Difficulty conceiving again
A real association, mostly linked to the scar pocket.
In a systematic review of 35 studies, secondary infertility among women found to have a uterine niche was reported between about 27% and 75%. The range is wide because the studies were small and used different definitions, so this should be read as a signal rather than a precise figure.
Proposed mechanisms include thinning of the remaining muscle over the niche, chronic inflammation, and fluid pooling in the pocket that interferes with implantation.
What is not established is whether cesarean delivery in general reduces fertility. A dedicated time-to-pregnancy study comparing cesarean with vaginal birth was not identified for this tool, and no such claim is made here.
Where this comes from:
323. Nuamah MA, Browne JL, Öry AV, Damale N, Klipstein-Grobusch K, Rijken MJ. Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study. Reprod Health. 2017;14(1):143.
325. Jayasundara DMCS, Jayawardane IA, Jayasingha TDKM, Weliange SDS. Exploring uterine niche: a systemic review on secondary infertility rates, pathophysiological correlations, impact on assisted reproduction technology (ART), and the efficacy of surgical interventions. BMC Pregnancy Childbirth. 2025;25(1):566.
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