Infertility after c section

[Lucy040288]

Hi

Just wondered if anyone had any experiences of infertility post c-section. I had an emergency c-section in July 2022. I started having some right sided abdominal pain about a year later. We have been trying to conceive our second child since January 2024. I went to the GP in June 2024 and had a transvaginal ultrasound which was normal. In September I went back to the GP and we had bloods and investigations and referred to fertility. Bloods and husband’s semen analysis all normal. I had a HSG in March 2025 which did not show any spill of dye from right tube indicating blockage. I’m wondering if I should have a laparoscopy to see what’s going on but my consultant says they don’t usually do laps that often anymore and go straight to IVF. I just don’t want to do IVF for it to fail and then have a laparoscopy and find a problem that could have been sorted meaning we could conceive naturally. Obviously we would have to pay for IVF as we already have a child. Also, I don’t know what could be causing the right abdominal pain. Could it be adhesions, endometriosis, the blocked fallopian tube??? Some months I’ve experienced extremely tender breasts in the 2 week wait but then came on my period so I don’t know if that could mean the egg’s been fertilised but unable to implant due to inflammation or this blocked tube?! I think I had a couple of chemical pregnancies last April and June as I had very tender breasts and a faint positive pregnancy test but then period arrived. I then stopped testing as it was too upsetting. I didn’t have any problems conceiving my daughter. I just don’t know what’s going on or what to do for the best.
has anyone been through anything similar?

x

@VioIetMoon i don’t think I had an infection post c section but my right side was more swollen when I was recovering. It’s strange though that I now have this right sided pain where the blockage has been found which I never had before my c section.

@amiadoormat i’m so sorry to hear that. Did the scar tissue damage your tubes and that was what led to your ectopics? The same with me, I never had this pain on my right side until after my c section. I’m swaying towards going for a laparoscopy to see what’s going on there before I spend thousands on IVF. I’m concerned that my blocked tube and the pain I get is causing some sort of inflammation and preventing implantation as I’m sure I’ve had a few chemical pregnancies. I’m pleased to hear you finally did conceive again though, even if it meant spending a lot of money.

@Lucy040288
there were no blockages found - I had a HSG done after my first ectopic- but the doctors were honest in that there is no test which can prove either way whether a tube is damaged internally/externally and no longer functions - the only way of knowing would be to get pregnant with a baby in the right place.
in fact when they removed my first tube they said visually my remaining tube looked “perfect” - but I went on to lost it pretty much on the next pregnancy

if you’ve been having chemical pregnancies post c section it’s entirely possible that these were in fact ectopics which you me body managed to resolve itself

@amiadoormat i really feel for you. That must have been absolutely horrendous going through all of that. How many cycles of IVF did you have?

@Lucy040288bumping this tread as reading your post I did a double take to see if it wasn’t me who had written it a few months ago! Also TTC since Jan 2024 for my second baby after c section. After 9 months and several scans that showed nothing I went to a fertility clinic and did a hycosy. They found my right tube was closed with right ovary immobile and stuck to my uterus. Left tube appeared healthy but was “slow to fill” on the test. Was pleased initially as thought they had finally found the problem and cleared my left tube and so I would get pregnant. 3 months later and no success and I was back at the clinic and they recommended IVF. Like you, I wanted a laparoscopy to check for endometriosis. However, my fertility consultant advised against it. Her take was that it was my c section that had caused adhesions that were blocking my tubes. She said a laparoscopy risked further scarring and was not recommended without a proper reason to do it. Fast forward and the IVF cycle was very successful. I am lucky to have a high egg count so finished up with several good embryos (which I had PGT-A tested due to being 38 and more than half were genetically abnormal so the add on was worth it IMO). My consultant was confident in my prospects but my first transfer failed. We are going to do one more transfer and if that doesn’t work, she has recommended further investigations to see if anything else is wrong. It is a tough decision and a huge gamble but at least having done the IVF I have “banked” a few healthy embryos. Time is critical the closer you get to 40. Have you had any luck since you posted?

Just to add generally, I wanted a natural birth but had an elective c section as I was advised I was more than 50% likely to finish up with a c section if I was induced or went into labour (won’t go into details as not relevant here). However, I was never made aware that secondary infertility was a risk of c section. Many doctors tell you c section is much safer. I do wonder whether with more and more people having c sections, in a few years we will be more aware of the risks of damage to the reproductive organs. I am regretful of my decision to have an elective c section now for obvious reasons.

