Fertile Biomarkers: Basal Body Temperature

Basal body temperature (BBT) tracking is a popular method of fertility tracking used by many women to monitor and gather information about their menstrual cycles and optimise their chances of conceiving or to avoid pregnancy naturally. The technique involves taking and recording your temperature every morning immediately after waking up, before getting out of bed or engaging in any other activities.

Why Track Basal Body Temperature?

Basal body temperature changes throughout the menstrual cycle, rising after ovulation occurs and dropping before menstruation. By tracking your BBT, you can identify when you ovulate and predict when your next period will be due. This makes it a useful tool for fertility-awareness based methods of contraception or for increasing your chances of conceiving naturally. Additionally, tracking BBT can help detect hormonal imbalances or other reproductive issues that may affect fertility, as well as certain autoimmune conditions.

How to Track Basal Body Temperature

To track your BBT, you will need a basal body thermometer, which is more sensitive and accurate than a regular thermometer. In Celcius, this will give you two decimal places instead of one.

If tracking manually, you should take your temperature at the same time every day, and ideally at the same time each morning. To get an accurate reading, you must take your temperature before getting out of bed or doing anything else, as movement can affect the results, as can taking at a different time each day, sickness, alcohol consumption or a number of other factors.

For many women, these requirements can be a barrier to entry, maybe shift work, night waking to attend to children or other lifestyle factors would make it difficult to take your temperature every day at the same time, or without having woken multiple times through out the night. The rise of wearable BBT devices has been a huge leap forward in overcoming the common disturbances such as sleep, sickness or alcohol consumption, by continuously tracking and using tech to remove aberrant data, giving a more accurate BBT, all while reducing the mental load of BBT tracking. My favourite wearable, which I have used myself since 2020 is TempDrop – and they very generously give a 10% discount to my followers. {Use the code: NATURALFERTILITYCOLLECTIVE}

Make sure to record your temperature daily in a chart or digital app to easily monitor the fluctuations in your BBT, most wearable devices will automatically sync this information for you. You may notice a pattern of temperature changes throughout your cycle, with a sustained and significant increase indicating ovulation has occurred. This information can then be used to determine closure of the fertile window, and can be used to inform decisions about the timing of intimacy to avoid or achieve pregnancy.

Benefits of Basal Body Temperature Tracking

Besides helping you identify the fertile window, tracking your BBT allows you to spot any irregularities in your menstrual cycle. For instance, if you frequently experience unusually short or long cycles, early or late ovulation, or prolonged periods, it could be indicative of a hormonal imbalance, thyroid issues, or other underlying health conditions.

By tracking your BBT over several cycles, you and an experienced health professional that is versed in the symptothermal method (like me!) will gain a better understanding of your reproductive health, which can help address any issues and improve your chances of conceiving, or inform holistic care that manages your health issues.

Basal body temperature tracking is an effective and inexpensive way to monitor your menstrual cycles, detect ovulation, and assess the health of your luteal phase and progesterone production. With a few simple steps, you can easily track your BBT and gain valuable insights into your reproductive health.

Wanting to learn to chart and understand your fertile biomarkers to avoid pregnancy naturally? I have created Contraception: Naturally, just for you!

Or maybe you are preparing for pregnancy and want to supercharge your fertility and have clear insights into your cycles? Then Conceiving: Naturally is the perfect life-long investment for you and your family.

As always, if this article has raised questions – please feel free to reach out via Instagram or email.

Maddy x

What I’ve Done to Prepare for Birth

38 weeks. I feel beyond blessed to have made it to full term for the third time. I know that realistically, from my previous pregnancies, that I likely have some weeks left to go, being 40+5 and 41+2 with my two boys – who knows when this little person will make their appearance!

Coming into my third birth, I haven’t had as much time to prepare intentionally for labour like I had with my first labour – but that is okay, because I feel that I laid some valuable ground work in my first pregnancy that has supported the process in subsequent pregnancies, and of course, I have the same wonderful team looking after me this birth as I did in my previous pregnancies.

Having had two vaginal deliveries previously, with labour lasting 12 hours for my first birth and 2 hours with my second, I am very interested to see how quickly this labour progresses. The most helpful thought going into this birth is the knowledge that I CAN do this, I have done this before and my body knows what to do.

What I would love to share with you this week is some of the wonderful resources I have accessed over the course of three pregnancies to support myself in labour and postpartum – this week I’ll focus on what I’ve done to prepare for birth.

