Secondary Infertility and Uterine Niche Correction After C-Section

By the Editorial Team · Sunday, August 2, 2026

Specialists have identified uterine niches—defects at cesarean scar sites—as a significant factor contributing to secondary infertility by impairing embryo implantation. With cesarean rates rising, fertility experts are increasingly focusing on diagnosing and surgically treating these niches, though outcomes remain uncertain and further research is needed.

Secondary infertility linked to uterine niches arising after cesarean sections is increasingly recognized as a challenge for women seeking to conceive again, according to specialists in reproductive medicine. A uterine niche, a defect that forms at the site of a cesarean scar, can accumulate fluids such as blood and cervical mucus, which may adversely affect embryo implantation and pregnancy outcomes.

The prevalence of uterine niches following cesarean delivery is reported to range widely, from 42 to 84 percent, based on a recent overview published in a Nordic gynecology journal. Consultant gynaecologist Dr. Harish Bhandari of Jiva Fertility in Leeds explained that the development of a niche is typically linked to wound-healing issues rather than surgical technique. Dr. Ippokratis Sarris, director of King’s Fertility in south London, referenced a 2025 study in the Annals of Medicine indicating that a large niche—defined as at least 5 millimeters deep—can reduce the chances of subsequent pregnancies by approximately 30 percent.

One patient undergoing treatment at King’s Fertility was diagnosed with a 5mm uterine niche via MRI after experiencing secondary infertility. The patient described how premenstrual spotting was an early symptom but noted that initial IVF consultations provided limited information on the condition. Seeking private surgical advice, the patient consulted Dr. Nitish Narvekar at King’s College Hospital, who has observed a correlation between uterine niches and decreased embryo implantation rates.

The patient subsequently underwent an experimental niche correction procedure involving surgical excision of the defect and uterine reconstruction. The three-hour operation resulted in reduced spotting and imaging confirmed a smaller scar with minimal fluid accumulation. Although data on the fertility outcomes of such surgery remain limited, a 2023 Dutch study involving 133 women found the results “promising” though not definitive.

Dr. Narvekar reported that he has increased the frequency of performing niche correction surgeries, now conducting about one per month in the last two years, which is double his previous rate. Dr. Sarris noted that as cesarean rates rise in the UK, awareness and diagnosis of uterine niches have become more common within fertility clinics, designating niche correction research as an emerging field.

Despite undergoing surgery, the patient’s subsequent IVF attempts—including transfers of genetically screened embryos—were unsuccessful. Multiple fertility specialists have since been unable to identify the precise cause, though they acknowledge that factors such as maternal age and residual uterine issues may play a role.

While the patient expressed no regret about the original cesarean section, which was necessary to ensure the survival of her son, she reflected on the impact of the secondary infertility that followed. The experience underscores a growing need for greater awareness and earlier evaluation of uterine niches in women seeking to conceive after cesarean delivery.

This article was reported by synthesizing coverage from multiple independent news outlets to present a balanced, unbiased account. Read about our editorial standards. Spotted an error? Let us know.