Problems conceiving after csections

[Dipsy3]

Hi there! Been ttc for 12 months now: 'no' luck. Have had three c sections. Could they be the cause of my subfertility? All tests on dh and I have come back normal. Should I ask for a scan of ovaries to check if scar tissue may be the culprit? If scar tissue is an issue, would that mean I would have normal periods or not? I have a regular 28 day cycle. Opks predict regular ovulation, and fertility friend confirms ovulation on days 14,15,or16(varies from one month to the next). If scar tissue was an issue, would this affect my cycles, or would they be this normal? I am 43 and dh is 47. Maybe it is due to our ages? I have an 15yr old, then 6 year old and 4 yr old ( all delivered by c section). Grateful for any/ all replies and advice. Thankyou xxx

i have pcos and have had 3 c/s.took me 18 mths to conceive my 2nd baby and i was worried the c/s had caused probs. i had placenta accreta and a lot of other probs but it only took 1 month of trying to get pg with no.3.

might be worth going to gp and asking for scan referral just so that they can check and hopefully put your mind at rest.

good luck!

Well it did take us a while after our CS to conceive our DD.

However, I'd like to very gently point out that, although the CS may be a factor, I suspect your ages could be a bigger factor.

However, I could be taking rubbish here.

Good luck!

We would like a baby together. We have only been together for two years. My previous husband is the father of my 3dcs. He succumbed to cancer when my youngest was only 3 weeks old. My present dh has 'no' kids of his own, and I would dearly love to give him his own biological child. He is a wonderful dad to my kids and a good husband. Just trying to understand whether it is my sections or age which are the factor here, for not falling pregnant as quickly as I used to do in the past.

try reflexology iam convinced it worked for me when ttc no.3 esp as it took me 2yrs for 1st and 18mths for 2nd.

if nothing else its relaxing which might help in itself.

i have a lovely friend who is 45 and has just had her third baby so age doesnt necessarily mean itll be more difficult.

Thankyou very much Ariane and Ripmac( loving your name! ): you've confirmed what I was thinking i.e. Age and stress, so I will try to persevere, whilst requesting a scan and looking for a decent reflexologist in my area.

Hello Dipsy I am in a similar situation...have two DC 6 and 7 both by sections, and was advised any further births would be section also.

I am in a new relationship now, and we would love a child together...so far this year we have two early losses and one chemical pregnancy.
I have had basic bloods done, all ok, and have been referred to recurrent mc clinic to hopefully get some answers.

Like you though, I am worried that my scar tissue may be stopping implatation??? even my GP agrees it may be the problem.

Hopefully somebody will be along soon to advise better.

I am starting acupunture next week as have read many good reports! may just relax me...but worth a shotx

Anytimenow: sorry to hear of your losses. Hope you get some answers and more importantly SOLUTIONS. FX for you. We haven't even had a BFP. I think my age is a contributing factor too though. I just feel sorry for my dh really

Hello,

I am no expert but have been doing a lot of reading lately about Ashermans Syndrome (scar tissue on in the uterus), as I am going to be tested for it too.

A scan of your ovaries wont be able to tell you if you have AS (which affects the uterus lining, making implantation difficult or impossible and/or fallopian tubes affecting conception) but they scan will show you if you have any cysts, and then thickness of your uterine lining (if done post ovulation) so it could still be useful in looking for infertility problems generally.

Women with AS have lighter than normal periods or no periods at all. They ovulate normally and in cases where there are no periods often feel period pain around the time they should be bleeding. Diagnosis of Ashermans syndrom can be done via:

• Sonohysterography your uterus is filled with saline solution and then looked at with 4D ultrasound
• an HSG exam, where dye is put into your uterus and then an xray is taken
• a hysteroscopy (keyhole surgery where a small camera is inserted to have a look)

Here are two great sources of info about AS

Dr Lower interview
www.ashermans.org/

Of course there are many reasons for subfertility, AS is usually the last to be explored. Have you had day two blood tests to see if your hormone levels are OK? Is your ovarian reserve OK? Do you have good quality CM? If not, have you tried taking evening primrose oil or Guaifenesin?

