What to Ask Your Doctor

Preparation is key. Bring documentation and be ready to advocate for yourself.

• 1Write down your full symptom history — when spotting started, how many days it lasts, and when in your cycle it occurs.
• 2Bring a list of all previous surgeries, including the date and type of each cesarean section.
• 3If you have previous ultrasound or imaging reports, bring printed copies or have them sent to the new provider.
• 4Note any fertility treatments you've had (IUI, IVF, embryo transfers) and their outcomes.
• 5Write down all current medications and supplements.
• 6Bring a trusted support person if possible — appointments can feel overwhelming.

Standard pelvic ultrasounds often miss an isthmocele. You may need to ask specifically for these tests.

• 1"Can you evaluate me for a cesarean scar defect (isthmocele / uterine niche)?"
• 2"I'd like a saline infusion sonogram (SIS / sonohysterography) — it gives a clearer view of any uterine defect."
• 3"What is my residual myometrial thickness (RMT)? Please give me the measurement in millimeters."
• 4"Can you check for fluid in or around the cesarean scar?"
• 5"What is the depth and width of any niche you find?"
• 6"Have you evaluated for isthmocele before? How many patients have you diagnosed?"

If an isthmocele is found, ask these questions to understand what comes next.

• 1"What is my niche depth and width in millimeters?"
• 2"What is my RMT (residual myometrial thickness)?"
• 3"Based on my RMT, do you consider my defect mild, moderate, or severe?"
• 4"Do you recommend surgical repair? Why or why not?"
• 5"What repair type do you perform — hysteroscopic, laparoscopic, or open?"
• 6"How many isthmocele repairs have you personally performed?"
• 7"What outcomes have your patients had? What is your complication rate?"
• 8"Should I get a second opinion before deciding on surgery?"

If surgery is recommended, make sure you understand the risks, recovery, and what to expect.

• 1"What are the risks of repair for my specific case?"
• 2"How long is the recovery period, and what are the restrictions?"
• 3"When can I try to conceive after repair? Is there a minimum waiting period?"
• 4"What uterine closure technique do you use?"
• 5"Will the repair improve my RMT? What post-repair RMT do you aim for?"
• 6"What will post-operative imaging look like? When will we confirm the repair worked?"
• 7"What happens if the first repair is incomplete — would you do a second repair?"

Pregnancy after isthmocele repair requires extra monitoring. Know what to expect.

• 1"Should my next pregnancy be monitored differently than a standard pregnancy?"
• 2"At what gestational age should I have my first imaging appointment?"
• 3"What delivery method do you recommend — vaginal or cesarean?"
• 4"What signs of uterine rupture should I watch for during pregnancy?"
• 5"Is there a risk of another isthmocele forming after a future cesarean?"
• 6"If I need another cesarean, what closure technique would you recommend to reduce the risk of a new defect?"