@HPrior thank you for sharing your experience. We seem to be scarily similar! Do you have any abdo pain at all? I have a very localized area on the right side of my abdomen which is painful. Sometimes a full ache, sometimes a sharp twisting pain and I think this is my blocked tube. I’m concerned it’s inflamed and that’s what preventing me getting pregnant even though my left tube appears normal. I saw my fertility consultant early May and I have been consented for a laparoscopy. I don’t want to risk paying out thousands for IVF if it’s going to fail because of this pain I’m experiencing. Unfortunately due to NHS waiting times, I think I’m going to pay for this privately to get it done quicker, especially being 37 and time not being on my side. I never thought I’d need a c section either and certainly wasn’t aware of the risk of infertility. I have a family member who had a c section and 18 months later had an ectopic pregnancy and lost her right tube. She was told that this was probably due to residual infection from her section. She has ended up managing to have 2 more children naturally though. It’s very upsetting that it seems women aren’t informed of the risks associated with c section. We will do IVF if needed but I want to know what this pain is and why I’m struggling to conceive. How old is your first child?

My fertility consultant said a laparoscopy was unlikely to cause adhesions as it is minimally invasive. I’m also going to have a hysteroscopy as you can get a c section niche where the womb hasn’t healed properly which stops an embryo implanting. Hopefully your second transfer will work but it may be an idea to push for investigations.

@Lucy040288i don’t have any pain but I have very heavy periods and pre and post menstrual spotting. This was why I wanted a lap to check for endo. However, my consultant advised my symptoms were more typical of adenomyosis. The latter is often detectable on scans but she has seen no sign of it so has advised if I do have it it is a very mild case. I also have a very mild c section defect but was advised it was very unlikely to affect things. If this next transfer fails the consultant has recommended a hysteroscopy and “endomeTRIO” test. Has your clinic recommended that latter?

I agree with you that it is better to investigate properly first. I think if I had been younger I might have pushed for more investigations before doing IVF but I was just so panicked by the thought of my eggs getting older all the time. The IVF was eye wateringly expensive - much more than I expected. This was mainly because I was lucky to get lots of embryos and because I chose to have them tested for chromosomal abnormalities it literally doubled the cost of the IVF (as you pay to test each embryo). So it is a big financial decision and ultimately a gamble. And one that hasn’t ended yet as it is around 3k per frozen Embryo transfer.

Can I ask which clinic you are with and do you think they are good?

@Lucy040288to answer you q. my daughter is 2 years 9 months so just a couple of months younger than your little one.

@HPrior aww my little girl will be 3 in a couple of weeks. Time goes so fast.
They’ve not found a niche on my scans but I think they are quite common after c section. My understanding was that niches can cause post menstrual spotting and the blood that fills that area is old and can be toxic to embryos and affect implantation. I’ve not been offered an endomeTRIO test at present. I am wondering about endometritis which can also be a complication after c section, especially with a prolonged labour and multiple examinations. I ended up having an emergency c section after a 36 hour labour and failure to progress.
It is worrying when you’re over 35 and you feel time is running out so I do understand why you’ve opted for IVF. If I didn’t have this irritating pain on my right side then I probably would have gone for IVF but I can’t help thinking that this is what’s stopping me getting pregnant. My consultant said they usually advise to go straight to IVF these days and not bother with investigations. I’m a nurse though and feel I need to know what’s going on.
it is so expensive but you’d do anything to have that positive pregnancy test. Hopefully it will work out for you. I was referred to Derby fertility clinic to have investigations on the NHS. My consultant does IVF at Care Fertility in Nottingham so we would go there if all else fails and depending on what they find at laparoscopy.
Which fertility clinic are you under? Have you been happy with the care so far?

@Lucy040288yes I can’t believe my little one is nearly 3 now. I found her 2nd birthday tough as I had expected to have had another baby around that time but wasn’t even pregnant. I will try not to let it get to me so much this year but I expect it will be hard not to think about it. I hate having any plans several months ahead as I always think “maybe I’ll be pregnant by then” and then it gets to that date and I’m not.

yes, the consultant that noticed the niche (I had several scans before anyone saw it) said it was a possible cause of spotting. And having looked it up I do wonder if that is the culprit as opposed to adenomyosis as there has been no sign of the latter.

Sounds like most clinics are taking the same approach of fast forward to IVF these days. I also feel like my consultant has brushed over my period symptoms. I hope I am wrong but I can’t help thinking that is an indicator of something else being wrong.

