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

The first section affected my fertility a bit, but because I lost an ovary. 1 month to get pregnant with first and 5 months with second.

Have the hysteroscopy, and have ultrasound to confirm how thick your endrometrial lining gets during your cycle and whether it takes on the right format (triple line visible on ultrasound) to support implantation of a fertilized egg. If your lining doesn’t grow thick enough after adhesions have been removed it is incredibly difficult to have a successful pregnancy. Get these tests before you go through the hormonal and emotional rollercoaster of IVF.
My experience is of ashermans after emergency c section, but I also had ablation to stop bleeding post c section as the uterus wouldn’t contract. I was left infertile, and although the surgery to remove the adhesions (and unblock a fallopian tube) was successful, my endometrial lining never recovered.
I wish you every success OP, find a doctor prepared to listen to your concerns.

@HPrior what is the size of your c section niche? I had another scan yesterday and have been found to have a 7mm niche. Previous scans haven’t shown this. Very frustrating!

Hi - sorry to join this thread randomly but I am experiencing the exact same thing as you. Had a c section early 2022, one year later I developed right side abdominal/pelvic pain and I was sent for an ultrasound but they reported nothing. Now I’ve been ttc for 13 months and no joy and I’m convinced the pain is causing my infertility. Going to try and get tests from the GP as they have been extremely unhelpful so far, basically telling me to go for private IVF because they will not do anything. So frustrating isn’t it.

@user0987637829 hi! So you can be referred for tests on the NHS. GP usually does blood tests for hormones and then NHS fertility unit can do a test to check if your tubes are open.
The fertility doctor I saw today said a niche would not cause pelvic pain but looking online it appears it can do. I’m wondering if that’s been the cause of my symptoms all along.
what day of your cycle did you have your ultrasound scan? I had my first scan on cycle day 7 in June 2024 then another 3d scan a year ago the day before my period. I have just had a scan on cycle day 14 and that’s where the niche has been picked up. I’m waiting to hear about a plan going forwards.

@user0987637829 i do wonder if I had gone to a private clinic and started IVF sooner then the niche may have been picked up earlier as they tend to do a lot of ultrasound scans to monitor the growth of your eggs so fluid in the uterus can be picked up that way.

The MRI I had a couple of weeks ago showed it was 5/5/8mm. I had a repeat hysteroscopy following the MRI so have now seen it for myself on camera as well. Mine was not picked up until I had had several ultrasounds either (including when I had a saline scan). They are obviously very difficult to see and perhaps only visible on ultrasound at certain times of the month.

My MRI showed no adenomyosis so that is now ruled out.

I am pretty much certain the niche is what’s caused my spotting as my symptoms are textbook. I can’t believe no one at the fertility clinic linked the two when I was constantly going on about the spotting! I also believe this is what is causing my infertility.

Whether or not it can be fixed is less certain but I think there is hope. There are two procedures to fix a niche - one is more straightforward where they go in via hysteroscopy and shave away the edges of the niche to stop blood getting trapped. You can only have this if your uterus by the niche is at least 3mm think (mine is 6mm). The alternative is to re-open the scar and mend it properly via laparoscopy. This is more major surgery with a longer recovery period but your uterine wall is thicker at the end so better to support a pregnancy. For minor surgery you can TTC after 2-3 months but for more major surgery you have to wait around 6 months). I am in theory a good candidate for the more minor hysteroscopy surgery, but my new consultant is extra cautious and wants me to get a second opinion as to whether this is the best way to protect my future fertility. So I am seeing someone he recommended in a couple of weeks to discuss.

One thing I would note (I’ve said the same before) is my consultant said he wouldn’t be recommending getting the operation if I hadn’t had the euploid embryo transfers because of the risk of surgery and his belief that for the vast majority of cases it is the embryos that are the problem. So just to warn you you’ll probably have a fight on your hands to get the niche taken seriously (sounds like it is small like mine). I don’t really agree with him that it’s most likely to be the embryos that are the reason for failure but that does seem to be the accepted medical opinion across the board, which is extremely frustrating! Just in my group of friends I have two people who had multiple attempts and failed at IVF and later found out they had structural issues (one stage 4 silent endo and the other asherman syndrome). I believe the doctors are wrong to assume aneuploid embryos without investigating the uterine environment - I don’t care if that sounds arrogant for a non medical professional to say!

On this, my private clinic (who are supposed to be one of the best in the U.K.) 1. Did not pick up the niche until I had done multiple scans and it was only picked up when I had a routine scan from a different doctor before my embryo transfer. He said it was small and “very unlikely” to cause problems with implantation. 2. Even after me asking for the niche to be checked when I did the hysteroscopy, don’t seem to have paid much attention to it because there were no photos of it (meaning my new consultant had to re- do the hysteroscopy) 3. Insisted after the hysteroscopy that the c section niche wasn’t causing the implantation failure and 4. Never once linked my post menstrual spotting to the niche despite me sounding like a broken record and asking what could be causing it on every appointment and despite the fact my symptoms are textbook and the new consultant upon hearing my symptoms immediately suspected a niche (I hadn’t told him I had one because I had repeatedly been told it wasn’t an issue).

