{"id":39602,"date":"2025-06-20T12:53:53","date_gmt":"2025-06-20T10:53:53","guid":{"rendered":"https:\/\/urecentrogutenberg.es\/isthmocele-and-secondary-infertility\/"},"modified":"2025-06-23T12:56:40","modified_gmt":"2025-06-23T10:56:40","slug":"isthmocele-and-secondary-infertility","status":"publish","type":"post","link":"https:\/\/urecentrogutenberg.es\/en\/isthmocele-and-secondary-infertility\/","title":{"rendered":"Isthmocele and secondary infertility"},"content":{"rendered":"<p>In assisted reproduction we talk about secondary infertility when a couple has already had one child but is now struggling to conceive a second child\u00a0<strong>after a year of unprotected intercourse<\/strong>. There may be many reasons why a couple is suffering from secondary infertility. Specifically, one of the causes we see in fertility clinics are\u00a0<strong>scar defects after caesarean section delivery<\/strong>. This is known as an isthmocele.<\/p>\n<p>Taking current data into consideration, the increased number of caesarean section deliveries has also demonstrated an\u00a0<strong>increased incidence and diagnosis of isthmoceles<\/strong>. Today we want to talk to you about this issue, why it can occur and what symptoms and diagnosis it involves.<\/p>\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_85 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Tabla de contenidos<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #3f3f3f;color:#3f3f3f\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #3f3f3f;color:#3f3f3f\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/urecentrogutenberg.es\/en\/isthmocele-and-secondary-infertility\/#What_is_an_isthmocele\" >What is an isthmocele?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/urecentrogutenberg.es\/en\/isthmocele-and-secondary-infertility\/#How_and_why_is_an_isthmocele_caused\" >How and why is an isthmocele caused?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/urecentrogutenberg.es\/en\/isthmocele-and-secondary-infertility\/#What_are_the_symptoms_of_an_isthmocele\" >What are the symptoms of an isthmocele?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/urecentrogutenberg.es\/en\/isthmocele-and-secondary-infertility\/#How_is_an_isthmocele_diagnosed\" >How is an isthmocele diagnosed?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/urecentrogutenberg.es\/en\/isthmocele-and-secondary-infertility\/#How_is_an_isthmocele_treated\" >How is an isthmocele treated?<\/a><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"What_is_an_isthmocele\"><\/span>What is an isthmocele?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>An isthmocele is a partial dehiscence, or what we commonly refer to as a\u00a0<strong>scar defect<\/strong>, which is produced following the process of a hysterotomy (the surgical opening of the uterus during a caesarean section), which leaves a sacculation or pouch\u2011like cavity at the site of the hysterorrhaphy, or surgical suturing, of the incision site.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"How_and_why_is_an_isthmocele_caused\"><\/span>How and why is an isthmocele caused?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>In order for an isthmocele to be produced, the woman first needs to have undergone a\u00a0<strong>caesarean section delivery (surgical procedure)<\/strong>. While it\u2019s true that the mechanism which causes this complication is unknown, its incidence is related to the number of prior caesarean section deliveries.<\/p>\n<p>Some recent studies have estimated that an isthmocele could appear\u00a0<strong>after the first C\u2011section delivery 60% of the time<\/strong>, and after three C\u2011sections this incidence could reach\u00a0100%.<\/p>\n<p>In addition, the appearance of this complication is also related to the\u00a0<strong>surgical technique used, the material and the type of suturing<\/strong>. The difference in size between the anterior and posterior edge of the surgical incision could also play a role, as well as the position of the woman\u2019s uterus, the most frequent position being retroflexed.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"What_are_the_symptoms_of_an_isthmocele\"><\/span>What are the symptoms of an isthmocele?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The truth is that\u00a0<strong>not all\u00a0<\/strong><strong>isthmoceles\u00a0<\/strong><strong>present clinical symptoms<\/strong>. At any rate, the most common symptoms include post\u2011menstrual bleeding, dyspareunia (pain during intercourse) and abdominal pain.<\/p>\n<p>Isthmoceles have also been linked to sterility and\u00a0<a href=\"https:\/\/urecentrogutenberg.es\/en\/secondary-infertility-when-a-second-pregnancy-doesnt-come\/\" target=\"_blank\" rel=\"noopener noreferrer\">secondary infertility<\/a>\u00a0due to\u00a0<strong>difficulties for the spermatozoids to penetrate\u00a0<\/strong>the uterus, as well as the detrimental effects on sperm that can occur in the cervical canal.<\/p>\n<p>An isthmocele may also have\u00a0<strong>a negative impact on implantation<\/strong>\u00a0if the pouch\u2011like cavity contains products of menstruation that can later leak out and enter into the endometrial cavity, possibly\u00a0<a href=\"https:\/\/urecentrogutenberg.es\/en\/female-infertility-conditions-and-diseases-that-can-cause-it\/\">lowering the likelihood of embryo implantation<\/a>.