What I used in previous labours (that I’m planning to use again)

  1. Music – I had a playlist already made on Spotify for both of my births, and I plan to use one again. Engaging oxytocin production is key for labour progression, and for me music is a helpful tool
  2. Warm water – I laboured in the shower on a yoga ball for both births, with my oldest son born in the hospital shower, and my second born in the bed because we needed some position changes to get enough slack on his thrice-looped cord for him to be delivered.
  3. Movement – I laboured on the yoga ball and birthed in a kneeling position for my first birth, positional changes were also key in delivering my younger son.


  1. Australian Birth Stories – listening to positive birth stories was something that was really helpful to me in my first pregnancy, prior to being pregnant I had not ever really heard a positive story. There is also a crazy phenomenon where every person wants to tell you horror stories about birth while you are pregnant – it is totally okay (and in fact, I advise you to) to say that you aren’t in a space to hear negative stories – that’s what I did in my first pregnancy and it made things manageable for me.
  2. The Middee Society – I love Mon, being a midwife herself, you can trust that the topics talked about are being approached with compassion and an expert eye. I especially enjoy the focus she puts on education and empowerment making all the difference in how women feel and experience their births.


  1. Ina May’s Guide to Childbirth by Ina May Gaskin – I’m going to start with a controversial one! I personally got so much benefit out of Ina May Gaskin’s seminal work, although there are plenty of things in there that I didn’t personally agree with, and some polarising topics, the focus on women’s ability to have natural births was very helpful to me, as I didn’t know anyone that had had an unmedicated vaginal delivery, so it sowed the thought that maybe it was possible – and it also filled me with conviction that a midwifery-led model of care was something that resonated with me. I ended up choosing a hospital birth with a midwifery led model of care, with a known midwife – I have been lucky enough to actually have the same midwife deliver both of my boys, and I am so thankful for that experience.

I would sum up my recommendation of this one by saying, chew up the meat and spit out the bones – if there are things you don’t agree with or don’t resonate with you, then just move on or even close the book and read something else. Fun fact: Gaskin’s manoeuvre for delivering shoulder dystocia babies is actually still widely in use in the pre-hospital setting.

My Most Important Tip: Breast-feeding Preparation

As a first time mother, I really hadn’t done enough to prepare myself for breastfeeding, I just assumed that it was something that would come naturally! If breastfeeding is something you would like to do, then take time to prepare for it prior to birth by getting education and support in place.

I would recommend that if you are planning to breastfeed you should do some education in advance to prepare yourself mentally for the long haul that breastfeeding can be. I had a hard time the first 6 weeks of feeding my oldest son, but with support from my midwives, who continued to visit me at home postnatally, and my husband, I ended up feeding him until he was 2 years old!

If you are a Brisbane local and want to do some pre-birth education, my lovely friend Katie at Flourish Lactation is a great option – she is also an invaluable support postpartum when you are getting breastfeeding established, facing challenges or preparing to return to work or wean.

And if you are looking for a great resource to access prior to birth to prepare for breastfeeding, Kate from Milky Business Lactation has a wonderful online course that you can access anywhere in the world from the privacy of your own home.

Both of these amazing women are not only breastfeeding mothers of multiple children and experienced midwives, they are both Internationally Board Certified Lactation Consultations (IBCLC) – the absolute gold standard when it comes to breastfeeding support and education.

These resources and tools were so helpful to me on my pregnancy and birth journeys – and I hope that some of them are helpful to you soon, or are a helpful and thoughtful gift you can give to an expectant mother in your life soon. Keep an eye on my Instagram this week to keep updated on all things in the final countdown to delivery day!

Maddy x

Hyperemesis Gravidarum: Surviving my Third HG Pregnancy

Nausea and vomiting in pregnancy is one of the most commonly discussed symptoms in popular culture – nearly every pregnancy experience alludes to “morning sickness” – but what about when its morning, noon, night sickness?

1-2% of pregnancies meet the criteria for hyperemesis gravidarum, however the actual numbers of women experiencing moderate to severe nausea and vomiting in pregnancy, that impacts on their daily function, their quality of life, their mental and physical health and the wellbeing of their unborn child and their family is likely much higher, but not assessed appropriately by current diagnostic criteria. HG often results in significant weight loss in early pregnancy, dehydration and electrolyte disturbance and often requires medication or IV hydration in order to cope with the effects.

