Isthmocele After C-Section: A Treatable Cause of Infertility

Infertility after a previous successful pregnancy can be confusing and emotionally distressing for many women. In some cases, the cause is not related to hormones or ovulation but linked to a prior Caesarean delivery. Isthmocele after C-section is an increasingly recognised condition where the uterine scar does not heal completely, leading to fertility challenges and abnormal bleeding. With early diagnosis and appropriate isthmocele treatment, many women can achieve successful pregnancy outcomes.
At Kiran Infertility Center, women with unexplained secondary infertility are routinely evaluated for conditions like isthmocele to ensure timely and effective care.

What Is Isthmocele After C-Section?

An isthmocele is a pouch-like defect or niche that forms at the site of a previous C-section scar. Ideally, the uterine incision should heal smoothly after surgery. However, in some women, incomplete healing leads to a small indentation in the uterine wall.
This defect can trap menstrual blood, preventing normal drainage during periods. Isthmocele is also referred to as a C-section scar defect, and its incidence has increased with rising Caesarean deliveries.

Symptoms Associated With Isthmocele

The symptoms of isthmocele can vary from mild to severe. Some women may remain asymptomatic, while others experience noticeable discomfort. Common symptoms include:
• Spotting or brown discharge after periods
• Prolonged or heavy menstrual bleeding
• Pelvic pain or pressure
• A feeling of incomplete menstrual flow
Because symptoms may be subtle, many women remain undiagnosed for years, especially if infertility is the only concern.

How Isthmocele After C-Section Affects Fertility

Isthmocele can impact fertility through multiple mechanisms:

1. Disrupted Uterine Environment

The accumulation of old menstrual blood within the scar creates an unhealthy uterine environment. This can interfere with sperm transport and reduce the chances of fertilisation.

2. Implantation Failure

Successful pregnancy depends on a healthy uterine lining. Chronic inflammation caused by trapped blood can reduce implantation potential, leading to repeated conception failure.

3. Irregular Bleeding Patterns

Persistent spotting can disturb the hormonal cycle and affect ovulation timing, lowering natural conception chances.

4. Secondary Infertility

Many women with isthmocele experience secondary infertility, meaning difficulty conceiving after a previous childbirth, most commonly following a C-section.

Who Is at Risk?

Women may be at higher risk of developing isthmocele if they have:
• One or more previous C-section deliveries
• Multiple or closely spaced Caesarean births
• Poor wound healing after surgery
• Persistent abnormal bleeding after delivery
It is important to note that isthmocele after C-section can occur even after a single Caesarean delivery.

How Is Isthmocele Diagnosed?

At Kiran Infertility Center, diagnosis is done using advanced imaging techniques, including:
• Transvaginal ultrasound
• Saline infusion sonography (saline scan)
These investigations help assess the size and depth of the scar defect and determine whether it is contributing to infertility or symptoms.
Early and accurate diagnosis plays a vital role in planning the right isthmocele treatment.

Isthmocele Treatment Options

The good news is that isthmocele is a treatable condition. Treatment is individualised based on symptoms, defect size, and future fertility plans.
Common isthmocele treatment approaches include:
• Hysteroscopic repair, a minimally invasive procedure performed through the uterus
• Laparoscopic surgery, especially for larger or deeper defects
• Vaginal surgical repair, in selected cases
Surgical correction helps restore normal uterine anatomy, improves menstrual symptoms, and significantly enhances fertility and IVF success rates.

Why Early Isthmocele Treatment Matters

Delaying treatment can lead to prolonged symptoms and repeated fertility failures. Early isthmocele treatment reduces inflammation, restores a healthy uterine environment, and improves pregnancy outcomes.
Women planning future pregnancies benefit the most from early evaluation and timely correction of the scar defect.
When Should You Consult a Fertility Specialist?
A fertility evaluation is recommended if a woman has:
• A history of C-section delivery
• Unexplained secondary infertility
• Persistent spotting after periods
• Heavy or prolonged menstrual bleeding
• Failed fertility treatments without a clear cause
At Kiran Infertility Center, a comprehensive and personalised approach ensures accurate diagnosis and effective management of conditions like isthmocele.

Conclusion

Isthmocele after C-section is an often-overlooked but significant cause of infertility and abnormal bleeding. With timely diagnosis and appropriate isthmocele treatment, women can experience symptom relief and improved chances of conception. Early consultation with a fertility specialist can make a meaningful difference in achieving a healthy pregnancy.

Frequently Asked Questions (FAQs)

1. Can isthmocele after C-section cause infertility?

Yes, it can interfere with sperm movement and embryo implantation, leading to secondary infertility.

2. Is isthmocele treatment always surgical?

Not always. Surgery is recommended when symptoms or fertility issues are present and based on defect severity.

3. Can pregnancy occur without isthmocele treatment?

Mild cases may conceive naturally, but treatment often improves pregnancy outcomes.

4. Does isthmocele treatment improve IVF success?

Yes, correcting the scar defect can significantly improve implantation and IVF success rates.

5. Is isthmocele treatment safe?

When performed by experienced specialists, treatment is safe and highly effective.