Can My Past Cesarean Section Affect My Future Fertility?

Whether or not a previous cesarean section can affect a woman’s future fertility is becoming an increasingly common question. With approximately 30% of all deliveries in the United States being via C-section, this can be an important question for many women.

Generally cesarean sections are not thought to cause any major implications on future fertility. When a C-section is performed, an incision is made through the muscle wall of the uterus to deliver the baby through the uterine incision. The obstetrician will then sew the muscle layer of the uterus back together in hopes that it will heal normally and to be of normal strength and thickness for future pregnancies.

There are situations when the healing does not happen completely normally, and the uterine muscle layer does not completely close back to its normal thickness. When only a small portion of the muscle layer heals together, women can be left with a defect in the area of the uterine incision that has been termed many things: an “isthmocele”, a “cesarean scar defect”, or a “cesarean scar niche”.

The cesarean scar defects are potentially thought to be a cause of some women’s infertility or miscarriages. The area tends to fill with fluid which in theory can prevent embryos from implanting normally in the uterus or serve to flush out embryos from the uterus. There is also some concern that this weakened area may pose risks in any future pregnancies. In severe cases of large isthmus, we do generally recommend surgical correction of these areas before pursuing fertility treatment. This is still a growing area of knowledge and generally requires a thorough discussion between the fertility provider, the patient, and the OB/GYN surgeon.

By: Heather Cook, MD