… I can only say my experience whilst doing IVF Over 18 months and taking all the supplements know to science as well as throwing in fertility acupuncture was that yes my fertility was in decline between the ages of 35 and 37 evidenced by the decline follicles, egg maturity and quality etc