best wishes
xxx

Mummyabroad: I have had all of the tests you kindly suggested above. I have been taking a lot of supplements including the ones you mentioned; B6, B complex; iron (prescribed by gp as I'm anaemic), co-enzyme Q10,flaxseed oil, vitabiotics, seaweed- reason: I always have done for as long as I can remember. I'm a health freak! I spend an hour a day working out: weights, aerobics and sometimes swim too! CM very embarrassing: pantyliner in place most days of the month. Ovarian reserve: that of a 29 year old ( apparently), hormone levels good: but to be on the safe side (because of my age), the dr kindly prescribed clomid for 3 months: with 'no' tracking: to help things along. First month 50mg dose, increased for the next month to 100mg and the last to 150mg. No use. Ended that treatment after 3 months. What have you tried MA?How long have you been trying? What's your story? x

Hi Dipsy,

I had a mc 7 months ago and never got my period back. Even progesterone wont bring it on. I had some weird complication where placental cells grew back, they thought it was molar for a while but it turned out not to be. Basically I had retained tissue for about 3 months which is very unusual. My blood tests are also all normal (although I have to get more done next week, because my doc still suggesting this could be a hormonal problem)

I am really worried that I had AS before the pregnancy and this may have caused the mc. It was a mmc discovered at 14 weeks, the baby died at at least 8 and half so right around when the placenta would have started doing its job (which it wouldnt have been able to do if there was scar tissue present)

I have a DS, who is 2. When he was born, I opted for a natural third stage but the midwife pulled the placenta out straight away causing massive hemoraging, a month later I had to have an ERPC for retained placenta products, I am worried that this did damage.

I have been put on the pill , to see how my body responds to hormone stimulation, I have around a week left, then I am doing more bloods and then an HSG. I know from scans that my uterine lining is only 3mm (should be 8 post ov) I am ovulating (both scans and charting confirm this) and am also fit, healthy and vitamined up to my eyeballs
My dilema at the moment is finding the best way to get diagnosed. I live in Costa Rica and am paying privately but I am finding it really hard to find a doctor I trust (they all just take your money and tell you what you want to hear!) I would rather a 4D scan than the HSG because I believe it has better accuracy, but a scan is only as good as the person reading it and there are no AS specialists over here. The other problem is getting the courage up to do it, I have had so many sessions in those stirrups, I start having panic attacks now! I hate it so much!
Having said that I will do it, because I really need to know whats going on with my body.

MA: you've really been through it haven't you darling ? I am so so sorry for all that you have been through. Couldn't you travel to somewhere like London( just seen your AS link on YouTube: very informative: also highlights just how important it is to see a specialist, as the list of things he mentions which could go wrong don't bear thinking about)for treatment? This is very important: please weigh up all your options before you go for treatment. You only get one chance: don't waste it. I also read somewhere that whilst conducting these investigations, the implements cancause damage to the Walls of your tubes and cause further adhesions and scar tissue to form: so it's even more important to get the correct diagnosis and treatment; and for that it requires you to go to a person who has the credentials to match. I know you are more knowledgeable than I, but please don't be hasty... Make judgements you'd recommend to a friend. This is not something you can afford to compromise on. I sense that you may try and cut corners to stay local, but you might well have to travel further afield if you want the best for you and any future children. If I have spoken out of turn then please forgive me: especially if I have misread your situation. x x x

Thanks Dipsy, it has been a bit of a rough year!

