Secondary infertility due to emergency c-section?

[JHartX]

I’m looking for some advice please or similar experiences as I feel like I’ve really exhausted all other options.

My husband and I have been TTC our second child for the last 3 years. We did fall pregnant in January 2024 but lost the baby at 10 weeks due to a subchrionic hematoma, which left us heartbroken.

As far as I know, I have had all possible tests for infertility, such as hormone blood tests (prolactin, thyroid, FBC etc.), an AMH blood test, several Abdominal ultrasounds & transvaginal scans, a Hycosy dye test and all results have come back good. My husband has also had two semen analysis tests which have also come back good and we have been told by our fertility doctor that there should be no reason why we can’t conceive again.

However, despite being told this, as it was coming up to nearly two years of TTC since the MC, we decided to do IVF, but unfortunately the fresh embryo transfer failed. We still have 5 good graded frozen embryos, but I’m really worried to try a FET in case it fails again because maybe there is still an underlying issue that no one has picked up.

When my son was born 4 years ago, I was given an epidural at 9cm as he got stuck and needed more time to turn, however, the epidural was put in wrong and pierced my spinal canal, which made me go unconscious and my baby’s heart rate went right down so they had to do an emergency c-section to get him out quickly. But I am now wondering if the c-sec scar tissue is possibly causing implantation issues?

All my scans and Hycosy dye test confirmed that my scar had healed fine inside and shouldn’t cause a problem with falling pregnant again, but I can’t help but feel like this still could be the reason I’m unable to fall pregnant and possibly the reason why I had a subchrionic hematoma back in Jan 24, as I had no problem conceiving my son, my husband and I are both healthy, fit people with good BMI and good diet and taking fertility supplements etc. My periods are also regular and I ovulate every month.

Has anyone had a similar experience or know anything about this type of infertility? I’d really appreciate any advice given. Thank you in advance and thank you for taking the time to read x

So you can get c section niches which might cause secondary infertility. However a lot of fertility specialists don’t agree as the evidence is poor. I have a large niche I have had repaired after 3 failed embryo transfers. They are a lot more common in emergency sections where you were fully dilated as the baby is lower down and the uterus is more stretched - my section was also done at this stage. They can show on ultrasound but not always, SIS or MRI tend to be the best way to see if you have one.

@NiftyAmberLion thank you so much for your response, I’m so glad I put this post now. After doing my own research and seeing several doctors & fertility specialists, this information was never mentioned. I did read up about niches after my failed fresh embryo transfer, but my fertility doctor said she could see that the scar was fully healed and that nothing was highlighted when I had my Hycosy. But the fact it’s a lot more common when the uterus is stretched etc., makes more sense and this could possibly be the case. I’ll look into getting either an MRI/SIS and go from there. Again, thank you so so much, this has really given me hope again x

I know doctors say there is not alot of science behind issues conceiving after a c section because of niches as its called but it can happen more then most people think. I would look further into the uterus atmosphere with extra testing just to make sure all grounds are covered. It could really just be unexplained Infitility and that most of the time first transfers dont work for most people but before transferring again I would make sure you, yourself is comfortable moving forward. The next thing you can also do is have your embryos tested so you know with more clarity what you are transfer and how likely they are going to work..

@Miraclemuma03 thank you for your helpful advice. I will definitely look into further testing and also the possibility of testing our embryos. I know they are graded (4AA, 4AB etc.) but from my understanding this is only grading by the shape and size of them, rather than what’s inside. Thank you again, I really appreciate it x

I had an ECS in very similar circumstances. I was very concerned about fertility but had no issues conceiving. I also have close friends/family who have had ECS and had no issues.

I also know people who conceived fine and absolutely normal vaginal first time, and are struggling with secondary infertility.

Please don't take my anecdote as a suggestion that it wasn't the surgery that caused your issues - but perhaps insight into how rare it must be, which is why it may not be picked up. Everyone is different and their bodies react differently.

Similarly my neighbour had fertility issues after an ectopic, and was only able to conceive one child. One of my close friends had an ectopic, lost a tube, and had a still birth. She has managed to conceive multiple times since.

