Q&A: Could previous Ceserean-Sections interfere with trying to conceiveApril C. Sanchez, M.D.
Q Could previous Ceserean-Sections interfere with trying to conceive? I guess what I am trying to ask is, could scar tissue from 2 previous sections prevent implantation from happening? I have been trying to conceive for 15 months (with the last 11 cycles timed perfectly) and managed to get pregnant this past cycle, but lost the baby (very, very, early) I was only 2 days late for my period... (had I not known my body so well, I wouldn't have even thought I was pregnant) I am thinking that maybe the egg did get fertilized, but had a hard time implanting? Is that possible? My second ceserean-section was a uterine rupture. If I had gone into labor and my water broke, my son probably wouldn't have made it. He would have slipped into my abdomen. Now I am thinking that maybe there could be scar tissue in my uterine area. Could that possibly play a part in why I haven't conceived again? I successfully got pregnant 2 times before (first one was a surprise, we were on a trying to conceive break) the second one happened 3 months after I gave birth to my first. So, by it being 15 months of TTC already, it has me concerned. What would cause someone who was able to easily get pregnant two other times, have such a hard time getting pregnant again? What would you do in a case like mine? Are there any tests that I might suggest to my Ob/Gyn to do? Any info would be great!!!
A I'll start with a few statistics on the events you have experienced. Uterine rupture, for any reason, occurs in approximately 1 in 2000 births. The best prognosis for future fertility is in a case like yours sounds to be, where the rupture occurs along a previous C-section scar and is discovered incidentally at the time of a repeat C-section. These separations are often not bleeding and can be relatively easily repaired.
The overall rate of miscarriage is about 10-15%. About 45% of these occur within the first 2 weeks of the missed period and most can be attributed to chromosomal abnormalities. Yes, scarring of the endometrium (lining of the uterus) can prevent implantation. Such scarring is more likely to occur following a procedure like a D&C, which directly involves the lining of the uterus. Scarring can also be a result of an infection which involves the endometrium.
In working up the cause of your infertility and pregnancy loss, it is important that other potential causes not be excluded. Although you easily conceived twice in the past and went on to carry two babies, things may have changed. One of the easiest and least invasive things to confirm is that you are, indeed, ovulating. This can be done be using basal body temperature charts, over-the-counter ovulation predictor kits, and blood work (like a day-21 progesterone level). A semen analysis should also be done on your partner. A biopsy of the lining of the uterus done in the luteal phase of your cycle (about a week after ovulation) can determine if the endometrium is appropriately responding to the hormonal stimulation from the ovaries. This is a simple office procedure, which can be done in about 5 minutes. If all of the above is normal, a hysteroscopy can be done to directly visualize the lining of the uterus. This involves inserting a scope through the cervix into the uterus. Some physicians have the necessary equipment in their offices, whereas others do the procedure in a surgery center or hospital. If scar tissue is visualized, there is a possibility that it may be cut back. Hormonal therapy may be necessary after such a surgery to restore a normal endometrium.
Keep in mind that I have provided a basic outline of a work-up. Your physician who knows you, and your medical history, may need to tailor the process to your needs. I wish you the best of luck.
April C. Sanchez, M.D.
Click here to Ask Dr. Sanchez your pregnancy questions.
Dr Sanchez lives with her husband and two boys ages 5 and 18 months in Mandeville, Louisinana. She is a Board Certified OBGYN with a dregree from Louisiana State University Medical School. She completed her residency through the Tulane University Medical School Residency Program. She also received a Surgical Excellence Award.
Total Woman Care
She is now practicing Obstetrics and Gynecology at Total Woman Care, in Manderville, Louisiana. The Total Woman Care website, (http://www.totalwomancare.com) is an "Advanced" Obstetrics and Gynecology Practice that cares and provides for the needs of women with total Compassion, Empathy, and Understanding. Dedicated to Provide Obstetrics and Gynecology Related Information for the Women of West St Tammany Parish.
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