I am with the Evewell in London. So far I have been pleased with them. The IVF cycle was very well managed and closely monitored and they took a lot of care afterwards as I was at high risk of OHSS.

Best of luck with it all. I will try to remember to check in on here with an update when I have one as I know it’s interesting to hear how people get on!

@HPrior how are you getting on? So on Father’s Day I had a positive pregnancy test but at 6 weeks I started bleeding and miscarried. After 17 months I thought it had finally happened but wasn’t meant to be. This month I’ve had the most horrendous ovulation pain on my right side. We’re going to pay private to get my laparoscopy done quicker as I’m sure there’s something going on. My consultant isn’t convinced and is 80% sure that when he goes in he’ll find my right tube to be fine but I’ve asked him to remove it if it’s non functional. He thinks it’s just going to be adhesions causing pain but I really think that there’s some inflammation going on there that’s causing implantation failure.

could you right sided pain be ovulation pain?
i only started to get distinct ovulation pain after i had a baby (via EMC). And yes we never managed to have another (we did have a natural conception though it ended in A missed miscarriage). But I dont put that down to the C Section - just being 5 years older and in my late 30’s.
go for the IVF. It’s
too late for us now, I wish we had.

@moderationincludingmoderation i seem to get severe ovulation pain on my right side after my HSG but no it isn’t just ovulation, it’s constantly there. Plus with the right sided fallopian tube block there’s something going on. I’m concerned if I go straight to IVF then it won’t work as I’ve had several chemical pregnancies and now a miscarriage so I think there’s something preventing implantation.

I had emergency c section in Oct 2011 and gave birth naturally in June 2013.

my breasts do get very tender around ovulation and before periods

Sorry to head of your losses. Infertility & losses is heartbreaking. The pain of Secondary infertility is not acknowledged much.
I may be mistaken, but I thought ‘pregnancy’ was only detectable (via a pregnancy test rather than a blood test) once implantation has occurred. So if you were testing yourself with a traditional pregnancy test, and getting positives, then it would suggest implantation was occurring?

Having paid over £20k in ivf treatment last year, and THEN having laparoscopic surgery which found adhesions, endometriosis and adenomyosis- I would recommend getting the lap first. I had countless ultrasounds which showed nothing - it’s not usually used to diagnose these things. If you’re based anywhere near south wales, I’d highly recommend dr. Anthony Griffiths.

have you ruled out endometritis infection? Worth getting a course of antibiotics maybe as this was a concern for me also. Best of luck x

I’ve just read your recent update; I’m so sorry to hear of your loss - that must have been devastating. And could well be a result of what’s going on in your uterus. I had multiple early losses and it’s because of all the conditions preventing successful implantation. Really can’t recommend dr Griffiths highly enough x

@MotherOfShihTzus thank you for your response. Have you been successful in getting pregnant after your laparoscopy? I have thought about endometritis and asked my GP about antibiotics who refused and said she would write to my fertility consultant. He doesn’t think they will be of benefit unless there’s an active infection and doesn’t seem to think it will be endometritis. I may end up buying some antibiotics online as I know what I would need! My immunoglobulin A is also raised which further raises the possibility of chronic inflammation but no one seems to want to take me seriously. It’s frustrating. I know my body and there’s something not right.

@Lucy040288 I ended up ordering Doxycycline antibiotics from Superdrug online pharmacy - said I was going to India! That would be the treatment so thought I would make sure, tested negative for it after.

I’ve not been successful yet- but currently on my final embryo transfer so trying to stay positive! My son was an ivf baby so I’ve always struggled with fertility, was unexplained for years and eventually PCOS diagnosed before the ivf for my son. I had ivf last year and had 3 early losses from it which got me wondering about my pain / heavy periods. I had an infection in childbirth which can leave behind adhesions / endometritis, so all this led me to dr Griffiths. Turns out I had ‘colossal’ endo, adenomyosis, asherman’s syndrome and adhesions. None showed up on the 20 odd ultrasounds I had so I wouldn’t rule out based on ultrasound. I first had an MRI which indicated it was all there, then the laparoscopic surgery to remove as much as possible last December. Been healing since! and I’ve been on 3 months of prostap to calm inflammation before this last transfer.

I’ve also been with dr Shehata re. Reproductive immunology - might be something to look into if high markers for inflammation found? Or the postal down regulation, before any IVF.

lot of info there! But as I say - you know your body best and if you’ve had a loss as well as pain, may well be worth investigating further. Get a specialist consultant and start with MRI as less invasive. I’m lucky I could go private with Bupa through work. But I really wish I’d done this testing first - as I wouldn’t have spent £20k and wasted 3 healthy embryos that would never have worked given all the things I had going on! So I get it - get things resolved before ivf is my 2 cents x

Not postal - meant prostap!