You make a really good point. I had already got the message from the links above that it is very important to get treated by an expert, but I hadnt thought that getting the HSG diagnostic done may cause damage.
The first gyne I saw about this wanted to do a hysteroscopy (I think she just saw ££££) but after checking out the links above I realised that there is no way I would get that done over here. I have already checked out who does what and how much it costs in London. I was hoping that the HSG would give some useful info first, because if for example I have it and it is very severe then DH and I would have to have some big discussions about whether it is worth carrying on. On the other hand, if it comes back clear we will have to decide if its worth pursuing a more expert diagnosis. Here is a study (2005) which shows that an HSG only spotted AS in only 60% of cases! Well I still have some time to decide what exactly to do next, as I have to take the pill for 5 days more, then do some bloods 8 days after that. (I would bet money the bloods come back normal, its just a repeat of what was done 2 months ago and they were fine)

So it looks like you are even further down the investigative road than me, it must be very frustrating after all this time not to have answers. Any idea what your next move is?

take care xxx

Unfortunately, that's it for us for the time being. We are totally at the mercy of the nhs. He is a delivery driver and I am a SAHM. It is our lifestyle choice to play the roles we do, therefore money is not abundant enough for us to spend on ivf, or iui etc. Hoping still at the back of my mind that I may fall naturally- but hope getting slimmer every day- as not getting any younger! Both of us feel blessed to have the children we already have. But what makes it poignant is the fact that dh is an only child and for him to not have any biological offspring is particularly sad for his parents. I'm sure there's a solution somewhere to all this - but we are just not seeing it- the tunnel vision tends to make it worse than it is too. At the end of the day we all have our health and each other, but you know when you're too close to something and you lose all perspective? Started to feel little claustrophobic of late.

Its very hard isnt it? I am also a SAHM, something which we can afford to do while living over here as the cost of living is so much less, but it would be very difficult in the UK. DH has said that if I wanted to pursue treatment over there he could look for a job there and we could relocate, which would obviously be a huge step. Its so hard to think about things like that when I dont even know for sure if I have AS! I know what you mean about claustrophobia (except mine often feels like full blown panic!) Having just lost a baby makes me want one more than ever, even though I have a wonderful DS already, I feel such an ache for another one

I have just joined the yahoo group via ashermans.org and also found a support group on facebook. Hopefully they can give me some more info on what is the most accurate, safest way to get diagnosed (and one that doesnt involve taking out a mortgage )

So will the NHS give you a Sonohysterography or HSG? If you are not eligible on grounds of fertility, could you get it for health reasons, i.e. no periods, very painful periods etc?

xxxx

No, my gp has ruled the hsg out due to the fact that periods are too regular, and the twice monthly bloods confirmed hormones fine. Also ovulating regularly. Personally, I'm not that clued up on fertility either. Apart from charting, etc. Which show the most perfect graphs, I don't understand if I had underlying fertility problems: age related, or csection wise: how would they manifest themselves. Outwardly everything seems fine. It might even happen naturally soon, after all we've only been trying for a year FX for us both eh?
Hope you find a solution soon. It is hard, wish we could get some answers quick!
I feel for you especially because of your recent loss. Hope the pill hps sort your hormones out- you are brave to be taking it, as it does exactly the opposite of what you desire. Hope that you can try again soon. Good luck xxx

Dipsy- I've not read the entire thread but if I were you I'd push for a HSG or a HyCosy. I've had 2 CS and been ttc no.3 for 18 months. All blood tests great etc but a HyCosy revealed my tubes and ovaries are stuck in weird positons after last CS. I've just had surgery to correct things (though my chances are slim because other things were discovered). At the very least though, a HSG would reassure you of your fertility and many people conceive after them as it kinda gives your tubes a flush through iykwim!! Good luck

P.S. GP's are clueless. Regular periods have absolutely nothing to do with any tubal issues.

I was misdiagnosed with PCOS at first and now am doing repeat bloods to double check if I am premenaupasal so I have inadvertantly got clued up on these two conditions as well.

Checking FSH levels at the beginning of your cycle (usually day 2) gives a good idea of your "ovarian reserve" basically if you start running out of eggs, this hormone goes beserk producing more and more trying to stimulate the follicles into growing more eggs. As long as you dont have a high level of this, you can be assured that you are not approaching menapause.

A high level of Prolactin (the hormone produced when breastfeeding) affects your fertility and sometimes indicates a brain tumour (treatable) This would definitely be investigated further if found.

Thyroid function can also affect pregnancy rates, you would probably have other symptoms that got you to the doctors office first though, this is rarely discovered while investigating fertility issues.