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"How_is_an_isthmocele_diagnosed\"><\/span>How is an isthmocele diagnosed?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The diagnostic process for an isthmocele is clinical and requires the\u00a0<strong>help of imaging techniques<\/strong>: an endovaginal ultrasound and a hysteroscopy.<\/p>\n<p>During the endovaginal ultrasound\u00a0<strong>the size of the defect is measured<\/strong>: it is observed as an ellipsoidal or triangular eco negative image, so both diameters can be measured and its area can then be calculated.<\/p>\n<p>The\u00a0<a href=\"https:\/\/urecentrogutenberg.es\/en\/diagnostic-hysteroscopy-in-assisted-reproduction\/\" target=\"_blank\" rel=\"noopener noreferrer\">diagnostic hysteroscopy<\/a>\u00a0provides direct evidence of the defect,\u00a0<strong>determines its severity\u00a0<\/strong>and makes it possible to decide whether it should be surgically managed with a hysteroscopy or a laparoscopy.<\/p>\n<p>On occasion,\u00a0<strong>magnetic\u2011nuclear resonance imaging has been used to decide which surgical approach\u00a0<\/strong>should be applied to correct the defect depending on the size, in millimetres, of the thickness of the anterior surgical edge.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"How_is_an_isthmocele_treated\"><\/span>How is an isthmocele treated?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Treatment of an isthmocele requires\u00a0<strong>surgery only in cases presenting clinical\u00a0<\/strong><strong>symptomatology<\/strong>\u00a0or if the patient suffers from infertility and there is no other known cause.<\/p>\n<p>The treatment performed is a\u00a0<strong>resectoscopic<\/strong><strong>\u00a0correction by hysteroscopy<\/strong>\u00a0with the intention of reducing the size of the pouch\u2011like cavity defect, in addition to coagulating and closing the site of the surgical incision. When it is a wide, deep defect that cannot be treated by hysteroscopy, surgery must be performed by laparoscopy in order to suture the pouch\u2011like cavity.<\/p>\n<p>There are still very few published cases on this technique, but the initial results are promising. In fact, women have been able\u00a0<strong>to get pregnant naturally in the majority of cases\u00a0<\/strong>just a few months after the surgical correction. Patients, however, are advised to wait about three months before trying to conceive again if a hysteroscopy was performed, and six months if a laparoscopy was performed.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In assisted reproduction we talk about secondary infertility when a couple has already had one child but is now struggling to conceive a second child\u00a0after a year of unprotected intercourse. There may be many reasons why a couple is suffering from secondary infertility. Specifically, one of the causes we see in fertility clinics are\u00a0scar defects [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":34160,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[497,537],"tags":[559,538,528,511,512,504,529,543,550,542,545,521,523,522,532,517,519,531,518,507,508,540,567,503,541,514,509,510,533,506,578,535,515,589,590,591,539,564,557,516,505,530],"class_list":["post-39602","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-fertility-problems","category-miscellaneous","tag-age","tag-artificial-insemination","tag-assisted-reproduction","tag-assisted-reproduction-clinic-in-algeciras","tag-assisted-reproduction-clinic-in-malaga","tag-assisted-reproduction-techniques","tag-causes-of-infertility","tag-centro-gutenberg-en","tag-centro-gutenberg-malaga-en","tag-clinic-gutenberg-en","tag-donate-eggs-in-malaga","tag-egg-donation-in-algeciras","tag-egg-donation-in-algeciras-en","tag-egg-donation-in-malaga","tag-embryo-cryopreservation","tag-family","tag-female-fertility","tag-fertility","tag-fertility-clinic","tag-fertility-clinic-in-algeciras","tag-fertility-clinic-in-malaga","tag-fertility-preservation","tag-gutenberg-malaga-en","tag-in-vitro-fertilisation","tag-infertility","tag-ivf","tag-ivf-clinic-in-algeciras","tag-ivf-clinic-in-malaga","tag-pre-implantation-genetic-diagnosis","tag-pregnancy","tag-pregnancy-complications","tag-reproduction-unit-gutenberg-centre","tag-reproductive-treatments","tag-secondary-infertility","tag-secondary-infertility-algeciras","tag-secondary-infertility-malaga","tag-single-mothers","tag-spermatozoa","tag-sterility","tag-ure-en","tag-ure-centro-gutenberg-en","tag-vitrification"],"_links":{"self":[{"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/posts\/39602","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/comments?post=39602"}],"version-history":[{"count":1,"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/posts\/39602\/revisions"}],"predecessor-version":[{"id":39765,"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/posts\/39602\/revisions\/39765"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/media\/34160"}],"wp:attachment":[{"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/media?parent=39602"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/categories?post=39602"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/urecentrogutenberg.es\/en\/wp-json\/wp\/v2\/tags?post=39602"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}