Infertility after c section

I'm 31 and TTC for two years now, just over actually. We are due to start next cycle.

It could well be other issues for you, but there is a well known link between chlamidya and blocked tubes - particularly in those of us who had the infection for a sustained period of time. Chlamidya doesn't damage your tubes immediately, but after many months it will do. If you are lucky enough to find out quickly it will often have no time to cause damage.

It's very hard to come to terms with - I was very young when I had the infection. I wish i had found out sooner at the time, but it is now so long ago I've had to accept it for what it is.

It is still possible to get pregnant and implant normally if your tube isn't blocked completely, but the risk of the embryo implanting in the tube is much higher than for the average person.

Hi OP I've just read the whole thread. Like you I also had chlamidya as a teenager unknown for over a year. This damaged my tubes though I didn't know it at the time.

I've had a chemical and two ectopics. It's very possible the chemical was an early ectopic my body absorbed.

I'm now doing IVF. I had one tube removed after an ectopic and the other shows clear on HSG - but I'm not getting pregnant from it so can only assume has some unseen damage too.

We sound really similar. Prior to my tube being removed I used to get bad pain (still do but it's different now) and I think it's from having a blocked tube.

You may still conceive again from your less blocked tube but you should know the risk of ectopic is high with blocked tubes and it's life threatening (I could have died with my second one). If I was you (and I am in the same boat but without any living children) I'd do the IVF. Yes it will be heartbreaking if it doesn't work, but natural conception not working is also heartbreaking.

@Lucy040288I agree it is a good idea to take a break from it all. Save for the consultation, I haven’t done anything since July and won’t have the hysteroscopy and laparoscopy until October (due to holidays). It has been nice not to think about it, especially after 2 failed transfers. I do think it is worth speaking to different specialists if you can though. I saw someone different for the most recent consultation and he was 100x better than anyone I have seen before and it was the first time someone has engaged with my period symptoms. I never really trusted the consultant who did my IVF - I felt she was overconfident and dismissive of my concerns and in the end I have been proved right when she (the supposed expert) was wrong. She also told me my lining was very good but when my new consultant looked at my file, he said actually it is too thick and he thinks that might be part of the problem. I think it is a little odd to say you don’t need a hysteroscopy because you have done a laparoscopy and ultrasounds and I expect not all consultants would advise the same so I would be cautious of trusting one person’s opinion. I don’t want to sound like one of those people that doesn’t trust doctors but, as someone in a professional job myself (not medical), I know that people have different approaches, make mistakes and some are very good whereas others can be quite bad at their job! I suspect similar is true of the medical profession. I am really hoping the corrections done during the lap have a positive effect for you!

@Lucy040288thanks for the update? How are you feeling after the laparoscopy? Sorry you have been left disappointed. Have you been able to get any advice on whether the cysts and polyp could have been causing the infertility? My understanding is they can both interfere with fertility so can’t be a bad thing to get them removed. Do you think you might push for a hysteroscopy and biopsy now? I would feel without doing both you don’t have the full picture since the laparoscopy doesn’t look inside your uterus. Hysteroscopy with biopsies may be worth exploring (I am going to be doing the EMMA and ALICE tests which test the microbiome of uterus and test for infection). Probably not available on the NHS but the cost isn’t too extreme compared to IVF. Hopefully things will be clearer once you have had your follow up appointment.

@Sarahdaydreamer1234I’ve just seen a new consultant who was much better than my old one and is the first person who has actually been interested in my period symptoms. I am going to have a hysteroscopy with endometrial biopsy and laparoscopy at the same time. Interestingly, he said my lining was actually too think which is contrary to what the doctor who did my IVF told me so I’m a bit annoyed about that but this is why it’s a good idea to change consultants if things aren’t working out. I won’t be having the procedure for a couple of months due to holidays and work and having to recover but will keep you all updated! Best of luck with your journey.

Hi all. Just wondering how you’re all getting on? @HPrior did you have your hysterscopy yet? I’m in same boat. TTC after c section and had a lap which removed mild endo and adhesions which apparently shouldn’t have affected conception and I actually think grew back. I’m now wondering about intrauterine adhesions. All tests including NK cells are normal, albeit my AMH and hunband morphology a little bit on the low side. I did take ages to conceive my first so I’m not sure it is due to the c section.

@Lucy040288just to update, I had my follow up consultation. I am going to pause on transfers while I do proper investigations. Going to start with hysteroscopy and endometrial biopsy (tbc which tests I’ll do from the biopsy- probably ReceptivaDX, ALICE and possibly the other endomeTRIO tests depending on costs), will see results of that and then decide whether to do laparoscopy. Consultant advised I may be able to get lap on private health insurance as it would be a referral for endometriosis investigations. Feel happy that I am now getting the investigations I wanted from the start. Although also feel pretty deflated as this is basically back to square one in not really knowing the cause of infertility. Hopefully we’ll both get some answers over the coming months. Part of me is relieved I get some time off from the transfer process - the two week wait after a transfer and dreading the disappointment is like hell!

