# C section scar causing secondary infertility



## Lou55

Hi all just wondering if anyone has problems with a c section scar causing their infertility. I have a four year old little girl conceived naturally first time trying but resulting in an emergency c section due to being breach. After lots of fertility testing when failing to conicieve a sibling I was told that my scar is fine and I have no issues. But I have recently done ivf which worked but resulted in a miscarriage at 6 weeks. In my scan by a nurse after my miscarriage I was told I have a niche on my scar and a pocket of fluid which has never been brought to my attention before. The consultants completely brushed it for saying it’s only a problem if the fluid is leaking into the uterus, however looking online I can see that even a pocket of fluid could have caused my secondary infertility and my miscarriage through ivf and this should be instead corrected first with a laparoscopy. Just wondering if anyone else has come across anything like this?


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## HopefulKayte

I would definitely do a lap when dealing with I explained infertility and possibly past c—section issues.
For me, I finally had success after 5 years of trying (doing IVF the whole time as I did for my first) moving onto donor. I had a chemical and a m/c over the years, and it seemed my age now was the issue as every other test came back fine.
I do know that some women experience success after doing uterine investigatons (via lap, hysteroscopy) and being able to diagnose an issue. I think that’s an important first step to ruling things out or treating them.
Also has your husband gone through investigations too? Although we were able to have our first child, it turns out his morphology had quite worsened over the years and nobody had really looked into it or the potential to add to the problem as his numbers are high and many assume ICSI helps all.


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## Mumsy35

Hi Lou55

Im so sorry to hear about your miscarriage. Its always so difficult to understand when we concieve naturally then all of a sudden we cannot for our second! Im in exactly the same situation.

I also had a hysteroscopy and they found fluid at my upper cavity but said it was normal and nothing to worry about. I havent been able to concieve naturally for my second. 

Im going for ivf for second child and im  really afraid it wont work out. 

Sent from my BND-L21 using Tapatalk


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## hannahjm81

Hi Lou, I am new to FF so just getting up to speed with how it all works so apologies if all my acronyms are wrong etc !! 

I just wanted to quickly write to you that I am starting to think that I have a similar issue. I had a nightmare birth 3 years ago for my daughter , 3 days of strong contractions, issue dilating after 2 epidurals hours of oxytocin drip, daughter was breach then c section. Not emergency, but recommended based on contraction level & hours of labour. I know my body and I have felt "different" every month since trying, I feel like I fertilise and implantation is attempted then fails. I can feel little strange pains around implantation. Every month. 2 chemicals the past 12 months then 2 months where I have had pinkish wipe around implantation, then nothing. I am currently looking up hycosy, lap, and hysterocopy HSG (sp?!). 

I am TTC #2 for 12 months now, and first time caught quickly too. Nothing else found - slightly lower than preferred AMH @ 7.7. Considering IVF route now. I had a pelvic scan and it showed tiny bit of liquid in my scar, plenty of follicles.  Saw Dr George Nduwke @ Zita west for a first consultation and he said he would be VERY surprised if c section was causing it - the embryo can implant ANYWHERE in the uterus and theres plenty of other space. He has far more experience than me.. but I'm still convinced it's related.  

NHS have referred me for hycosy, I'll have that then I may try and go for a HSG or Lap. I would rather not have lap though, already had keyhole for appendix and c section in last 4 yrs. sending lots of love please let me know how things go with you X


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## Lou55

Hi Hannah! Sorry to hear your going through something similar to myself, is awful and I wouldn’t wish it on anyone. Since my post I met with my IVF consultant and he told me that the niche I have developed with fluid in after my c section won’t affect IVF and won’t have caused my miscarriage. They have however admitted that this could be the cause of my secondary infertility. So looks like IvF could be the only way. I’m currently down regulating to try again next month on a frozen cycle. It’s very likely that your c section could be causing problems but for some reason nobody wants to admit it!! 

Please don’t be scared of IVF. It is very invasive and intense but I didn’t actually find it that bad. I kept positive throughout and laughed my way through it with my husband and it really helped. I didn’t get bad side effects and I actually found the whole thing magical and it did work but I however miscarried at 6 weeks. I think you have to go into it with a positive head and have a great support team around you. Message me if you have any questions about IVF. 

Your birth story sounds crazy, just like mine! X


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## HopefulKayte

Long history here. I suffer from infertility in general (couldn’t get pregnant starting at 31) and after a few years was blessed to have an IVF cycle work and stick and we had our son via emergency c-section. We didn’t waste much time and started trying again with IVF at 35 and had 3 years of BFNs and 2 m/cs. We decided I had always had poor egg quality from a young age and I was very lucky to have had a child (admittedly with significant effort but recognize this is lucky.) We were open to having another through an alternate way. 

We moved onto donor eggs with proven donors and after 2 rounds of fresh cycles I had another early m/c and a BFN to show for it. In our last cycle we had finally had someone tell us that DH’s sperm morphology might be an issue (no one had ever mentioned any concern with his test results,  and with his high numbers and always using ICSI, it had been figured this solves all apparently.) 

At this point and well about $150 000 invested over almost a decade, (Canada is the most expensive country in the world for IVF treatment - zero health or work coverage) - we were gutted to feel there could have been an undiagnosed or communicated issue all along. We took a break for a year and I chose to go overseas for donor embryo transfers with a guarantee program - all in all a tiny cost of what we’ve been through and the path of least regret before closing the door.

I did two separate rounds of donor embryo transfers with proven donors and the highest ranked, hatching blasts I’d ever had. One round was PGS tested. My lining was perfect, zero uterine issues, everything ideal. Both failed!!

After all these years and now proven donor gametes the past few years, I didn’t know what to think and felt it was too disruptive to my life and my son for me to any longer try to figure out what was going on. 

