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

@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

@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.

@Mushypeas101 actually my fertility consultant told me that yes if you delve deep into the literature that c section can indeed cause infertility

@MotherOfShihTzus thank you. The pre op nurse scared me a little as she said if they remove adhesions then doing too much too soon can cause them to come back. So yes I will definitely be trying to take it steady. Thank you x

@TheLivelyViper I asked my consultant to look at my c section op notes and there was no mention of endometriosis. I do have symptoms other than infertility. I started having right sided abdominal pain a year after c section which I have now been having for 2 years. So that coupled with the right blocked tube on HSG makes me suspicious. Also, since my HSG, ovulation pain on my right side has been very painful. I never feel ovulation in my left. And in between the 2 months where I felt right sided ovulation pain I caught pregnant so assuming that was from my left ovary. I’m guessing my right sided abdominal pain could be my blocked tube. Ultrasounds haven’t shown fibroids or any ovarian cysts.

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.

@TheLivelyViper I don’t think I have endometriosis at all. I think it may be adhesions post c section or possibly an infection post c section which has caused a blocked fallopian tube. It is right lower quadrant and as already explained gets worse during ovulation so seems likely it is my tube causing the pain. I have no gastro symptoms. All of my symptoms point to my blocked tube.

@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.

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.

@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!

@HPrior thank you for the update. I’m really pleased for you that you’re getting the investigations you want now. It’s not starting from scratch though as you know there is something wrong and you’re hopefully going to find out what that it is. You did what you thought was right and was advised by your consultant to go straight for IVF. Hopefully you’ll get your investigations done soon. We’re both still the right side of 40 so there is hope! Keeping everything crossed for you!

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.

@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.

I had my laparoscopy a couple of weeks ago but feeling quite frustrated and disappointed as it didn’t show any adhesions or endometriosis. I had 2 small cysts on my right tube that he removed and could have been the cause of my pain. No dye flowed through my right tube but it looked healthy on the outside and my left tube dilated when dye was pushed through, which means it’s not great but it must be functional for me to have gotten pregnant. I also had a cervical polyp removed. Unsure if this could have been affecting anything. He didn’t do a hysteroscopy as nothing on ultrasound to suggest there’s anything wrong. So I’m not sure what to do now. Got a follow up appointment next month. I’m now wondering if there isn’t really anything particularly wrong and maybe it is just my age and egg quality. I’m wondering whether to give Proceive Max and ubiquinol a go. I’m also unsure if stress was a factor as I started a new job in April and got pregnant 2 months later but it wasn’t to be. I absolutely hated my previous job and feel less stressed in my new role. Also unsure if I may have had a blocked right tube for years as I unfortunately had chlamydia when I was 19 but didn’t know about it for about a year before I got treated so maybe that caused some damage.

@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.

@HPrior to be honest it wasn’t that bad at all and hasn’t taken me long to recover. I’ve got a follow up appointment with my Consultant next month so I’ll ask him then. It’s a positive there has been something for them to remove but not sure how much it’ll improve things for me. My Consultant was insistent that since my ultrasounds were normal it was highly unlikely there would be anything wrong on hysteroscopy but if he found something on the lap, such as adhesions, then he’d have done the hysteroscopy as well. I do keep looking at the University of Warwick implantation clinic website and wondering whether to give that a go as it’s not too far for me to travel to. But part of me is just so deflated at the moment and think I maybe just need a break from the constant worrying about what’s wrong with me.
Hopefully your new Consultant will provide the answers for you. It would be nice to find something that can easily be fixed.

@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!

@HPrior i had my follow up after my surgery at the end of September but saw a lovely registrar as my consultant was away. She said the cysts and cervical polyp wouldn’t have affected fertility and they’re usually just incidental findings. I asked her about hysteroscopy and she said because on ultrasounds they can’t see a niche and the endometrium looks even and uniform they don’t suspect anything wrong. They have put me down as unexplained infertility, even though I appear to have a right blocked tube but she said this shouldn’t affect fertility too much as the other tube can pick up an egg from the other ovary. She did advise taking co enzyme q10 and melatonin to improve egg quality as that may be a factor due to my age. I’m feeling quite down at the moment and I’m scared to try again in case I miscarry again. There is the option of IVF still but I’m even afraid to do that because I’m scared it’ll end in disappointment.
I do understand what you’re saying and I think I feel happier having seen this registrar but a bit deflated as I was so convinced there was something wrong but maybe there isn’t after all and it is down to my age.
Are there any updates your end? Did ultrasounds show you had a niche? Hopefully you’ll get some answers soon!

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.

@MocktailMe that you for sharing your experience. I was completely unaware of any issue until trying to conceive my 2nd child and then it’s only recently I’ve began to wonder if the chlamydia had caused my blocked tube years ago. It’s strange that I conceived so quickly with my 1st. I’m not sure whether my problem could now be more age related and due to egg quality. I think we’re going to consider IVF after Christmas. But yes maybe you are right that my other tube may have some damage and that’s also a factor in why we’re not conceiving.
how old are you if you don’t mind me asking? How long have you been trying to conceive? Have you just started IVF?