I never understood how debilitating nausea and vomiting in pregnancy could be until I experienced it for the first time myself. In my first pregnancy I lost 12kg in the first 16 weeks of pregnancy, my second pregnancy I lost 8kg and my third pregnancy my weight fluctuated throughout the first 25 weeks. While 70-80% of pregnancies involve some level of nausea and vomiting, many of these will resolve by 12 weeks – HG may persist until delivery, with it often persisting until mid-pregnancy at a minimum.

Commonly suggested strategies for managing nausea and vomiting in pregnancy such as vitamin B6, ginger, sour drinks, Fruit Tingles, may be helpful for some women, however the majority of women in the throes of even moderate nausea and vomiting in pregnancy will find that additional medical support is necessary.

There are safe and effective medications available for reducing your symptoms, however the reality for many is that the vomiting will not be prevented entirely. Three pregnancies, three different management strategies – some medications that worked in my first pregnancy didn’t work at all in my subsequent pregnancies.

Three Key Strategies for Managing HG:

  1. Advocate for yourself with health professionals.

Finding a supportive team to manage my subsequent pregnancies made a huge difference in my experience. I didn’t have to recurrently present to my GP to get the prescriptions I needed, and I knew that if I required hospital admission or hospital in the home services, I would have access to them in a timely manner. If you are struggling to access effective support, I would encourage you to follow up with Hyperemesis Australia – who provide a great number of resources and support services that make self-advocacy or advocacy for a loved one easier. You may also find it helpful to access the current guidelines for Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum and print a copy to take to appointments with you.

2. Get your support system in place

Having supports and reasonable expectations in place in this season of your life is essential to your health and wellbeing. If you have supportive family or friends, consider sharing news of your pregnancy with them early and asking for their practical help where you feel comfortable (e.g. help with older children, meal prep for other members of your household). If you don’t have family or friends to help, consider taking this time to access support systems such as meal delivery services like Youfoodz, a house cleaner, or sending your laundry out if you can. And lower your expectations: your house is going to be a mess, you are going to eat what you can keep down and get some calories from, not what is nutritionally best.

3. Consider accessing early leave or sick leave.

If you have sick leave, use it. You are sick. Get a doctors’ letter confirming your condition, and apply for a flexible work agreement if necessary. Some employers that provide you with paid or unpaid maternity leave will allow you to take a portion of your time off during your pregnancy when you have a complicating condition, and hyperemesis falls into this category.

If you are suffering with HG, or have previously experienced a HG pregnancy and are planning another pregnancy – I would highly recommend Hyperemesis Australia as a resource to you.

Cycle Basics: Luteal Phase

Although this is the final portion of the menstrual cycle, it usually forms around half of your cycle length in women with regular cycles. The luteal phase immediately follows ovulation. The ruptured follicle that the egg was released from develops into the Corpus Luteum, which secretes progesterone, and the lining of the uterus thickens.

If the egg has been fertilised, everything is prepared for implantation and ready to support a pregnancy. If the egg is unfertilised, or implantation is unsuccessful, the Corpus Luteum will begin to break down and menstruation will start.

A sufficient luteal phase is essential for establishment of a healthy pregnancy – a luteal phase length of 11-14 days is necessary to allow for implantation to occur and the Corpus Luteum will start producing progesterone to support the growing embryo until the placenta forms.

There are two phases to the Luteal phase. The first portion is immediately following ovulation, and the highs of progesterone are still pumping in your system. Your metabolic demands are higher in this phase so you may find yourself feeling hungrier – your body does need extra calories in this time, so be kind and listen to these nutritional demands. 
The second half of the luteal phase is when many women may notice premenstrual symptoms such as fluid retention, tender breasts, constipation or loose stools, and those infamous mood swings, you may also notice increased fatigue in this phase. 

Investments made in your cycle health in the forms of supplements and stress management, mindful movement in the follicular and ovulatory phase pay off in the luteal and menstrual phases – if you have had a stressful and demanding follicular phase without supporting your health, you may find that your PMS symptoms are particularly marked. You may also note that health issues that are present throughout your cycle are particularly exacerbated during the pre-menstrual portion of your luteal phase – this phenomenon is known as premenstrual magnification, and can be a helpful indicator of underlying autoimmune and chronic health conditions when charting and tracking symptoms.

