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

@Chelseaaaaa I don’t have endometriosis. I had a laparoscopy last August that was clear for that. Periods very regular, no period pain. I had an emergency c section. The right sided pelvic pain started a year after c section. Not cyclical. The pain just there all the time. After taking antibiotics the pain has now changed, adding further fuel to the fact my pain is inflammation related.
honestly though, please try not to worry yourself! You probably won’t have any trouble conceiving so don’t let my story panic you!

@Lucy040288

I have pelvic pain around the time I am due on,it’s more pressure if anything hurts when I walk but goes after while! That only started this year hoping it’s nothing related to c section.

I wish you the best of luck and I hope you get your baby xxx

@Chelseaaaaa if you’re concerned then see your GP and ask for an ultrasound. It doesn’t automatically mean that there is something wrong that is going to affect your fertility so try not to worry about that just yet.
thank you, I hope you do too! Xx

Sounds like you are getting closer to an explanation. And I think it is 100% the right path to get MRI and hysteroscopy. Once consultants start on the “unexplained” path ditch them IMO. It just means they don’t know the answer and can’t be bothered to look for one. To give some context I had multiple ultrasounds with 3 different specialists, including a saline one, before someone (the 4th person) even saw my niche. I was objectively told my scar had healed well by the other 3. Even after the niche was known about and I had my first hysteroscopy I was told it was too small to be problematic. I have told countless different medical people (multiple GPs, a gynaecologist, 3 consultants at my fertility clinic, nurses and sonographers) about my post menstrual spotting and not one knew this was a symptom of a c section niche. Then when I found the right guy he said immediately, without me even mentioning the niche, “I would be interested to take a look at your scar as post menstrual spotting is very typical of c section niche”. I’m glad you’ve stumbled across this potential sutures explanation. I have never heard of it and I expect many specialists haven’t either. Best of luck with the investigations.

Update on my end- I’ve had my c section resection now. Very straightforward day case, little pain afterwards. Have to wait a few months for it to heal now before I can TTC. Crossing everything!

@HPrior it’s very frustrating not being listened to. It’s so sad how women have to go to so many different specialists to get the right help with gynaecological issues.
How many days did you spot for after your period? Has the resection stopped the spotting now? I really hope it works out for you! Are you going to do another round of IVF or TTC naturally?
So I’ve seen another private consultant today who is a specialist in c section niche repairs. I showed him my ultrasound images and he doesn’t think that is my problem. He actually thought my endometrium looked heterogenous which has never been mentioned before. He is a bit perplexed by my symptoms and didn’t seem convinced by my suture theory. He was also confused as to why I didn’t have a hysteroscopy at the same time as my laparoscopy especially seeing as I have a proximal blocked tube so thought this should have been looked into.
I’m booked in for a hysteroscopy at the end of this month so I’m hoping I get some answers. My only other thought was that maybe I had some retained tissue after my c section that has calcified and lodged in the entrance to my fallopian tube causing the blockage, pain and inflammation. There’s got to be something wrong as this pain isn’t normal.

@HPriorhi, i hope you don’t mind me messaging. I feel like I could have written what you’ve said on this thread, our stories are so similar. Would you mind sharing which consultant did your resection? I saw Adrian Lower a few months ago who told me that he could do this for me, but I’ve seen various other names on other forums so trying to figure out the best option for me. Thank you 🙏

Dont mind at all. I used Mahantesh Karoshi. Really liked him. His specialist area is mainly treating irregular bleeding as opposed to secondary infertility though so he wanted me to get a second opinion from a fertility specialist before I had my resection, which I did but I stuck with Mr Karoshi for the procedure. I have just discovered there is another thread on Mumsnet called secondary infertility following emergency c section which discussed niches and resection. There are also a couple of Facebook groups on c section niches which I have just requested to join.

I had my c section resection 6 weeks ago. I’ve been searching for stories about recovery from the procedure as so far I have some improvement (no more horrible dark sludgey spotting post period) but still several days of lighter spotting so am concerned. But the official line from my consultant is it’s too early to assess the success of the procedure as it heals over time (have to wait for 3 cycles).

