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

@HPrior we may be onto something with the dna fragmentation then! Yeah we’re exactly the same, too knackered most of the time but going to try and make an extra effort and see if this helps at all. It’s got to be worth a shot!
Ok, so the EMMA and ALICE results may still uncover something for you.
I do know how you feel. I was convinced that this right sided pain I was having was the reason I wasn’t getting pregnant but obviously not.
I’ll keep you updated with any other theories I have!

@Lucy040288EMMA and ALICE tests were clear. Just had my consultation. He has suggested a few other things but I feel I am now into the random tests / add ons stage and don’t really believe anything else is going to work.

@HPrior did you ask about sperm dna fragmentation? I just feel that it could be the missing part of the puzzle. Women are always the ones having so many tests and procedures but men just do a semen analysis and if it’s normal then that’s it but even with a normal semen analysis they can still have dna fragmentation.
there are loads of other things they can do now with steroids and lipids and all sorts for IVF so try not to feel defeated just yet.

@Lucy040288i checked with the clinic and we didn’t do the DNA fragmentation test when we did the original sperm testing. I forgot to ask about it at the appointment today. I’ll try to remember to bring it up at my next appointment.

@Lucy040288i just wanted to do a proper update as I was a bit emotional last week. Overall it looks like my issue is implantation failure based on no blocked tubes, trying naturally for over a year, and having two failed transfers of euploid embryos. However, they have done pretty much every test and check they can do and can’t find anything that would suggest an embryo couldn’t implant so I am now in the dreaded “unexplained” category. My consultant said I should see that as a good thing as there is no reason why I can’t get pregnant again. But my pessimistic outlook only really leads me to believe there is something wrong and we can’t find it.

Re the spotting that I have been fixated on the whole time and convinced is linked in some way to the infertility, the consultant didn’t really have any answers. But he did say the lining shedding after my period had ended shouldn't really cause any issues with fertility. The spotting before my period coincides with my progesterone dropping off naturally so I think that is why that happens. When I had my first transfer using a natural cycle I had to top up progesterone twice and I didn’t have spotting that month after I came off the IVF drugs, presumably because the synthetic progesterone was taken away suddenly as opposed to dropping off gradually. I discussed taking progesterone at the end of my cycle with my consultant but he said he didn’t generally like doing that because it delays your natural period. He said if I get pregnant naturally, to take progesterone once I am pregnant. In any event, I don’t think this is the problem because I had plenty of progesterone on the two failed IVF transfers.

I asked about doing a MRI to check for adenomyosis which could account for the spotting but he said he didn’t think that was necessary as if I had severe adenomyosis, it would have been seen in the tests I have already done. An MRI could pick up mild adenomyosis. For the same reason, he didn’t think down regulation would help.

My iron levels are pretty low (probably from heavy periods) so I am going to do an iron infusion to see if that helps.

Because of my insistence to try to work out the cause of the implantation failure, I am going to do a test for natural killer cells, which my consultant admitted is a controversial area but there are some small studies that support it.

Finally, for my next transfer I am going to be put on blood thinners. This will help blood flow to the uterus. The consultant explained that if I did have mild adenomyosis, this is what would be prescribed as adenomyosis restricts blood flow to the uterus. That was his reason for not needing an MRI- because we will essentially treat the adenomyosis anyway.

I also tried acupuncture the other day (I always thought the day I did that would be the day I lost all hope as I really don’t believe in that sort of thing). I wasnt particularly convinced and didn’t really find it relaxing so don’t think I’ll bother again as it isn’t cheap.

So that’s it really. My husband is more optimistic but I am trying to start to come to terms with only having one child. It’s really hard to picture my family that way as it feels so incomplete (I always wanted 3 children, let alone 2!) and I feel sad for my daughter not having siblings. I expect you are having all the same thoughts as me. It’s difficult but I need to try to not let it ruin everything I do have.

