Here’s Why You Can’t Get Pregnant Again

Secondary infertility is the inability to get pregnant after having at least 1 child. This common condition impacts hundreds of thousands of couples yearly. Getting pregnant naturally now feels impossible. There are several reasons for this condition. The body changes over time, with women and men naturally experiencing diminished fertility with age. Imbalanced hormones, lifestyle decisions, and certain diseases like cancers can also lead to infertility. A sometimes-overlooked reason is a cesarian section, or C-section, scarring complication known as uterine isthmocele.


Do you have uterine isthmocele?

Caused by complications from a cesarian section delivery, uterine isthmocele is a form of damage to the uterus. The condition occurs when a slight indentation or pouch forms in the uterus during the healing process. This scar forms at the site of the C-section incision. The indentation can cause menstrual blood to collect, leading to abnormal uterine bleeding (AUB) and pain. The cause of uterine isthmocele is unclear, but the irregular healing of scar tissue is often at fault. Multiple cesarian sections, the surgical technique used, and advanced maternal age (AMA) are other risk factors. This consequence of C-section scarring, in some cases, can lead to difficulties getting pregnant again.

Blame the scar

During a C-section, an incision is made on the uterine wall. After the child is delivered, the surgeon closes the incision. As the incision heals, scar tissue forms at the incision site. If the scar tissue heals abnormally, uterine isthmocele forms and complications like secondary infertility can occur. These irregular scars or dents can disrupt the uterine lining or damage receptivity. Some scars can even change the shape or architecture of the uterus. Additionally, the new environment can impact the ability of sperm to pass through the uterus and reach the fallopian tubes. Fertility challenges and AUB are the only signs of uterine isthmocele, which can only be detected via ultrasound.

Here are your treatment options

The first step is to visit a doctor for abnormal bleeding or any signs of secondary infertility. A reproductive specialist can perform an ultrasound to confirm if there is uterine isthmocele. As a first point of treatment, the doctor may recommend hormone medication or other means to regulate bleeding and improve reproductive health. However, this condition typically benefits from minimally invasive surgery (MIS) to address the scarring. Using small incisions, a surgeon can shave off the defect in the uterus to improve overall function. Studies show surgical interventions can repair damage to the uterus with great success. After a short recovery period, the chances of conception increase significantly.

Turning to fertility treatment

There are cases where non-surgical or surgical options fail to improve the woman’s fertility. At this point, the medical team will recommend assisted reproductive technology (ART) to increase the chances of success. Some approaches include intrauterine insemination (IUI) and in vitro fertilization (IVF) to improve pregnancy outcomes. IVF helps by creating healthy, mature embryos outside of the uterus. The embryos are then transferred by the medical team, reducing the impact of an existing scar. IVF is beneficial for women of advanced age who also struggle with diminished ovarian reserve.

Don’t fall victim to uterine isthmocele

Scarring from a previous C-section can happen to almost any woman, but there are preventative measures that can help. Proper wound care and adherence to rest and medication are essential for an excellent recovery. Doctors are also encouraged to perform techniques proven to preserve the integrity of the uterine wall. While prevention is preferred, this is not always possible. Therefore, doctors encourage women to act quickly if signs of uterine isthmocele, such as abnormal bleeding or secondary infertility, occur. Follow-up treatment is critical to fighting secondary infertility. Either through surgery, fertility treatments, or both, growing a family is an achievable dream.

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