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

I read this the other day. Thought it may give us some hope!

@Lucy040288thanks so much for your reply!
Sorry to hear youre struggling post surgery. I really pray this is your answer! Did you have the niche removed? Did everything else look okay? No chronic endomitrisis?

Thank you so much for the advice. Can a hysteroscopy and CD138 be done at the same time? Would the NHS do this do you know? Or would I need to go private.

The doctor didnt mention any fluid being seen before she put the saline in. But then could clearly see the niche! I have had multiple scans over 1.5 years (only 2d) but never any mention of fluid. Would it have been seen?

Its such a hard journey trying to figure out why we cant concieve. I actually hope this is my answer, as gutted as I am. Im 39 now so time isnt on my side.
Wishing you a speedy recovery. And you will have to keep us updated ! 6 months seems a long time but i bet it will actually feel nice to turn the pressure of ttc off x

@ChaE05 yes he cut out the niche and re-sutured my uterus back together. I had a hysteroscopy in March where an endometrial biopsy was taken and this showed chronic endometritis. This biopsy was following a 2 week course of doxycycline and metronidazole so the surgeon I saw felt that my niche was directly causing the inflammation. My CD138 count was 6 and generally anything above 5 is chronic endometritis but having a count of 0 is preferred.
an endometrial biopsy can be done at hysteroscopy and sent for CD138 staining. The only problem with NHS is the wait. I paid private for mine as I was told my NHS hysteroscopy would be a good few months wait. I’m 38 so like you I feel time isn’t on my side.
do you have spotting after your period? My spotting wasn’t horrendous actually but my niche was like a trap door so constantly holding onto fluid. My niche only showed up on ultrasound mid cycle. It hadn’t shown up on any other days of my cycle before.
it is all so frustrating!!! Thank you, yes I will keep you updated. It is a long time and I am stressing that I’ll have gone through this procedure and it won’t work but I’ve got to try and hope it does.

Appreciate all this info so much !
So basically you had antibiotics and then a biopsy taken and it showed CE. So clarification that the niche was causing it. I feel so hopeful for you now ! Will you retest at all or just see how it goes?

Yes I have spotting. Sometimes 1 or 2 days before then about 5 days post period till about cd8. Nothing terrible. Dont need to wear a pad. Just occasionally some watery brown discharge. Did you have spotting?

How did you find the right surgeon for you? Are all of them able to test for this CD138?

If you dont mind sharing how much your surgeries were? Hysteroscopy and lap? Sorry for all the questions ! After finding out the news my mind is such a mess ! X

@ChaE05 so here goes…..i was discharged from the NHS fertility clinic last September with ‘unexplained infertility’. I’d had a transvaginal ultrasound which was normal, a HSG which showed a right proximal blocked tube and a laparoscopy confirming right blocked tube but no endometriosis or adhesions and everything apparently looked normal.
I had several very faint positive pregnancy tests that came to nothing. Also right sided pelvic pain. I got pregnant 2 months after my HSG but miscarried at 6 weeks. My theory was the HSG flushed my uterus out and reduced inflammation enough to allow an embryo to implant for slightly longer. I did a lot of research and diagnosed myself with chronic endometritis as all my symptoms seemed to fit. I felt I wasn’t being listened to at all by professionals so I decided to purchase antibiotics online to treat what I believed was chronic endometritis. I don’t advocate anyone doing this but I was genuinely losing the plot and was desperate!
While taking the antibiotics I had a meltdown at work (I work in a hospital) and went to speak to one of the fertility specialist nurses about all of my symptoms. She really listened and booked me another ultrasound. It was this ultrasound on day 15 of my cycle which showed the niche containing fluid. I then had a consultation with a registrar the following day who thought that the niche may be my issue and wanted to look into it further however she had to get the approval of the consultant and wanted him to look at my ultrasound images but he was currently away. I also had recurrent miscarriage bloods taken to rule other things out.
I waited a couple of weeks and then heard I’d been listed for an NHS hysteroscopy. After chasing this up, I was told it had been triaged as routine and would be a long wait. I saw my fertility consultant privately who did not feel the ultrasound showed a significant niche but requested an MRI. The MRI was rejected in the NHS so I paid privately.
while awaiting the MRI scan I sought a 2nd opinion from a different gynaecologist who suggested we do a hysteroscopy. I told him about my niche but he did not think this was relevant. He said that the chemical pregnancies I was experiencing was likely due to my age and chromosomal abnormalities. I went ahead with the hysteroscopy which cost £4000 under general anaesthetic. He said everything looked fine and said we needed to get eggs from me and start IVF if I wanted another baby. He had taken a biopsy and when I went for my follow up appointment he was very sheepish and told me my results had shown chronic endometritis with a CD138 count of 6 despite already taking antibiotics so he believed my niche was causing the inflammation and affecting implantation.
I then had my MRI. This showed a 6mm niche with 0mm myometrium and only 2mm serosa covering the niche. My fertility consultant had not undertaken this procedure before so referred me to Professor Justin Clark. He had also referred 2 of his IVF patients to him before following recurrent implantation failures and both had got pregnant after laparoscopic niche repair by Professor Clark. So I booked a private appointment and 7 weeks later had the surgery. The laparoscopic c section niche repair has cost me just over £6000.
in total with consultation fees and scans and procedures we have spent around £13000 so far but that could have been a lot more if we had gone for IVF. I had always been reluctant to go down the IVF route as I felt that there was something wrong.
The consultant who did my hysteroscopy wanted to do the niche repair but I felt he’d been very dismissive of my symptoms and was very quick to put my problems down to being the wrong side of 35 so I didn’t feel comfortable with him. Professor Clark is internationally renowned for his surgical expertise so thought I’d go for it.
I know it’s hard. When we first started trying for our 2nd I read about c section niches causing infertility and was worried I had one but after my first ultrasound didn’t show anything I thought I was fine. In February when the ultrasound found my niche I was distraught. I felt so much time had been wasted and couldn’t stop crying for days. But then it gave me an answer for why we weren’t conceiving and I knew it needed to be fixed. I’m not saying this will 100% help us conceive but it’s got to be worth a shot. As well as the fact if I had have got pregnant then I would have been at extremely high risk of uterine rupture. Maybe it was my body’s way of telling me that my uterus wasn’t strong enough to carry a baby.
Try to take a few days to process it all and then plan your next steps. Xx

