Volume 29, Issue 164, October 2025

Cesarean scar defects as an underestimated cause of secondary infertility

Wiktoria Kasianik^1♦, Dmytro Kowalczuk², Darya Lazitskaya², Mykola Sobchynskyi², Natalia Surosz², Kamil Turlej³, Andrzej Myrny³, Valeryia Milasheuskaya⁴, Iga Kiełbaszewska⁵, Katsiaryna Miraniuk⁶, Dawid Wiczkowski⁷

¹Mazovian Rehabilitation Center STOCER Ltd. Saint Anna Hospital, Barska 16/20, 02-315 Warsaw, Poland
²Międzyleski Specialist Hospital in Warsaw, Bursztynowa 2, 04-749 Warsaw, Poland
³University Clinical Center of the Medical University of Warsaw, Banacha 1A, 02- 097 Warsaw, Poland
⁴Wroclaw Medical University, wyb.Ludwika Pasteura 1, 50-367 Wroclaw, Poland
⁵Independent Public Healthcare Center in Hajnówka, Doc. Adama Dowgirda 9, 17- 200 Hajnówka, Poland
⁶Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
⁷Independent Public Specialist Western Hospital named after St. John Paul II, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland

^♦Corresponding author
Wiktoria Kasianik, Mazovian Rehabilitation Center STOCER Ltd. Saint Anna Hospital, Barska 16/20, 02-315 Warsaw, Poland

ABSTRACT

Cesarean scar defect (CSD, also called isthmocele or niche) has become a more common issue after cesarean deliveries. Most women with CSD don't notice symptoms, but for some, it causes problems that get in the way of pregnancy. CSD can lead to old blood lingering in the uterus, fluid collecting, chronic inflammation, changes in the endometrial lining, and weaker uterine contractions. All these factors together make it more difficult to conceive. And it doesn't end there—women with CSD often have other conditions like adenomyosis, endometriosis, or sexual dysfunction, making fertility even more challenging. However, the lack of standard criteria among various studies concerning diagnosis and inconsistencies in nomenclature make it hard to identify how frequently this defect occurs. There is an increasing body of evidence relating CSD to infertility, but most of this data was collected from research on an observational basis, meaning the cause-and-effect relationship remains unknown. Surgical repair is performed by hysteroscopic or laparoscopic approaches. The outcome of this procedure seems promising, particularly among those with marked symptoms. However, more research on a larger number of subjects is still required. More awareness, proper approaches in the diagnosis of CSD, as well as individual programs of treatment, can help increase the possibility of pregnancies among those with CSD.

Keywords: Cesarean scar defect; secondary infertility; uterine niche; hydrometra; endometriosis

Medical Science, 2025, 29, e211ms3707

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DOI: https://doi.org/10.54905/disssi.v29i164.e211ms3707

Published: 30 October 2025