The other interesting hormone is LH which should be in proportion with the FSH level. If it is higher (ratio 3:1) this is an indicator of PCOS and you would expect other symptoms which may include some or all of the following: irregular periods, cysts on ovaries, excessive hair, adult acne, weight problems, diabetes, and difficulty getting pregnant. Of course you can have high levels (an LH surge) right before ovulation, so its important your blood test is done at the right time.

The tests at the end of your cycle confirms ovulation and that your luteal phase is long enough to sustain a pregnancy should conception occur. If you have nice charts, you know this is OK already.
If you know your numbers you can compare them here

Not referring you for an HSG on the basis of having regular periods is BS really. If you DONT have a hormonal problem, surely the next step is to check if you have a structural problem, blocked tubes, scar tissue etc. This is probably more about money than medicine. If you want to persue this I would ask why they are not investigating structural issues. (you dont have to have wonky hormones to have a structural problem) Most doctors accept that the time to do investigations is after a year of TTC naturally and you have more than done this (no harm in perhaps exagerating a bit too? )

Unfortunately every Ashermans story I have read so far starts with how difficult it was to get doctors to diagnose it. I am struggling myself and I am paying private! If you want to carry on down this route, you will need to be pushy. I do hope that you dont have AS though (and me neither!) but if I were you I would want to find out sooner rather than later.

By the way, its been shown that many women get pregnant soon after an HSG, although there is no proof, doctors suspect that "flushing out the tubes" helps aid conception.

good luck too xxxx

Haribofan: thanks for the advice. I'll push for the HSG then. I hope you don't mind me asking- but were your periods and ovulation regular? And which other things were discovered? Fear that I may be in a similar predicament to you now! Please excuse the inquisitiveness, just trying to suss out all the things that could be afflicting my body, with me being completely unaware!

x posts! Haribofan said it more succintly!

Ma: sorry for xpost. What you say makes complete sense. Have just made a drs appointment ( in a months time) to push for hsg and certainly further investigations. Wonder what gp will try and fob me off with?
You are so knowledgeable. Thank you so very much. Hope it happens for you soon, x

PS had thyroid checked first as was constant tired, thyroid was fine but I was anaemic: hence the ferrous sulphate tablets!

Dipsy- Yes periods and ovulation are regular, 29-30 day cycle. My tack with GP's has always been to ask for a referral because anything specialist like fertility, they are not likely to know a great deal (understandable I guess). Exaggerate the time you've been trying if needs be and say you are getting down about things which I'm sure is true. Each PCT is different I guess but here I got a referral to a fertility unit, blood tests, a HyCosy and would possibly get a few cycles of Clomid on the NHS. That would probably be the limit if you have children already. The surgery actually revealed I have an abnormal uterus (unicornuate, i.e. only half the normal size) and thus only one tube. This will obviously limit my fertilty. However, I've had 2 children without knowing about my weird uterus so I feel the main obstacle could be the adhesions caused by my c-section. Hence why I'd advise you to push for on. Also, I had a HyCosy when ttc no.2 and conceived 10 days later so I'm a fan of them!

Haribofan: thanks for your openness. Yes, I will certainly push for the hycosy, especially after such a good experience of one as yourself. Can nothing be done about the adhesions? I know you said you've had an operation for them, but what's the underlying cause? You're right about this ttc getting me down: it's frustrating, especially when it's like a shot in the dark. There are so many things that need to be investigated, and when you have children already the nhs refuses to delve deeper as a matter of course. Money IS an issue, as is age. I hope that I am able to give my dh at least one child of his own. Some days I blame him for not having kids before he got to this age, then there would have been 'no' pressure on me! Makes 'no' sense: but he couldn't care less! He seems to accept that my kids are ours and biology means nothing. He does say his parents are of the old school of thought and that the intricate genetics mean nothing to him- but it's depressing for me. Also it's the thought that I want his baby: very unreasonable selfish behaviour on my part, and I really do inflict this on our relationship. Forgive me for the rant. He's at his parents trying to repair a leaky roof, and I've got baby brain AGAIN x

I've just got some really useful info about treatment for AS over on this thread.