@MotherOfShihTzus thank you so so much for your understanding! It sounds like you’ve been through a hell of a lot and I’m sorry you’ve had to go through all of that to get answers.
I’d read about Dr Shehata on another forum too but unfortunately I’m in Derby so miles away from him and Dr Griffiths. I may look for reproductive immunologists closer to me.
I may be wrong but I don’t think I’ve got endometriosis. I do wonder if I may have had an infection post c section which has caused scarring and blocked my fallopian tube. I know so many people who have had caesareans and have had no issues so find it hard to believe that this pain just on my right side is adhesions from my section.
Exactly, I really don’t want to spend thousands on IVF if there’s a reason in my body that I’m not getting and staying pregnant.
I really hope your embryo transfer works this time. Sounds like there’s been a lot of preparation involved so fingers crossed it’s a positive outcome for you x

Hi Lucy, I am so sorry to hear about your miscarriage. I can only imagine how devastating that must have been getting your hopes up and then experiencing loss after 17 months. One thing it does show is that you have a functional fallopian tube so it is not blocked tubes causing the issue and suggests IVF as a quick fix to bypass damaged tubes isn’t the answer. Of course you can’t be sure from miscarriage that there is a problem with the lining/ womb environment etc. but paired with 17 months of infertility plus unexplained pain, in my mind that points to something causing implantation failure (obviously I’m not a medical professional).

I am sadly not getting on much better. I just had my second failed transfer. I luckily still have 5 embryos left but I am furious I let my consultant talk me into trying again without doing further tests. Apparently with euploid embryos there is a 70% likelihood of implantation per transfer and after 2 transfers that rises to 90%. It was that logic that convinced me to do a second transfer as I felt I would know (nearly) for certain that there was implantation failure after 2 unsuccessful transfers. In my last consultation my consultant recommended we should try a hysteroscopy and endomeTRIO test if we had failure a second time. I’m very sceptical about the endomeTRIO test - HFEA marks it as red (meaning bad basically) on its add on rating system and it just sounds a bit airy fairy to me (testing for perfect time to implant and the microbiome environment). I haven’t had my follow up consultation yet but currently my thoughts are 1. Have the hysteroscopy and ask about whether I can have my minor c section niche fixed at the same time (although minor, I highly suspect that is what is causing my spotting and heavy periods) 2. Change to another consultant because I have never really been happy with this one - I feel she’s overconfident and I want someone who has a more careful risk averse approach. 3. I may bite the bullet and just do the laparoscopy. The main thing stopping me with 3. Is the expense but I have just spent 6000 on 2 transfers that were bound to fail and I could have spent that money on the lap and still have my two best embryos.

The other thing that has come to the front of my mind since this second failed transfer is that I only have one blocked tube. The other one was “slow to fill” on the HyCoSy but was otherwise healthy looking. So perhaps the issue has been implantation failure the whole time.

I’m left feeling frustrated with the whole experience. I “knew” this would happen all along and I so wanted my consultant to prove me wrong.

Hopefully that gives you some assurance you are making a good decision. By the way there is a pre laparoscopy test you can do called Receptiva DX which looks for some kind of marker for endometriosis from a biopsy. It’s a relatively new test so I don’t know about the efficacy but worth exploring if you haven’t come across it.

Keep me posted and I’ll do the same

xx

@Lucy040288I had a call with the company that run the Receptive DX test this afternoon. Obviously it was someone selling the product so something to bear in mind but it sounded like it might be worthwhile. It detects BCL6 levels which, if elevated, indicate inflammation which can be linked to endometriosis. He did say because I had a blocked tube he would caution against assuming a positive result was endo because blocked tubes can also cause inflammation. However, I still think the test could be helpful if it shows inflammation and I can then explore the cause of that. You can also use the test to look for a marker called CD138 which indicates a bacterial infection or endometritis. He said the test is widely used in the US but they have had difficulty selling it to clinics in the U.K. market. There are a few places that do it in London including the Lister. He said they send a kit to you which you take to your clinic (I assume to do the endometrial biopsy) and then the sample is sent away to them so I don’t know if specific clinics actually have to offer the test - you just need a doctor to take the biopsy. Though I’d mention as the call I had was free and he spoke to me for about 30 minutes.