Cycle Basics: Ovulation

The main event! Ovulation is the main event of your menstrual cycle – it is an indicator of optimal health and fertility, and it also triggers the production of progesterone in the second half of your cycle – the luteal phase: which is essential for whole body health over your reproductive life and well into menopause.

In order for ovulation to occur, one of those beautiful little follicles that were developing in the follicular phase has reached maturity (or multiple have in the case of twins and triplets!). In response to the increased levels of oestrogen reduced by this mature follicle, luteinising hormone surges, triggering the rupture of this ovum from the follicle. It makes its way to the Fallopian tube – this is where sperm and egg should meet in order for conception to occur. In order to maximise your chances of conceiving, sperm should already be waiting or arrive within 24 hours of ovulation!

Wanting to avoid pregnancy? Then it is as *simple* (and as complex) as keeping sperm away from the fertile egg. That is why identifying the opening of the fertile window during the follicular phase, and confirming its closure after ovulation is essential to naturally avoiding pregnancy.

Even if you do not wish to become pregnant, ovulation is so important to womens’ health – because it allows for the development of the corpus luteum, which is created from the ruptured follicle in the ovary and secretes the higher levels of progesterone that are present in the luteal phase. Progesterone is essential for brain, bone, breast and cardiovascular health, not just now but well into menopause – and it is only when regular ovulation is occurring that you are building up your stores for the rest of your life!

Cycle Basics: Follicular Phase

Next in our series on Cycle Basics: The Follicular Phase! This is a portion of your cycle that is packed full of potential. Follicles are developing in the ovaries, with the dominant follicle being released as the ovum (egg) at ovulation. As the follicles mature, they begin to produce more oestrogen, introducing changes to cervical fluid and sensation at the vulva – opening the fertile window.

The Follicular Phase is the portion of the cycle that varies in length, if you are experiencing irregular cycles, the cause is nearly always occurring in this phase. During the follicular phase, hormones such as oestrogen are rising, and we are most susceptible to cycle disturbances due to stress, illness or health conditions – that’s because in this phase, our hormone receptors and hypothalamus are surveilling to make sure that this is an optimum time for pregnancy to occur, and will suppress or postpone ovulation if they determine it is not a safe time. Crazy?!

This phase is the part of a woman’s cycle where she moves from infertile to fertile, with the greatest likelihood of conceiving occurring when intimacy is timed for the fertile portion of the follicular phase, before ovulation occurs. When charting, a woman will learn to recognise the change from her Basic Infertile Pattern (BIP) to her fertile window during this phase!

The follicular phase is the time when women experiencing PCOS or ovarian cysts are most likely to run into problematic symptoms, and charting your cycles will give you clear insights into the impact that these conditions are having on your cycles, as well as providing help in identifying underlying health conditions, including those mentioned as well as others such as hypothyroidism and Hashimoto’s.

Wanting to learn more about charting and understanding your cycles to identify and manage womens’ health conditions? Send us a DM on Instagram, or check out our online courses to learn to chart today!

Cycle Basics: Menstruation

Menstruation may seem like the end of a cycle, but in fact, it is the beginning. The first day of fresh red bleeding is considered to be the start of a new menstrual cycle. This first day of fresh red bleeding is known as Cycle Day 1 (CD1) in charting. Menstruation is the shedding of the lining of the uterus, following a luteal phase with no pregnancy occurring.

A period can last anywhere from 2-7 days, with most menstrual periods lasting three to five days, including a day or two of light flow or spotting at the end.

Menstrual fluid should be red to brown in colour, and a loss of about 50mls over the bleeding phase is considered healthy. Greater than 80mls of loss is excessive, less than 25mls is considered very light. Not all menstrual fluid is blood, it also contains: cervical secretions, vaginal secretions, bits of endometrial tissue. Two thirds of the endometrial lining will be reabsorbed by the body, with the remaining third being shed. It should be mostly liquid, though a few clots the size of an Australia 5-10 cent piece is also normal.

Bleeding that is excessively heavy, very light, very short or very long, or unusual in colour or content always warrants investigation. Our menstrual flow is a helpful indicator of your overall health and wellbeing, and abnormalities can be indicative of a range of womens’ health, hormonal or autoimmune conditions.

Modern Menstruation

The modern woman is estimated to have approximately 400 periods in her lifetime, more than our ancestors due to wider availability of good nutrition. However, this figure varies greatly due to the widespread use of hormonal contraception.