@HPrior try not to give up hope just yet. I know it’s hard and frustrating and I felt completely the same after my laparoscopy. I really wanted there to be a reason it wasn’t happening so I completely understand how you’re feeling.
It sounds very simplistic but could it be stress that’s affecting implantation? Because you want it so so much your body’s so tense and that’s why it’s not happening? Just a thought.
I have read that low iron levels can affect fertility so an infusion sounds a good idea. Surely that could affect adequate blood supply to the uterus and affect implantation?!
I have read about natural killer cells too so may be worth a shot. It can’t hurt can it!
With blood thinners, is that aspirin? Or are you going to be having enoxaparin? That could be all you need and it works!
I’ve actually read evidence that acupuncture improves blood flow to the uterus so it might be worth considering continuing that while you do another transfer. I get that it’s a bit alternative but it is still evidence based and has shown improved outcomes with IVF.
I’m trying to have a more positive outlook and relax a bit at the moment. When we conceived our daughter, although we were trying, we were still having fun and enjoying ourselves but since trying for our second it’s just been about doing the deed to get pregnant. I’m trying really hard to have more sex all through the month at the moment and not pressure ourselves to only do it at ovulation. It might not help at all but I’m just thinking if I try to change my mindset it might work.
There’s a woman in my office who has recently announced she’s pregnant and it took her 5 years. The minute she relaxed and felt content with her life with the fact she may not have children she got pregnant!
I would still be up for doing IVF but I want to just try and relax for a few months and see how things go. The last nearly 2 years have been taken over by trying to get pregnant and fertility investigations and I feel I just need to chill a bit. I also feel a bit guilty as I’ve been so obsessed with having another baby that I feel I’ve not been fully present for my daughter and she’s growing up so fast and if she is the only child I have then I need to embrace every day and be thankful I’ve got her. So although I’m not giving up, I’m changing my mindset and hoping that will help.
Try not to give up just yet. There are still options open to you!

@Lucy040288Just messaging to see how you are getting on. Update on my end- I was due to have another frozen embryo transfer and my consultant had advised blood thinners to see if that made a difference. But I did some research and turns out there is very little evidence that blood thinners really do anything. He had insisted that the spotting and heavy periods were having no impact on my fertility and wasn’t interested in doing further investigations so I thought I’ve had enough of this and decided to get a second opinion outside the fertility clinic.

I’ve been using AI a lot recently to research my symptoms. It is extremely useful - obviously it may not always be correct and you have to check the sources but I really recommend putting in your whole fertility background and seeing what it comes out with if you haven’t done so already. I went to see a gynaecologist (recommended by AI) who specialises in bleeding disorders, including Adenomyosis. He was very helpful and had a very different take on my symptoms from the clinic. I went to him wanting him to look into Adenomyosis but after I’d explained everything to him he actually said he’d be interested in looking at my c section scar and seeing if there is a niche. It was at that point I told him I had a niche but it was very minor and I had been told by the clinic repeatedly that it wasn’t a cause for my infertility. He disagreed and said even if small, a niche could affect things and explained how blood pools in the niche and can flow back into the uterus making the lining toxic (and causing the spotting). My research after that appointment has left me very surprised that no one at my fertility clinic has linked my symptoms to c section defect. If you look up symptoms the top one is dark brown spotting which starts shortly after your period has ended and lasts several days - exactly what happens to me.

Incidentally, he also agreed with me that blood thinners would likely have made no difference. He actually said that if I had Adenomyosis, blood thinners would make the condition worse. He said they were simply one of the drugs they add in to see if they make a difference but there isn’t much evidence to suggest that they help.

My new gynaecologist is now doing further investigations looking for adenomyosis and c section niche. I have had an MRI, am having an ultrasound and he said he may re-do the hysteroscopy to look at the niche. I’ve just started these investigations so it will take a little while for me to know the outcome but I’ll let you know if I learn anything from it.

Getting a second opinion that is so different from anything else I have been told by supposed experts has really opened my eyes to the fact you can’t trust a single (or even more than one) doctor when they sit there and tell you there is nothing wrong and your fertility problems are simply “unexplained”. They seem to only really know what they specialise in (which is essentially IVF) and are surprisingly ignorant about the range of causes for infertility. So my advice is to get another opinion and try to find the right person to ask by researching your symptoms on AI.

Hi @HPrior ! Good to hear from you! I did think about you the other day actually and wondered how you were getting on.
5 months post laparoscopy and still not pregnant. I think I’ve had another chemical this month though as had faint positives and my boobs were killing me. Of course I came on my period as normal.
It’s really interesting you say that as my husband had a massive go at me the other day for spending too much time on AI and telling me I need to speak to actual doctors who know what they’re on about!!!
I had a bit of a mental breakdown and rang a fertility clinic to start looking into doing IVF. However, I’m still convinced there is something that needs to be fixed.
I find it very strange how my right sided pain started a year after c section. And that is where I have a blocked tube. Consultant said that wouldn’t be causing me pain and is most likely due to chlamydia I had at 19. I asked about chronic endometritis but was told my ultrasound was normal so they wouldn’t do hysteroscopy. I am seriously wondering if that could be my problem as it’s under diagnosed. Also with me falling pregnant after Hsg, that can calm inflammation in the endometrium but obviously not enough as it still didn’t stick.
When I first started worrying about my fertility I looked into niches a lot and from what I understand they need repairing. I really hope this is what your problem is and it can be sorted out.
Part of me thinks I should just give in and go for IVF and see what happens but the other part of me wants to find out what’s wrong. I’m toying between paying for a private hysteroscopy or just buying antibiotics online and seeing what happens! I must sound completely bonkers but I’m desperate. I can’t understand how easy it was to get pregnant with my daughter and now 2 years down the line and nothing. There has to be some answers!
I really really hope that your new consultant gets to the bottom of what’s going on for you.