Anyway hopefully previous posts help you, and you're able to get some answers. Best of luck

No worries - there’s a helpful Facebook group to join if you do find you have a problematic niche! Good luck xx

Hi @NiftyAmberLion I just wanted to let you know that I went for a SIS and they did find a c-section niche. The surgeon was shocked that this hadn’t been picked up in any of my other scans etc., and that my ivf clinic even allowed me to go ahead with embryo transfer. So I am now having a hysteroscopy to repair the niche this coming Tuesday. I just wanted to say how grateful I am for your advice because without it, I wouldn’t be doing this now. It has also given me great peace of mind, knowing this was the problem all along and I finally have answers after 3 years. So thank you xx

Sorry to hear you have a niche but happy you’ve found an explanation and one that can hopefully be fixed! How long will you have to wait to try to conceive again after repair? I had to wait 4 months as mine was too big for hysteroscopy repair so I had to do laparoscopic. It seems mad to me how they don’t look into these niches more especially given how expensive and traumatic failed transfers are, surely anything you can do to maximise success should be done. Let’s hope this is the answer for both of us!

@NiftyAmberLion I completely agree. My surgeon said not many professionals are aware of this and they only started to look into it properly since the last 5 years! He said I’d only need to wait to have my first period after the procedure, then can start TTC again. My procedure is called a “c-section scar resection” and they said they just need to “shave it down”, so I’m guessing from that it’s not that big of a niche. I’m just hoping that they can repair it in this procedure, I’ve seen so many comments on fb about how some women have to go for a second repair. How long ago did you have your procedure? I really hope it works for you 🤞🏻 xx

Yeh it does seem like a lot need a second repair.Really hoping I don’t but even post repair I have a small residual niche - mine was very large to start with though. I’m going to try a FET and see how I get on! That’s great you don’t have to wait too long to TTC.

@NiftyAmberLion tbh I still think we’ll give it at least 3 months before TTC just to be on the safe side. Sorry to hear you still have a small niche after your procedure, but from what I’ve read, people are still getting pregnant who are in the same position. I really wish you all the best with your FET xx

@JHartXand @NiftyAmberLionvery sorry to jump on this thread, but would you mind giving me the details of the specialist who did your treatment (if done privately)? Many thanks

Hi @overwork my specialist was Mr David Ogutu at Herts & Essex fertility Centre. https://hertsandessexfertility.com/team/david-ogutu-mrcog/

He was absolutely brilliant and so understanding of my situation. He also seemed to be really knowledgable compared to other professionals (private & NHS) that I have seen over the last 3 years x

Thankyou @JHartX - I really appreciate your help!

@JHartXjust jumping on here as I had c section resection to treat a niche 6 weeks ago. I have a lot of similarities with your story- 2 years secondary infertility, multiple specialists not detecting my niche, even after it was detected being told it was too small to be causing my symptoms or infertility and during this whole process going through very expensive IVF including two failed embryo transfers (of PGTA tested embryos). It was when my fertility clinic told me to try a third transfer that I lost all faith in them and saw someone else who immediately recognised my symptoms as typical of c section niche. As well as secondary infertility I had pre and post menstrual spotting with the post menstrual spotting being very dark heavy and sludgy. I now know these are textbook symptoms of a niche but most fertility experts are remarkably ignorant about this problem.

Anyway, I had the resection at the start of March. I had 3.5 weeks of spotting after this and then it stopped. Then had my period. The dark sludgey blood did not appear after my period but I have had lighter spotting right up to ovulation. My consultant just says you can’t judge the success of the procedure until the third cycle afterwards but I am worrying a lot that the procedure has not worked properly. How was your recovery?

Also, are there any other forums on this? Really struggling to find much information online.

@NiftyAmberLionwhat is the Facebook group you mentioned please? Really keen to see stories about recoveries following the niche repair via hysteroscopy. Thanks

Did you have a hysteroscopy repair or laparoscopic? The Facebook group is private - just search c section defect and it should come up? Then request to join x

Hysteroscopy. My niche was on the small side 5/5/8 mm and I had RMT of 6mm so deemed safe for hysteroscopic resection. Thanks will have a look for the Facebook group