Did you know that the cyclical bleeding you experience when taking the oral contraceptive pill is not a period? Instead, it is a withdrawal bleed, in response to taking the “sugar” pills without the active ingredient during a particular part of the medication regime – it simulates a period bleed, but was in fact predominantly introduced into the Pill protocol to reassure women they weren’t pregnant, to attempt to satisfy some Catholic criticism of the Pill, and to *ding ding* save money in manufacturing. Taking the placebo pills and allowing a withdrawal bleed to occur does not serve any medical purpose, however it may reduce the incidence of breakthrough bleeding that is more likely to occur if pill packets are run together – at some point the endometrial lining will shed.

While menstruation is an essential part of the cycle if choosing to chart your cycle – many women suffer from excessive pain, heavy bleeding or mood-related symptoms during or immediately prior to their menstrual phase. What do we do about this?

Painful Periods

The causes of excessive bleeding and excessive pain are not treated by suppressing the menstrual phase – while the use of hormonal contraceptives may prevent or reduce symptoms, it does not always stop disease progression, and can delay diagnosis. While you may choose to use hormonal methods such as the oral contraceptive pill or hormonal IUD to manage complex conditions such as endometriosis, prescription of these options without investigations of the causes of significant symptoms prevents women from making informed choices. For example, the current delay to diagnosis for women with endometriosis is is 6.5 years – this has a significant impact of quality of life for women, and the delay in diagnosis and treatment has significant impact on the likelihood of conceiving successfully in the future if desired: addressing symptoms alone without diagnosis and investigation reduces the options and informed decision-making of individuals – this is a concern that has been raised by the Royal Australian College of General Practitioners in the routine prescription of the oral contraceptive pill for adolescents presenting with heavy or painful menstrual periods.

While women with complex conditions such as endometriosis will likely require specialised support to manage their conditions, many choose to do so with allied health and alternative health support, not just traditional biomedical approaches. For women without underlying conditions, options such as magnesium supplementation, exercise programs and lifestyle modification, with or without breakthrough medication use, can make marked differences in their menstrual phase, without the need for hormonal contraception.

Want to learn more about how we can support you with period problems? Send us an Instagram DM or book a personalised consultation to get started!

Conceiving Naturally After Fallopian Tube Loss

Fallopian tube loss can be an emotionally distressing occurrence, particularly when it is complicated by an ectopic pregnancy loss, a complex womens’ health condition such as endometriosis or pelvic inflammatory disease. One of the questions that many women come away asking is: how will this effect my chances of having children in the future?

The Fallopian tube is an important structure residing within the pelvic cavity – it’s role is to facilitate the movement of the ovum from the ovaries to the uterus. It is also where sperm and egg meet if fertilisation is to occur and then the fertilised egg makes its way to implant in the uterine wall.

Occasionally, some women are only born with one Fallopian tube (or only one ovary for that matter), but more commonly, some women lose their Fallopian tubes as the result of an ectopic tubal pregnancy requiring its removal, or their Fallopian tube may become blocked or scarred in the context of certain condition such as endometriosis with adhesions, or untreated chlamydia, leading to pelvic inflammatory disease. The questions is, is it still possible to become pregnant with only one Fallopian tube?

The Fallopian tube is not a fixed structure – attached firmly to the ovary and immobile. Instead, the Fallopian tube is actually a hyper mobile structure within the pelvis – with little fimbriae at the end of the tube, similar to fingers on your hand – when the ovary is ready to release an egg, the Fallopian tube fimbriae “pick up” the egg, and allow it to move into the tube.

One study revealed that there was evidence that the corpus luteum was present in the opposing ovary in 32% of pregnancies in women that had a single Fallopian tube- which indicated that the opposite ovary had released the viable egg and had been collected by the Fallopian tube even though it was not on the “same side.” [1] So that represented a 1 in 3 chance of becoming pregnant from an egg released from the opposite ovary, even with only one Fallopian tube!

If you have experienced a condition resulting in the loss or damage to one of your Fallopian tubes, the good news is, it does not have to be a barrier to conceiving naturally – and optimising your reproductive health, practicing intentional preconception care for both yourself and your partner and learning to chart and understand your cycles to supercharge your chances of conceiving. If you would like to discuss these options more, and get tailored support and advice for your situation, why not book in a Nurture consultation with the Natural Fertility Collective.