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.

@MocktailMe hopefully you’ll be fine as you’ve got age on your side which is a big factor.
yes it’s frustrating. It’s difficult as there are no symptoms so you don’t know you’ve got it until it’s too late and then the damage is done. It’s not worth beating yourself up about it though as you weren’t to know.
yes that’s true, it is a concern.
I really hope IVF works out for you. I’ll keep my fingers crossed! You’ll have to keep us updated!

Hi @Lucy040288thought I would provide you with an update. I had the laparoscopy and hysteroscopy a couple of weeks ago. Consultant also did endometrial biopsies, removed the extra thick part of my uterine lining and re-did the hycosy while I was under anaesthetic. Outcomes: found and removed a small amount of stage one endometriosis, both tubes are in fact open, no apparent issues with uterus and biopsies have so far come back clear (waiting on 2 tests). I have had my period and was initially hopeful to see the spotting pre period had stopped. However, I am really disappointed to still be experiencing spotting post period and the period itself was still heavy.

I was pretty shocked to find my tubes were not blocked. Consultant said sometimes tubes can spasm when you have hycosy and this can make them appear blocked. This doesnt happen under anaesthetic because you are fully relaxed. Very frustrated that I was not warned about this possibility by the doctor who performed the procedure originally as it means I did IVF on a false positive test result.

Had a quick chat with the consultant following the procedure and he said whilst it was tempting to be disappointed that we had not found anything obviously wrong, I should see this as a good thing as he cannot find any reason I should not be getting pregnant. I am due to have the full follow up consultation in a few days time. However, seeing that my period symptoms have not been “fixed” by him removing the extra lining and removing the endometriosis has been very disappointing and I really don’t believe this has fixed things as a result.

It is difficult but I am starting to come to terms with the fact it’s increasingly unlikely I’ll have anymore children.

I’ll let you know if I have any further updates. Best of luck with your journey and good luck if you go down the IVF route.

Hi @HPrior thank you for the update. I’m sorry they didn’t really find anything. However, even removing the small amount of endo and some of your uterine lining may improve things for you. Was anything said about the niche that had been seen on ultrasound?

I understand your frustration about the tubes. I was aware that there could be a spasm and it not be a true block. My right tube still did not allow dye through it during my lap but my Consultant said it could still just be preferential flow through the left but I feel that my right is truly blocked.

I’ve been doing a lot of reading up about things recently. When I did fall pregnant in June I had been eating more live yogurt with probiotics and I wonder if this helped? Your uterus should be abundant with lactobacillus and if it isn’t then this can cause implantation failure. Did you have the EMMA/ALICE test and have they come back normal? I have started taking optibac probiotics for women to see if they may help.

Also, was your husband’s semen analysis normal? And was he ever tested for sperm dna fragmentation? My most recent thought, and sorry for TMI, is that we have only been having sex during the fertile week and rarely at any other times of the month. My husband also does not self pleasure so he is not ejaculating regularly. This can lead to sperm dna fragmentation as it’s been stored for too long and subject to oxidative stress. When we conceived our daughter we were having very regular sex. NICE guidelines and NHS state to have sex every 2-3 days throughout the month. Also, my husband doesn’t have the best diet so I have been giving him vitamins for the last couple of months to see if that improves things. He hasn’t had a sperm dna fragmentation test but I wonder if this could be at least part of the issue. My understanding is that even with euploid embryos there could still be dna fragmentation which means they don’t keep developing normally. It could also be why I miscarried very early at 6 weeks.

I think we’re all too quick to blame ourselves being women and thinking it’s our bodies failing us when actually it could quite well be the male side. Even if their semen analysis is normal it doesn’t rule out sperm dna fragmentation and it isn’t something that is routinely tested for. I may be completely going off on one and it not be a factor at all but just feel it might be worth thinking about.

@Lucy040288thanks for the additional info. Re the niche - the consultant said it was very tiny and said correcting it isn’t an easy procedure so that was ruled out for now but I may raise it again.

We did sperm testing with the clinic but I do not know if they did the fragmentation test. I will phone them tomorrow and ask. For the IVF my husband was told to ejaculate every 2-3 days before the egg collection day. They didn't tell us why but I assume what you are saying was the reason. So I hope he did do it! We are similar in that we only have sex around ovulation (toddler, stressful jobs and just us both generally having a low sex drive have affected that a lot) so this may be worth exploring - thank you. Good to hear we aren’t the only ones!

I do have kefir most mornings so that should help with lactobacillus. The EMMA and ALICE are the test results I’m still waiting for so I’ll get confirmation either way re whether that side of things is fine.

I have always been convinced the period symptoms were resulting from whatever the underlying cause of the infertility was. I’ve always believed if they recover, I’ll be able to have another baby. Just my own instinct but at this stage I’ve lost faith in medical professionals..