We had one round left for donor embryos and I flew over this summer on my own yet again depressed, lonely, exhausted and really without hope. But my choice to carry on with the plan. When I got a BFP, I was certain it would be short-lived again. I made it one week before the bleeding began. I experienced the heaviest bleeding of my life... for 9 weeks. I was on bedrest and very uncomfortable... every week it was miracle upon miracle and somehow the baby survived. I remained on modified bedrest and dealing with extreme sickness and couldn’t believe the miracle. Then at 17 weeks it began again and I was in and out of hospital for the next month. Totally traumatized and again going minute to minute, hour to hour. Between the ultrasound place and the hospital, every scan’s outcome contradicted the previous and there was a lot of “unsures” in the reports (hematoma bleed? Placenta previa? Placenta accreta?) which was unhelpful and scary.

Finally at 21 weeks I saw a very experienced doctor from another city who did the ultrasound herself with an “expert” ultrasound teacher technician and tried to understand what was going on in my uterus. They scanned me forever and threw around all sorts of ideas about what they were seeing and as I lay there, I couldn’t believe things could be so complicated and unexplainable. I also felt like their guesses weren’t solid enough to help the emergency nature of my pregnancy. They actually could not decipher where my placenta began and ended, and where it had implanted and how far. Finally they explained to me that my c-section scar from 6 years ago was obstructing any definite conclusion about my placenta, the bleed, and the vessels in that area of my uterus. Only having an MRI could reveal the location and depth of my placenta and go beyond the difficulty the traces of my c-section presented.

So... obviously I couldn’t get pregnant prior to IVF, but it took this medical emergency, 6 years, 4 clinics in my province, 2 overseas, and about 15 cycles in total of OE, DE, DD IVF and their transfers, and multiple check-ins to hospital to hear a WORD about c-section complications! I must have had more ultrasounds and tests than almost anyone. And no one ever mentioned to me the complexity of my c-section scar or how it could affect fertility, implantation, or carrying a baby.

This is a long story and a rare case in terms of severity I’m sure, but I really wish years ago someone had ever looked into it. They always ask if you’ve had a c-section, then don’t do anything with the answer when it’s yes!

(it’s a week following MRI and continuing the bedrest while I wait for my next scan. Praying and thankful for this miracle every day.)


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## Perfectlyflawed

Hiya. This is my first post on here in years since having my twins but we have been trying to conceive for about 2 and half years now 

I actually conceived last April/may but ended having to have the baby removed as it implanted in my csection scar. This type of pregnancy is called a cesarean scar ectopic pregnancy and although rare, it is on the increase. Why I've posted here is because scar ectopics are a sign of a defect in the csection scar. They've told me I do in fact have a niche but no one has measured it as of yet. There was guidelines created late last year made by 15 specialists in Europe that said if there is a defect then it needs investigation as I can cause secondary infertility. Basically, the niche can hold a pocket of old blood between the period and ovulation and that can not only cause difficulties with sperm getting to the egg, but also make implantation difficult because it causes the body to react as though the womb is a toxic environment.

I just wanted to pop on to say that if anyone says you have a niche in the csection scar, or if you have unexplained secondary infertility after a csection then get the scar checked!


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## trying1

Perfectly - which guidelines are these
Thanks!


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## kittykat76

A good friend of mine had this issue, 1st child conceived naturally but couldn't get pg again, she had to have fertility treatment which worked 1st time, her consultant said that she had scar tissue that was stopping it happening naturally


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## lollypop3

Hi I had a cesarean scar ectopic pregnancy last year June 18.  My DD was conceived through IVF and she was delivered by C-Section.  We decided to do another round 5 yrs later.  The scar did not show on my scans and only materialised when I had my first scan at 6 weeks.  There was a huge blood clot next to the gestational sac.  My consultant saw a HB at 6wk but was concerned about the size of the blood clot right next to it.  Went back for scan the following week and HB gone and lost our baby.  Had a D&C in July but in Sept had another scan and was still pregnant.  Another D&C later and more scans but the blood clot was still there.  It was 7cm by Oct 18. In Nov went to see a specialist who deals with C-Scar ectopics and although it has reduced to 4cm I couldn't have another transfer until gone.  Had another scan in July 19 the blood clot is still there 0.5mm now (some 13 months since I got pregnant).  The embryo had implanted into the scar tissues (niche defect) and had started to grown through the scar tissue.  I have spoken to more women who have had this happen to them as it is becoming more and more frequent.  I have started another medicated FET cycle this month.  Scan is next week - praying I don't have another C-Scar ectopic when they put the embryo back.  Will post my journey to help others out there like me.  X


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## trying1

Hi lolly sorry to hear about your loss.  good luck for next cycle
Did the consultant say the niche could stop you getting a bfp? Or just the risk of having the ectopic there?


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## lollypop3

Hi Trying1,

The consultant just said due to the previous C-Section Scar Ectopic I am at risk of having another implant into the C-scar again.  However this is about 1:10 chance of that happening.  My IVF consultant wanted me to have the internal C-Section scar re stitched before I tried again but my gynaecologist consultant suggested this op was very complicated and not many have been done.  The op itself was prone to risk and I could either end up having a hysterectomy, it could rupture my bladder or it could reduce the size of my womb by about a third, if I did get pregnant and the pregnancy continued it could rupture towards the end of the pregnancy and I could bleed out and there was a high risk of death.  Not a great combination and it put me off having the op. 

In the end I've decided to go ahead with another TX without having the op even though I still have this niche defect on the left hand side.  We will see if this works and I'll post with the updates.  Hoping and     we are lucky and I have good news to tell.  Good luck ladies with all your journeys!  Baby dust to everyone!


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