[1] Jackie A. Ross, Amelia Z. Davison, Yasmin Sana, Adjoa Appiah, Jemma Johns, Christopher T. Lee, Ovum transmigration after salpingectomy for ectopic pregnancy, Human Reproduction, Volume 28, Issue 4, April 2013, Pages 937–941, https://doi.org/10.1093/humrep/det012

Caesarean Scar Isthmocele and Secondary Infertility – are we talking about this enough? 

April is Caesarean-Section Awareness Month. In 2020, 1 in 3 babies globally was delivered by C-section, and for many a C-section delivery is a life saving procedure for mother, child, or both [1]. 

I wanted to take this opportunity to discuss one increasing trend that we have seen emerge around secondary subfertility and Caesarean-scar isthmocele – if you have had a C-section in the past, and are struggling to conceive now, or are suffering from unexplained pelvic pain or abnormal uterine bleeding, C-section isthmocele might be a condition to ask about.

Unfortunately, Caesarean section isthmocele is a condition that not many women are aware of, so it can take a prolonged amount of time to identify this as the cause of their symptoms.

What is Caesarean Section Isthmocele?

Uterine isthmocele was first described in 1995, however our awareness of its relevance in fertility and future pregnancy has only come into its own over the past few years – with much more extensive research necessary and indicated. 

Diagnosis of Caesarean section isthmocele, starts with the symptoms that a woman is experiencing – after excluding other causes of abnormal uterine bleeding, a transvaginal ultrasound and hysterosonography may be undertaken. Hysteroscopy may also be implemented, as it allows a clear view of the pouch itself, and may allow its correction [2]. 

An isthmocele is a reservoir-like pouch that has formed in the front wall of the uterus at the site of the Caesarean section scar. They are bigger than 1-2mm and are usually triangular in shape, although some will be semicircular [3]. 

These pouches may contain fluid or blood, sometimes small volumes of a few ml, up to >30ml. 

Usually, a woman with a Caesarean scar isthmocele will experience no symptoms, and these require no further treatment, even if incidentally noticed on ultrasound. Unless they are causing symptoms they do not require intervention [3]. 

The most common symptoms associated with Caesarean scar isthmocele are: 

1. Abnormal uterine bleeding – particularly dark post-menstrual spotting (in the absence of other causes),

2. Pelvic pain,

3. Secondary infertility [3].

Yes, you read that right. Secondary infertility on its own is a SYMPTOM of a underlying condition.

Secondary infertility is difficulty in conceiving following previous successful pregnancy and birth – whilst the specific rates of secondary infertility are difficult to pinpoint, it is beginning to be evident in Western countries that secondary infertility can be as high as 1 in 6, the same is primarily infertility.

Sub-fertility represents one of the serious, potential long-term impacts of Caesarean section [4]. Rising numbers of C-sections may lead to rising trends in secondary infertility, if we don’t push more research and comprehensive support in this area. Despite rising numbers of C-sections, there has been little progress in raising awareness around the effects that isthmocele may have on future fertility, or the importance of its investigation in presentations of secondary infertility.

Secondary infertility may be caused as the collected blood/fluid in the pouch may affect the quality of cervical mucus, making it inhospitable to sperm [5].

Persistence of menstrual blood in the much may also obstruct sperm transport through the cervical canal, interfere with embryo implantation and lead to secondary infertility [6]. 

The post-menstural spotting is usually due to the accumulation of blood in the pouch during menstruation, then being discharged subsequently [3]. 

Risk factors and prevention of caesarean section isthmocele

Whilst the complication is more common in women that have a retroverted uterus and in women with multiple C-sections, the exact mechanism is not completely understood. It is thought that the tissue may have reduced healing due to poor blood circulation in that area, however other factors such as the stage of labour of the C-section, the suturing technique and a few other surgical wound closure factors, may also play a role [7]. 

Other risk factors include: premature rupture of membranes, short operation time for the C-section and the extent of cervical dilatation at time of C-Section. The short operation time was taken to indicate that more time should be taken to ensure a careful and thorough approach to uterine closure post C-section [7].

Pregnancy complications in future pregnancies may include higher rates of ectopic pregnancy and lower implantation rates [7].

Caesarean Scar Isthmocele & ART/IVF

Even within the context of IVF, women with history of an existing isthmocele from previous c-section have increased risk of developing intracavity fluid during ovarian stimulation – in fact, this may happen in 40% of cases. Presence of this endometrial fluid has an adverse effect on implantation, reducing pregnancy success rates.  However, in cases where women with isthmocele did not develop intracavity fluid, success rates were comparable to women without isthmocele [8].