@ChaE05 forgot to say, my spotting wasn’t horrendous. I had some brown spotting after my period for a couple of days but think because I had 0mm myometrium there wasn’t any muscular wall to contract the fluid out of my niche for days on end so I believe the fluid tended to stay in its pouch and stagnate.

@ChaE05 i’m not sure about retesting…part of me is scared to know! I should have a follow up scan in a few months to see how I’ve healed though.
yes any gynaecologist who does a hysteroscopy and takes an endometrial biopsy can request a CD138 stain from the labs.
I’d also suggest getting an MRI scan. On my ultrasound it looked like I had a thick myometrium until my MRI showed 0. Quite worrying as I could have gone for hysteroscopic resection and they’d have likely perforated my uterus.

@ChaE05 on ultrasound sometimes adhesions can look like myometrium. I had dense adhesions between my bladder and uterus which only showed on MRI.
i hope all of this helps! X

@Lucy040288😪 WHAT a journey. I can only imagine the stress and upset. Thank you for sharing and im so sorry its been such a long road trying to figure everything out. Im glad that im not the only one that has felt so sad by this diagnosis. I was crying for a couple of days too. Everyone I spoke to was saying atleast you know what could be stopping you falling pregnant now? As if I should feel happy? But I just felt devastated that it was another hurdle and the thought of a laparoscopy honestly scares the hell out of me. More money to spend that we dont have. Its not as simple as, "atleast you know"
Im about to ovulate and we have been doing the deed and all im thinking is..what's the point? Its not going to work. And all I can imagine is my body killing off all the sperm. Even if by some miracle I did fall pregnant there is that fear that it will end anyway with this niche. Its horrible isnt it.
Also worrying that the scan might not be showing the true picture. I think im going to go ahead and email some gynaecologist that have been suggested and go from there. I just dont have the time to waste.
Also from what im reading these are more common with 2nd or 3rd c sections and if you were in labour before. Mine was a planned one (well kind of, my boy had stopped growing and was small so he needed out either induction or c section. Silly me choosing the c section). So im quite suprised I have a big niche.

I think I was relieved to know I wasn’t going completely mad and there was a problem but I was annoyed and upset as a niche was my first thought when I knew we were struggling to conceive but then had felt reassured by my 1st ultrasound which was normal.
I was terrified at the thought of my first laparoscopy but it wasn’t too bad when they just went in to have a look.
it is hard every month doing ovulation tests and then nothing coming of it. I went decaf, I cut out sugar, I spent a fortune on supplements and none of it was ever going to help.
I think unfortunately very little is known about niches but research is being done. I was in labour for 36 hours and was dilated to 5cm for 12 hours. I tried the oxytocin drip to progress labour but it didn’t work so ended up having a section. I never in a million years thought I’d need a c section and I was devastated for quite a while afterwards. So now having this complication from the section is difficult.
to be honest though, you could have been induced and still ended up needing a c section. There are more and more being done and I think in the next few years we’re going to be hearing a lot more about the complications from them.