Our Summary

A caesarean section, also known as a C-section, can sometimes cause a small dent in the wall of the womb (the myometrium) at the site of the scar. This dent is referred to as a “niche”. Some women who have a niche may experience unusual bleeding from the uterus, painful periods, chronic pelvic pain, painful intercourse, and possibly difficulties in getting pregnant. While not all niches cause these symptoms, there are theories that they may be connected to fertility issues, although this needs further research.

Possible reasons why a niche may affect fertility include: creating an unfavorable environment for sperm and the fertilized egg to attach; acting as a physical barrier to the embryo attaching to the womb; and causing psychological stress that reduces the chances of getting pregnant.

New surgical methods have been developed to address the problems caused by niches. While early results seem promising, more research is needed before these techniques can become standard practice. It’s important that any benefits from these procedures are compared to other fertility treatments or simply waiting to see if the problems resolve themselves. Until more evidence is available, these theories should not be used as a reason to undergo any particular medical procedures outside of clinical trials.

FAQs

  1. What is a “niche” in the context of a cesarean section?
  2. How can a niche potentially affect a woman’s fertility?
  3. What are some new surgical methods developed to address problems caused by niches?

Doctor’s Tip

It is important for women who have had a C-section and suspect they may have a niche to discuss their concerns with their healthcare provider. Your doctor can evaluate your symptoms, perform tests if necessary, and provide guidance on the best course of action for your individual situation. Remember that every woman is different, and what works for one person may not work for another. It’s always best to seek personalized medical advice from a qualified professional.

Suitable For

Patients who may be recommended a cesarean section include:

  • Women with certain medical conditions that may make vaginal delivery risky, such as placenta previa, active genital herpes infection, or certain heart conditions.
  • Women carrying multiple babies (twins, triplets, etc.).
  • Women who have had a previous cesarean section and are not considered good candidates for a vaginal birth after cesarean (VBAC).
  • Fetal complications that may make vaginal delivery risky, such as breech presentation or certain birth defects.
  • Labor complications that may make vaginal delivery difficult or dangerous, such as failure to progress or fetal distress.

Timeline

Before the cesarean section:

  • The patient may undergo prenatal care and testing to monitor the health of the mother and baby.
  • In some cases, the patient may have a planned cesarean section due to medical reasons or complications during pregnancy.
  • The patient will be prepped for surgery, which may include fasting and receiving anesthesia.
  • The cesarean section procedure will be performed, typically involving an incision in the abdomen and uterus to deliver the baby.
  • The patient will be monitored during the recovery period in the hospital, which may involve pain management, breastfeeding support, and monitoring for any complications.

After the cesarean section:

  • The patient will continue to recover in the hospital, typically for a few days.
  • The patient may experience pain, discomfort, and difficulty moving in the days following the surgery.
  • The patient will be advised on how to care for the incision site and manage pain at home.
  • The patient may experience challenges with breastfeeding, bonding with the baby, and adjusting to life with a newborn.
  • The patient will have follow-up appointments with healthcare providers to monitor healing, address any complications, and discuss future fertility plans if desired.
  • If the patient experiences symptoms related to a niche, they may undergo further testing and treatment options to address any issues that arise.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cesarean section and niches include:

  1. What is a niche and how common is it after a C-section?
  2. What symptoms should I be aware of that may indicate I have a niche?
  3. How can a niche potentially affect my fertility?
  4. Are there any tests that can diagnose a niche?
  5. What are the treatment options for a niche, especially if I am experiencing fertility issues?
  6. What are the risks and benefits of surgical procedures to address a niche?
  7. Are there any lifestyle changes or alternative treatments that may help with symptoms related to a niche?
  8. How long should I wait before seeking treatment for a niche if I am experiencing fertility issues?
  9. Are there any additional precautions I should take during pregnancy or when trying to conceive if I have a history of a niche?
  10. Is there any ongoing research or clinical trials related to niches and fertility that I should be aware of?

Reference

Authors: Vissers J, Hehenkamp W, Lambalk CB, Huirne JA. Journal: Hum Reprod. 2020 Jul 1;35(7):1484-1494. doi: 10.1093/humrep/deaa094. PMID: 32613231