Infertility after c section

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

Yes sorry, my phone autocorrected

For endometritis you need doxycycline. If your GP or fertility dr won’t prescribe you can order this online from reputable pharmacies if you do a consultation saying you need it for travel to a malaria region. It’s what I had to do ! Gp was so dismissive

I just thought of a third reason for IVF- if the uterine environment or your hormones need to be treated / controlled in some way for an embryo to implant. For example, if you have adenomyosis or endometriosis, they do downregulation before transferring an embryo. Of course, I’m not an expert, but those are broadly the things I know of that IVF is useful for.

Yes, I have APS too. Well oddly I did, but I had further tests recently and it looks like I haven’t!!

I had three miscarriages before my first and that’s when they did the tests (well after the second miscarriage). I tested positive for APS and was prescribed blood thinners. Unfortunately that wasn’t the issue with that one as I had the product tested and it showed chromosome deficiencies. We were both karyotype tested and those results are fine.

I know they can’t always see everything during a scan as it took a lot of them for them to pick up my septum, which was later removed (prior to my first born). It’s such an imprecise science as they can never say definitely what is the reason for the miscarriages.

I think the egg quality is an issue for me as I easily got pregnant early 20s despite using contraception (unfortunately wasn’t in a position to continue). They definitely didn’t say this as a standard response as they did so many tests after my first two miscarriages. It was the IVF clinic (who I would imagine want my money!), who talked about this with me.

I saw a nutritionist who gave me a very detailed eating plan for egg quality. But, it was very laborious and expensive (so many avocados!!), so I didn’t really stick to it. I have been taking CoQ10 for the past 4yrs (along with other supplements), but haven’t noticed any improvement.

Im sorry to hear you think you have endometriosis and they’re not looking into it thoroughly. I have a few friends that have it, and a couple have had a lot of success with Bupa. It’s so frustrating!

@Lucy040288I find that the clinics don’t sort of look at the evidence analytically / logically. They just follow procedures without really thinking outside the box. Re your chlamydia, applying very basic logic, that happened before your first successful pregnancy, so I wouldn’t rule it out but I also wouldn’t place it as a likely cause of the problem. Re doing IVF, this could work if your problem is aneuploid embryos, because you could test them and only put in a euploid one. However, again, this seems unlikely - at your age you will definitely have some eggs that have chromosomal abnormalities but you’re not that old and are only +2 years from your first successful pregnancy (or were when you started TTC) so after all this time I’d expect you to have had a healthy one stick. One useful thing for me about having done IVF with PGTA testing is the doctors can’t sit there and say you’re late 30s so it’s probably the embryos that are the issue. Considering you have one clear tube, have had early positive tests and a definite miscarriage suggests to me that IVF won’t fix the problem - at the end of the day all IVF really does is 1. Allows you to test embryos before they’re used and 2. Puts the eggs and sperm together and into the right place in the uterus if that process isn’t happening naturally for some reason - which for you it is because you are getting pregnant. Your problem seems to be implantation failure/chemical pregnancy/repeated miscarriage. Now let’s turn to another thing the doctors seem to ignore once they’ve done a few basic tests and can’t find the problem - your symptoms. You’ve got pain and a blocked tube and they are on the same side. You also had a difficult labour and emergency c section. The pain started after the surgery but with a delay of a year - interesting there was a delay. You also don’t know what is actually blocking your tube - I think that’s the case? For the endometritis, you can do various biopsies to test for this. I had the ALICE test but have since learnt that this only looks for the bacteria that causes endometritis, it does not look for general inflammation so if you’ve got inflammation caused by structural issues, that will be missed- the test for that is CD138 (I wasn’t ever advised of this, it is another thing I’ve learnt online). Re being told ultrasound was normal - don’t ever listen to this - ultrasounds are “a science of shadows” and are not very reliable. They are also very dependent on the skill of the person who does them. If I were you, I would be looking for specialists in repeated miscarriage and tubal defects. Appreciate the cost of this racks up if you’re paying for it all yourself. Have you looked into getting health insurance? In my experience policies will cover gynaecological investigations as long as it is not fertility related - so if you have sufficient reason to get treatment outside the infertility (the pain) - you might get some of this paid for. Also sorry to hear your husband is getting annoyed. I have had similar with mine - I never trusted my original consultant at the fertility clinic but he acted like I was some kind of “antivax” person for questioning her advice. After we didn’t conceive following the laparoscopy (which I was was told would “clean” everything and I’d probably get pregnant naturally bla bla), the penny finally seems to be dropping with him that we have perhaps not been receiving the best advice. It was him believing me that was my motivation to find another specialist.

It could be down to egg quality, and unfortunately that’s something they can’t test for.

I had an ectopic and possible tube blockage relating to that. After a laparoscopy they could see that all was well with the tubes and ovaries. Egg count is fine for my age, nothing wrong with sperm either. As you’ve had scans and laparoscopy, I doubt it’s to do with the section (and I wouldn’t punish yourself over it), I can’t see how that would affect things that prominently especially as they have checked things out - any issues with the incision can be seen on scans if it was prominent enough to affect it.

I also had a baby in 2021 and nothing has happened either (apart from the ectopic 18m later). I did speak with a few fertility clinics and due to the lack of actual issues with us, they spoke about egg quality and that IVF would have a very low chance (lower than the regular very low chance!) of success. I think egg donation has a much higher chance, but that’s not a route we want to go down as we already have a child.

It’s very hard, but just so happy we have our child. The more it goes on, the more I feel happy with my lot and not sure I want to do all those years of school runs as with the age gap they wouldn’t be at the same school together 🤣

I think it's time for IVF. I've had one failed fresh transfer and I'm gearing up for a frozen transfer in the next few weeks. It's been really hard but it's still better than trying naturally.

I definitely would not buy antibiotics online, this can be dangerous.

I stand by what I said earlier on the thread - I think your tubes are partially blocked due to the chlamidya. The flushing you had before will have helped you conceive your daughter if that's the case. I don't think your c section scar is relevant to the pain, like the consultant said it's likely your blocked tube. I had that before mine was removed. I think IVF is your best chance as it bypasses the tubes.

If you aren't ready for IVF then a do think a hysteroscopy could be a good next step.