Can a C-Section Impact Future Fertility?
I hear all the time: Does having a C-section affect your ability to get pregnant in the future?
This is a nuanced topic, and I want to break it down with the facts. I’ve personally had two C-sections, and there are many reasons someone may need one. Let’s explore the research, what it means, and what you can do if you’re trying to conceive after a C-section.
The Rise of C-Sections
The number of C-sections has been increasing worldwide. In 1990, about 7% of deliveries in the U.S. were by C-section. Today, that number is over 20%. In other countries, like China, Brazil, and the Dominican Republic, more than 50% of births are C-sections.
At the same time, infertility is also on the rise. Could there be a connection? Let’s look at the evidence.
C-Section and Secondary Infertility
Several large studies have examined fertility after a prior C-section versus a vaginal delivery. Here’s what they show:
The live birth rate is roughly 9–10% lower for people who’ve had a prior C-section.
In a study of over 6,000 people in each group who were actively trying to conceive, 19.5% of those with a prior C-section experienced infertility, compared to 8.3% in the vaginal delivery group.
Time to pregnancy was longer in the C-section group—typically two to six months longer, regardless of whether the C-section was urgent or planned.
Even in IVF studies, these differences persist. One study with 1,300 participants in each group found:
Prior C-section: 15.9% live birth after embryo transfer
Prior vaginal delivery: 23.3% live birth after embryo transfer
This shows that prior C-sections can have a measurable impact on fertility, even with assisted reproduction.
Why Could This Happen?
There are several reasons why fertility may be affected after a C-section:
Birth Trauma: Any delivery can cause physical or emotional trauma, which might delay future attempts at conception.
Age and Complications: People having C-sections are often older or experiencing complications, which can correlate with underlying fertility challenges.
Uterine Healing: The C-section itself is not a benign process; cutting into the uterus may affect placental implantation.
Scarring: C-sections can cause scarring in the uterus or fallopian tubes.
C-Section Defects (Isthmocele): This occurs when the uterine layers don’t fully heal, creating a small defect that can affect implantation or cause fluid buildup.
What Is an Isthmocele?
When performing a C-section, the surgeon cuts through three layers of the uterus:
Outer layer (peritoneum)
Muscular layer (myometrium)
Endometrial cavity (where the amniotic sac is)
If the myometrial layer doesn’t fully heal, an isthmocele can form.
Some people may have no symptoms.
Others may experience abnormal bleeding, such as prolonged periods or spotting between periods.
Studies suggest 50–60% of people after a C-section may have an isthmocele, but only about 30% show symptoms.
Diagnosing and Treating an Isthmocele
These defects can often be seen on ultrasound or other imaging studies like a saline sonogram or HSG test.
Surgical repair can improve fertility outcomes:
Laparoscopic repair: Reduced fluid in the uterus from 40% to 7%, with 52% conceiving naturally within two years.
Hysteroscopic repair: Smaller studies show 100% pregnancy rates post-repair.
Surgery isn’t necessary for everyone, but for people with abnormal bleeding, fluid in the uterus, or infertility, evaluation and repair may be worth discussing.
Healing and Timing for Future Pregnancies
After a C-section, most experts recommend:
At least 12 months before trying to conceive again.
Some suggest 18 months is ideal.
Minimum of six months if necessary—but many fertility specialists prefer waiting longer to allow full uterine healing.
Takeaway
C-sections happen for many reasons, and having one does not mean you won’t be able to have more children.
However, it’s important to:
Give your uterus time to heal
Watch for abnormal bleeding
Get evaluated if you experience infertility or other symptoms
Awareness of isthmoceles is crucial—most people have never heard of this defect. Knowing the signs and options empowers you to make informed decisions about your fertility journey.