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.

@MocktailMe i can’t understand if having chlamydia caused me to have one proximal blocked tube when I didn’t get pain that side until a year after c section. I conceived the first month trying for my daughter at 33 and didn’t have any fertility investigations before her. Also, chlamydia generally causes bilateral blocked tubes and not unilateral and are most commonly associated with distal blockages and not proximal.
the consultant told me that my proximal blocked tube would NOT be causing my pain. Which I fail to believe. I asked for him to remove my tube but he said it looked healthy from the outside so would not remove it. From my research, chronic endometritis can cause proximal blocked tubes due to inflammation inside endometrium.
I had chemical pregnancies prior to me having the HSG and I always knew it was coming from my left side as I felt ovulation on my right. I’m not having it that my repeated chemical pregnancies are down to chromosomal abnormalities. There is something preventing complete implantation.
I completely agree with @HPrior . I have felt all along that these experts just want to push you into IVF without investigating the reason you’re not getting pregnant.
Everything looks great for me apart from one blocked tube which shouldn’t affect natural conception. And if I did have a blocked tube when I conceived my daughter in 2021 then it didn’t hurt my chances then. However, I am convinced my problems stem from the c section. I had a prolonged labour with ruptured membranes for hours resulting in emergency c section.

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’m not known to have a c section scar defect and I’m not talking about that. I’m concerned I may have chronic endometritis which can cause chemical pregnancies and implantation failure. I have chronic pelvic pain. The thing is I haven’t been checked out throughly. They refused to do hysteroscopy as ultrasound looked normal when that is very common for chronic endometritis as it is microscopic inflammation that cannot be seen on ultrasound.

also, I thought I had a polyp in my cervix so went for a private consultation September 2024. I was told there was nothing there by the gynaecologist. Fast forward to August 2025 and I have a cervical polyp removed during laparoscopy. unfortunately so called experts can be wrong. I’m a nurse so I know doctors can be wrong.
I’m not punishing myself for having a c section as it got my daughter here safely but I’m concerned at what the after effects are that have prevented me having another child. Especially seeing as I never had pelvic pain before this procedure and never struggled with my fertility before that.
I also have a relative who had a c section in 2017. Then had an ectopic which was put down to residual infection following c section. She unfortunately suffered 3 more miscarriages before they found she had antiphospholipid syndrome which requires blood thinning injections. She has since gone on to have 2 more children. She is also only 2 weeks older than I am. Women are having babies into their 40s these days and it just seems a standard response that egg quality is the issue when there may be other things going on.

A gynaecologist also told me that my fertility and egg quality wouldn’t have declined that much from 33 to 36 when we first started trying.

@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.

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!

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.

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

@Dogsinthediningroom how did you know you had that and did the doxycycline work? What were your symptoms?

@Furlane I know I haven’t got endometriosis as laparoscopy was clear. I am concerned I may have endometritis.

Yes sorry, my phone autocorrected

@HPrior thank you for this. I really think you have to advocate for yourself and not be fobbed off by specialists when you know there is something wrong.
I think I’ll still concerned about doing IVF as I feel we haven’t got to the bottom of the problem. But very good point about them not being able to say it’s just poor egg quality with you having euploid embryos. Everything always seems to be blamed on that. And exactly I should have been able to ovulate a decent egg in the last 2 years to get pregnant but still no.
I haven’t got health insurance but willing to pay for a hysteroscopy privately. That’s a good way of describing ultrasounds! Have you had the CD138 staining as well though?
I’m glad your husband has come round to your way of thinking. My husband is very black and white with everything which is frustrating. He’s annoyed with me that I’m allowing all this fertility stuff to consume me. I agree it is driving me slightly mad but I need answers. I’m convinced my fertility and pelvic pain must be related.
I really do hope your new consultant is 3rd time lucky and the one that finds out what is going on for you.

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

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.

@amiadoormat my relative who lost her right tube due to an ectopic has had 2 more children since and no problems conceiving so not always the case. And I actually have conceived from my left side.
My concern is the right sided pelvic pain which must be connected to my blocked tube and fertility. My consultant said a proximal block does not cause pain but not sure it could be anything else.

@Imisscoffee2021 i did not have any adhesions or endometriosis on laparoscopy. It’s possible you may have adhesions with your pain. I have specific pain on my right side in a certain area.
I know plenty of women who have had multiple sections and have no issues which is great for them. But I think my symptoms must be something.

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!