The “fertility” clinics should just call themselves IVF clinics because in all honestly that’s all they want to do and all they are experts in.

Could you push for investigation on Asherman's Syndrome? I had it after a D&C and from what I learned from that experience is that it's not very well known and understood. Also, it's very difficult to diagnose if you are using standard diagnostic exams. I made some researches online and found a couple of the best consultants in the world were based in the UK and I contacted them privately.

@HPrior thank you for this. I had made an appointment at a fertility clinic to consider IVF and had an initial appointment yesterday. The ultrasound again showed a 7mm x 4mm niche. The sonographer said it’s small and they have had ladies with very large niches who have been successful with IVF. However, I think some women can have problems and others aren’t affected at all.
do you have any pelvic pain? I’ve read a lot about niches causing pelvic pain and I’m certain this is what has been causing it all along.
also, incidentally I was found to have a slightly raised Immunoglobulin A on a blood test to rule out celiac disease. This is also a marker of chronic inflammation, which fits with having the niche and my uterus being chronically inflamed and not supporting pregnancy. This wasn’t taken seriously either.
there is no way I‘m paying for IVF and it leading to disappointment before I have this niche repaired. I’ve known for 2.5 years that something is wrong because of this pain and so have been reluctant to do IVF because I’ve felt that it wouldn’t work.
i definitely think there is hope. It sounds good that your new consultant is cautious and wants a further opinion.
Was yours filled with fluid? The doctor I saw on Tuesday said they may have to think about the best time to scan women during their cycle for niches to show and found it interesting it hadn’t shown up before on previous scans.
you’ve been on one hell of a journey and I sincerely hope there is light at the end of the tunnel for you.

@HPrior also have you had CD138 staining now? As chronic endometritis goes hand in hand with a niche.

@Lucy040288I don’t get any pain with my defect, only the spotting and heavy periods (not sure if the latter is c section related). I haven’t ever been told there is fluid in the scar, no. My understanding is that the blood collects as you are having your period, gets stuck and then leaks out, which is why I get the post menstrual spotting - so I guess I’d see fluid there if I had a scan in the first week after my period but not sure. Re CD138, no I haven’t had that. The abnormal vascularity within my niche was really obvious during the hysteroscopy though, which can cause chronic inflammation.

Do you have a retroverted uterus out of interest? I do (about 1 in 5 women have it). It is a normal thing but it makes you more at risk from c section niche.

I would say definitely get the niche investigated via hysteroscopy and possibly MRI (depending on what is recommended). The CD138 test may also help you convince doctors your secondary infertility isn’t just down to bad embryos if you can show chronic inflammation. If you’re paying for a hysteroscopy, you may as well get the biopsy for the CD138 done at the same time.

I think the reason fertility experts overlook the niche is because it is so common to have a niche and in the majority of cases it doesn’t affect fertility. So you really have to convince them you are in the minority!

@Lucy040288my consultant showed me this video which may be of interest:

@HPrior that’s really interesting!
I’ve had a consultation with an IVF specialist this afternoon and she doesn’t think the niche is a problem as it’s small and they see much bigger. I’m not convinced. My ovarian reserve is very good for my age so she said I am better to do some more investigating before going for IVF. I am going to have a hysteroscopy and see what that shows. To be honest, I’d just rather go ahead and get the niche repaired instead of having to have a hysteroscopy for diagnosis and then another for treatment. I’ve wasted enough time as it is. It’s so frustrating.
My uterus is a bit strange - ultrasound June 2024 showed anteverted but 3D scan last year and my most recent scans last week have shown retroverted. I’ve also read that niches are more common after a long labour and dilation of more than 5cm. I was stuck at 5cm for a good 12 hours before the section.
I really need to find a specialist who will take my concerns about the niche seriously. At least it seems like you’re on the right track now.

Yes, I have had the same advice with my niche until now, because it is small they write it off as being an issue. You may need an MRI and/or hysteroscopy to assess what procedure would be needed to repair the niche. If your myometrial thickness behind the niche is less than 3mm you have to have more major surgery to open the scar and re-sew it. It’s only if your myometrial thickness is thick enough that you can have the more minor surgery to smooth out the pocket. I would happily recommend my consultant but he did say to me it was the fact I had had euploid embryo transfers that meant he was recommending the repair - otherwise he would have put the infertility down to being bad embryos. I am seeing the second opinion consultant next week so I will let you know if he is any good.