Endometriosis definitely has symptoms many symptoms. Unfortunately many people think they are normal or are gaslight by doctors. Yes I didn't mean HSG would detect endo - just cysts like endometriomas which are often due to endo. And could be as sign OP has it. I went back to edit, but then forgot about it just messed up my sentences.

Yes they might not have seen it during surgery but they might have. It was just a suggestion to check c-section notes. Many people have looked years after and the surgeon has wrote signs of endo. Pain often does relate to severity and where it is. More deep infiltrating tissue can be more painful. The stages of endometriosis are actually about the impact on fertility. And yes you are right don't correlate with pain but the amount. Someone with stage 2 endo could have worse quality of life and pain then someone with stage 4. Endometriosis is unlikely to develop during reproductive years - yes it is a progressive conditions so symptoms get worse over time even with surgery but the majority of people have had symptoms of it but we're unaware there could be a underlying cause. New research has show the majority of the time it starts in teens going into early 20s - in fact now more gynaecologist are specialising in adolescent gynaecology for issues like endometriosis. Most have symptoms and they they develop and get worse. So many girls miss school (for around 12 weeks) for heavy periods, bowel issues.

Endometriosis very rarely has no symptoms, it's a crippling, Debilitating, whole body inflammatory condition. Yes some don't have any symptoms (I'm pleased for them) but the majority of us do. Lots of people are disabled by endometriosis as its chronic and progressive. Also got some info from studies, NICE guidelines etc.

@TheLivelyVipercan I ask where you’re getting your info from? Endometriosis can have no symptoms at all. Pain levels from endo typically have little relation to its severity - they relate more to where the endo is located. I don’t think it typically develops in teens either - it can develop at any time during your reproductive years. Also endo would not be detected on an HSG - it might show blockages or adhesions but you can’t diagnose endo that way. Blocked tubes can be caused by endo. Also you can’t rule it out because a doctor didn’t see it during c section. It might be in areas not visible from the c section incision and in any event the surgeon wouldn’t be looking for it. Fibroids or ovarian cysts would typically be picked up during an internal ultrasound.

Good you haven't got any cysts or fibroids. The blocked tube doesn't seem to fit with endometriosis, perhaps it just happened. Yes abdominal pain is a symptom but it seems weird that the pain was triggered after birth. Most people with endo start suffering in their teens. But let's hope your laparoscopy gives you some answers and that they can do something. Go to your GP you can get NSAIDs to reduce pain and inflammation such mefenamic acid and naproxen. Often they help. If it's abdominal it could be anything , IBS, Crohns, ulcerative coliitis , especially if it's right and middle and/or upper quadrant See if food has an impact, and maybe ask for a referral to gastrology as it may be not pelvic for the pain.
The main symptom of endometriosis is not actually period pain because endo is not a period condition - it's a whole body inflammatory condition where the endometriosis tissue even produces its own oestrogen and the pain is felt throughout the month not just when on your period. Main endo symptoms:

• Irregular or heavy periods

• Pelvic pain

• Pelvic pain on opening bowels (dyschesia) and wider gastrointestinal symptoms (diarrhoea amd constipation)

• Pelvic pain on passing urine (dysuria) and bladder symptoms sometimes

• Referred pain to the tops of the legs or back
Vomiting and nauesa.

HSG also should have detected if there is endo tissue on fallopian tubes, ovaries etc. I think it can alsobdetect adenomyosis as well. Sometimes people just unfortunately get secondary infertility with no specific cause. Hopefully they can figure it out with your surgery. I think it's unfair the IVF isn't allowed if you have one child, especially as they keep on saying we need more children.

@Lucy040288 I've seen that you've made progress eith laparoscopy congrats. I imagine you could have fibroid or ovarian cysts. Endometriosis is unlikely as during your C-section I'm sure they would have seen it - maybe check your notes from that. Also you would need to have a variety of other symptoms across the month etc not just infertility. Anyways hope you find some answers. Secondary infertility can be horrible. I'm guessing the blocked tube is having the biggest difference. Laparoscopies tend to be minimally invasive so less pain, but I think some people feel better 4-6 weeks other a little longer.

@Lucy040288 I took 2 weeks off but already had subsequent weeks booked off for Christmas; depending on your job, I’d take at least the 2 weeks, then maybe see how you feel? I’d say 3 weeks is reasonable and maybe a phased return with working from home if you have a role where that’s possible? Really listen to your body and try not to do too much too soon as it can set you back. In hindsight l overdid it at Christmas x

are there studies to back this up? I’m interested to know where this information comes from.

I just looked in up and it seems the difference is the saline sonogram is more for checking the shape and lining of the uterus. For most the HyCoSy would be fine I’d guess. https://carefertility.com/treatments/hycosy