Hope this info helps!

I have heard of Adrian Lower. Did he have much information about the success of these procedures? This seems to be a relatively new field and there is very little information on it.

@1SparklingWater1 have you had an MRI?
just to update this thread…my consultant did not feel on ultrasound I had a significant niche but requested mri on nhs. This was rejected. I paid for a private mri and I am so glad I did! I have just had the results. 6mm niche with 0mm myometrium covering the niche and only 2mm serosa with dense adhesions between this and my bladder. I need a laparoscopic resection which my consultant does not do so I am being referred to another specialist. On ultrasound it looked like my myometrium was thick. If I had been able to get pregnant I would have been at very high risk of uterine rupture. I have also had hysteroscopy and CD138 staining came back at 6 plasma cells per HPF. Above 5 is showing inflammation.
@HPrior have you had CD138 staining as this can also cause spotting? Do you have a follow up scan or hysteroscopy after 3 months to assess niche repair success?

anyone reading this thread, please please trust your instincts. I have known something has been wrong with my body since September 2023 and have been reluctant to do IVF as I just felt it wouldn’t work. Even though consultants have told me this would be my only way to conceive after 2 years of trying. I have had to push to finally find what has been wrong all along.

@Lucy040288I’m so pleased for you that you have found out what is wrong! Really hope the laparoscopy repair goes well. Are you doing that on the NHS?

No, I never did the CD138 biopsy. I don’t see the point now as I believe I have identified the cause of my implantation failure. As you can see from my last message, I had the procedure done to smooth out the niche. I have been a bit disappointed so far with the results - there has been some improvement but I am still getting several days of post menstrual spotting. There is a useful study online that looks at recoveries after this procedure which does show that many people still get spotting for some time afterwards and there is even improvement up to 6 months. So I know it is too early to judge. But I am concerned - it’s hard not to think this is just another disappointment and my uterus can’t be fixed.

In terms of next steps, I can TTC naturally after I have my next period. However, I won’t get another embryo transfer unless I have had a real improvement in symptoms. If no improvement after 3x periods, I’ll look into further investigations. I have heard that some people have to have the procedure done twice before it works or I could try the laparoscopic repair.

And I echo your advice on trusting your instinct. You hear this so much and I never understood what people meant by it. Now I have experience, I can say that really what it means is don’t put too much trust in medical professionals - they don’t know everything and are really bad at telling you where their expertise is limited. They are often wrong and several can be wrong before you find one that is right. C section niches are a very new thing to be discovered and there is little research or consensus on them. They are very often missed on ultrasound. In my opinion, if you have secondary infertility and had a c section, they should be one of the first things considered as the cause.

@HPrior yes I’m relieved to finally know what’s wrong but very shocked at there being no myometrium where the niche is. My consultant said it would be risky doing it in the private sector but this other specialist has more of a team around him. I’ve arranged to see him privately. It apparently could be done on NHS but there would be a wait and I’ve waited long enough already so will pay whatever it costs.
I know the niche is your problem and hopefully the repair will have sorted it and it’s just taking a few months to settle down but just wondered if there might be some residual inflammation. At least it has seemed to help and you never know it might have smoothed it out enough to help with implantation. As majority of women have a niche but the severity varies. And a lot of women have no problems getting pregnant after a c section. We’re just very unfortunate.
fingers crossed you manage to conceive naturally and don’t need to undergo another procedure. To be honest I’m terrified of a laparoscopic resection and I wish I could have just had the hysteroscopic procedure.
i 100% agree with looking for a niche with secondary infertility. Even after my MRI results my consultant was saying we could do IVF as he has had women with very large niches succeed. But I know that after several chemical pregnancies, IVF won’t work for me. It won’t matter how amazing the embryo is, nothing will be able to fully implant into my defunct uterus and I’m not going to run the risk of uterine rupture! i’m tired of hearing a niche won’t affect fertility and that it’s my age and chromosomally abnormal embryos for the reason I’m not getting pregnant.
it’s so frustrating and draining having to be persistent and push for answers. In some ways I suppose I should be thankful that mine is so severe and I’m finally being taken seriously. But on the other hand I’m absolutely terrified of having the surgery. Plus there is a longer wait to TTC afterwards and I’m not getting any younger!
fingers crossed it works out for you and you conceive soon!