@HPrior I asked yesterday about residual myometrial thickness and she said it looked thick on ultrasound as the niche is only small so I would hope it can just be hysteroscopic repair.
Hmmm it’s very difficult trying to convince any of them that there’s a problem that needs sorting!!
did you get pregnant with your daughter easily before?
I found out today that my cousin’s girlfriend is pregnant with her 3rd baby. It’s really upset me. She’s had 2 c sections. It just seems so unfair. I’m really struggling at the moment. I’m so sick of this nightmare.
yes that would be good! Thank you! You’re in London though aren’t you? I’m east mids

I’m really sorry you’re struggling. I find I am ok mostly but I do get periods where I get very depressed about it. It has got easier over time but weirdly I have come to dread any new treatment as I know if it doesn’t work I’ll have to deal with the disappointment again. During the in between periods I’m ok I think because I have hope to cling onto that the next thing will work, even though I know it might not.

I think there is a real problem with the culture around infertility and the reluctance of doctor’s to investigate and treat potential structural problems.

With c section defect and secondary infertility, I think it is an area that is relatively new in its discovery and there is relatively little known about it. There are only very small studies looking at outcomes from these procedures which “fix” the niches. Definitely worth investigating for you I think but also remember to keep an open mind as to potential other causes. I expect you’ll be told that surgery is a risk - my consultant was clearly concerned about that because he was very keen for me to get a second opinion.

Is this actually true??
I had no choice but to have a c section due to pre eclampsia, I was not told this at the time and surely the health professionals should mention this before?

hi,

just came across your post!! I had a c section with my daughter due to preeclampsia she now is 19 months and are now TTC baby number 2: I did not know this was a thing with c sections and how it can affect TTC in future pregnancies!!! Now I am worrying!!!

when you say about pelvic pain where abouts roughly is it? Does it hurt to walk?

also I hope you manage to get your second baby 👶 🤞🏻

C Section niches are very common - current estimates are that up to 70% have some kind of niche following a c section. However, for the majority of women, niches do not cause infertility or any other symptoms / problems. All surgery, including c sections, carries risks, as does vaginal birth, and most people that have c sections go on to have successful second pregnancies and beyond. I was also told by my consultant that I was unlucky because it is relatively unusual to have a symptomatic c section niche after only one c section. Much more common to get problems after multiple c sections. I wasn’t, however, informed about this risk before I had my c section and my experience, having gone through multiple investigations with no one flagging this as a potential cause of my problems until now, is that medical professionals are generally not alert to this as a potential cause of secondary infertility and are not aware of the symptoms. So in conclusion, don’t panic if you’ve had a c section. It’s more likely than not that it won’t affect future fertility.

@HPrior

when I seen this conversation ngl i panicked as to me that’s a lot of women on here that are struggling to get pregnant after having a c section! I just never told this could have been a risk to me!! I do have pelvic pain just before I am due on my period but think that’s just normal although I never really experienced it until probably this year and my daughter is now 19 months.

I am so sorry you’ve gone through such a hard time ☹️ it sounds heartbreaking and I wish you nothing but the best xx

@Chelseaaaaa this post is not meant to scare anyone. It’s just been my experience post c section. I know many women who have had multiple c sections and they are fine so fingers crossed you will be too!

@HPrior sorry it’s been so long since my last update. I’ve had a lot going off.
So I bought 2 weeks worth of doxycycline and metronidazole online for chronic endometritis. Immediately my pain seemed to resolve. However, I then developed horrible throbbing pain and it was like a sharp area like something was embedded. I struggled to get comfortable lying on my front like something was lodged inside me. Since I finished my antibiotics I have a very sharp pain in one tiny area and then the rest of my pelvis feels itchy and irritated.
i met with my Consultant and again he isn’t convinced the niche is my problem. He told me that 40% of couple who go through his clinic are unexplained. He advised me to try distracting myself and to have some counselling……..! He did request an MRI pelvis and said to await hysteroscopy. I rang yesterday to chase up my hysteroscopy and was told it had been trained as routine so may be a few months.
something occurred to me the other day. On my ultrasound it showed a 7mm subserosal fibroid. I’m wondering if this is what is causing my sharp pain. A lot of research later and I found that ultrasounds can’t differentiate between a ‘fibroid’ and a suture granuloma. I’m convinced now that I have retained sutures from my c section. All of my symptoms fit. It was actually a couple of ex theatre staff I work with that suggested that may be my problem.
i’ve found another specialist and am having an appointment with him tomorrow.
i don’t feel like my consultant is taking me seriously and just thinks I’m mental! I know there is something wrong with me and it’s driving me mad that no one is listening to me.
how are you getting on?

Triaged not trained!

Did you have endometriosis before getting pregnant? Has your periods always been on time every month? Did you have an emergency c section also? When did these pains all start? Sorry I’ve not really read the comments so don’t feel like you have to explain yourself

Sorry for ALL the questions 🫣