Why This Exists
Four years. Two repairs.
One miracle.
This is Karen's story. It's also the story of thousands of women who never got the answers they deserved.
“Four years.”
That's how long I spent trying to navigate secondary infertility. I spent the first two years cycling through an “unexplained secondary infertility” diagnosis, watching pregnancies end in loss, and being told again and again that nothing was wrong.
I knew something was wrong. My body knew something was wrong. But my doctors either didn't know about isthmoceles, or if they did, they didn't think they were an issue.
The Diagnosis
After one c-section and one VBAC, I developed what doctors call an isthmocele — a defect in the uterine wall at the cesarean scar. Fluid filled the defect and also pooled in my uterine lining, disrupting my cycle, damaging my uterine lining, and making implantation nearly impossible.
Getting that diagnosis required persistence, hundreds of imaging studies, and finding a physician who knew what to look for. Most OBGYNs have never even heard of it.
Some dismissed my symptoms entirely, and by the time I had an official name for what was wrong, I had already lost two pregnancies, endured two and a half years of failed fertility treatments, and spent thousands of dollars chasing a diagnosis that should have come far sooner.
The First Repair
I had my first isthmocele repair locally. It was the only option my insurance would easily cover, performed by a surgeon who had done the procedure a handful of times.
It didn't work. The defect persisted. The symptoms remained. And the window for trying again was closing.
I started researching surgeons with deep experience treating isthmoceles, and that search led me across the country.
Flying to Missouri
I flew to Missouri to see Dr. Gavin Puthoff. He was methodical, experienced, and genuinely listened.
The second repair was everything the first wasn't. Careful closure technique, proper imaging confirmation, uterine PRP to promote better healing and help with inflammation, and a thorough post-operative follow-up.
My RMT (residual myometrial thickness) improved and my lining recovered. For the first time in four years, the conditions for a healthy pregnancy were in place.
One miracle.
Gracie Rose is the reason this project exists — not because the story ended neatly, but because so much of it never should have been this hard.
The Niche Project is here to help other women find answers sooner, feel less alone, and know what questions to ask when something still doesn't feel right.
“My story shouldn't be this common — but it is.”
— Karen Floyd, founder
The Mission
The Niche Project exists so fewer women spend years being told everything looks normal when they know it doesn't.
Build the registry.
Collect detailed, structured data from patients about diagnoses, symptoms, repairs, and outcomes — so researchers and clinicians have better evidence, and future patients have better answers.
Create the resource.
Provide clear, patient-centered information about isthmocele — what it is, how it affects fertility, how it is diagnosed, and what treatment can look like.
Grow the community.
Help women facing infertility, loss, and confusing postpartum complications know they are not alone — and know where to start advocating for themselves.
Be part of the change.
Your story matters. Every submission adds to the data that helps the next woman get diagnosed faster, find the right surgeon, and feel less alone.