@HPriorthanks for the info. Not heard of that consultant but I’ll look him up. I’m actually based in Scotland but I’ve had to travel to London many times over the last 3 years to get access to specialists, no one up here looks at the more ‘experimental’ treatments. I know the Facebook group well - it is useful to find others in a similar situation, a lot of the time I just use it to get hope that it will work out.

I hope the spotting resolves for you, I would take it as a positive that the bleeding pattern has changed - you’ll see from the fb group that plenty of women have managed to conceive whilst they have spotting, and it shows that the surgery has had some impact, maybe it’s all you need to have a successful implantation.

Adrian Lower didn’t say too much about the potential success, he said it might work in maybe 50% of cases (not a bad % in my opinion!) but as you say, the research is so limited right now.

I’m similar to you in that I have euploid embryos in the freezer but I’ve been reluctant to do another transfer. I did actually have a hysteroscopy with Lesley Regan a couple of months ago where she got rid of some adhesions (she didn’t think the niche was relevant, annoyingly) but my spotting pattern is the same as before so I’m not convinced it’s done any good! Despite this I’m going to try another transfer in a few weeks, I’m also doing some immune treatment (I’ve had multiple chemicals - 6 in total now), and higher progesterone dose to try and clear up the fluid. The consultant doing the transfer is also going to aspirate any fluid, although he is sceptical about whether that is worthwhile!

@Lucy040288thats so interesting what you’ve said about an MRI. I had no idea that it could show such different results. I have actually had a pelvic mri recently but for an unrelated issue, I might see if they can review the images again!

I saw in an earlier message that you’ve had chemical pregnancies too…I haven’t come across many people who have had them whilst having a symptomatic niche. I’ve had 6 in the last 3 years including 1 with a euploid embryo. Was told many times that it was my age (40 in a few weeks), but exactly the same thing happened in my IVF cycle with a tested embryo so the clinic seem to now agree that something else is going on. I’m lucky to have a good number of euploids in the freezer but it just feels like I can’t do anything with them because I keep miscarrying. So hard to keep the hope going.

@1SparklingWater1 definitely get your MRI reviewed. Although, I think there are different protocols for MRIs depending on what it is looking for. But if a gynae radiologist can look at it then it might show something.
I must have had at least 5 chemicals and a miscarriage at 6 weeks over the last 2 years. My understanding is that the fluid in the niche causes chronic inflammation in the uterus which prevents adequate implantation of the embryo or the embryo implants near the niche where the blood supply is compromised and it is unable to survive.
I honestly wish I’d paid for an MRI a year ago! Yes I kept being told it was my age and egg quality! I’m 38 now but been trying since I just turned 36. So so frustrating not being listened to.

@Lucy040288and @1SparklingWater1 thank you for your responses. I have now been given access to the Facebook group and it’s crazy to read all these stories and symptoms so similar to mine after two years of having my symptoms unexplained. How are medical professionals and so called fertility experts missing this so consistently?

Reading the facebook comments does also make me feel rather disheartened about the realities of how successful the repair procedures are. Seems it works for some and not for others.

I know I have to wait for one or two more cycles and see if there is any further improvement. Hard not to feel disheartened when after 6 weeks I am still spotting up to ovulation. I did have some small improvements: pre menstrual spotting was only one day (down from 3-5 days before) and post menstrual spotting was not the think sludgey black blood I had before, it was lighter brown in colour and more watery and much less in volume. However, the duration I think was slightly worse - previously it stopped just before ovulation but this time I had blood mixed with egg white mucus (so right up to and including ovulation).