In women experiencing symptoms, including secondary infertility, treatment of the isthmocele may be necessary. 

Medical and expectant “let’s wait and see” treatment are not reflected to be effective in current research. For women wishing to conceive, or planning a future pregnancy, minimally invasive surgical correction of the isthmocele generally gives the best outcome. 

Many isthmoceles can be corrected via hysteroscopic or laparoscopic repair, with a hybrid of the two options beneficial in many cases [9]. Patient outcomes appear similar across both surgical options, with improvement of pelvic pain, abnormal bleeding and secondary infertility in significant numbers after the surgical revision [10]. 

Surgical removal of the local inflammed tissue and correction of the pouch through a minimally-invasive method can improve pelvic pain, abnormal bleeding symptoms and has been demonstrated to restore fertility in many cases [6]. 

In one very small study of hysteroscopic correction of symptomatic isthmoceles:

  • 42.8% of the participants became pregnant within 6-8 months post-surgery [2]. 
  • In another small study, 91.7% of the participants who wished to conceive did so, including 60% of those with secondary infertility. 45% of these pregnancies carried to term and had successful deliveries both via C-section and VBAC [10].  

With so many births happening via C-section, having full and frank discussion about the possibility of Caesarean Isthmocele in cases of unexplained secondary infertility can be a fruitful and viable option for many women, with minimally invasive revision a helpful option.

Charting and understanding your cycle will provide valuable additional insight into the potential for caesarean scar isthmocele, with correlation between unusual post-menstrual spotting and cyclical pelvic pain becoming clear through cycle tracking. Insight from a qualified fertility awareness educator will also help to identify and rule out any other potential barriers to conception and help you to optimise your fertility and reproductive health, irrespective of caesarean scar isthmocele. We signpost to minimally invasive surgeons in these cases also.

You can learn more about our fertility course and personalised support here: Conceiving: Naturally.

Have questions regarding this article? Or seeking personalised clinical support in this area? Please reach out to us via our contact page! We’d love to hear from you.

Reference List 

  1. Cesarean Section Awareness Month, https://www.preventaccreta.org/cesarean-awareness

2. Carrillo de Albornoz, A.V., Carrasco, I.L., Pastor, N.M., Blanco, C.M., Matos, M.M., Pacheco, L.A., Bartolome, E.M. (2019). Outcomes after hysteroscopic treatment of symptomatic isthmoceles in patients with abnormal uterine bleeding and pelvic pain: a prospective case series. International Journal of Fertility and Sterility, 13(2), 108-112. 

3. Park, IY., Kim, MR., Lee, HN., Gen, Y. (2018). Risk factors for Korean women to develop an isthmocele after a cesarean section. BMC Pregnancy & Childbirth, 18(1).

4. Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, Gibbons D, Kelly NM, Kennedy HP, Kidanto H et al. (2018) Short-term and long-term effects of caesarean section on the health of women and children. The Lancet, 392:1349–1357.

5. Van der Voet, L,F., Bij de Vaste, A.M., Veersema, S., Brolmann, H.A., Huirne, J.A. (2014) Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. British Journal Of Gynaecology, 121 (2), 236-244. 

6. Florio, P., Filippeschi, M., Moncini, I., Marra, E., Franchini, M., Gubini, G. (2012). Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Current Opinion in Obstetrics & Gynecology, 24(3), 180-186.

7. Setubal, A., Alves, J., Osorio, F., Guerra, A., Fernandes, R., Albornoz, J., Sidiroupoulou, Z. (2018) Treatment of uterine isthmocele, a pouchlike defect at the site of a cesarean section scar. Journal of Minimally Invasive Gynecology, 25(1), 38-46.

8. Lawrenz, B., Melado, L., Garrido, N, Coughlan, C., Markova, D., Fatemi, Hm. (2020). Isthmocele and ovarian stimulation for IVF: considerations for a reproductive medicine specialist. Human Reproduction, 35(1), 89-99.

9. Vervoot, A., Vissers, J., Hehenkamp, W., Brolmann, H., Huirne, J. (2018). The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study. British Journal of Gynaecology, 125(3), 317-325.

10. Enderle, I.,Dion, L., Bauville, E., Moquet, PY., Leveque, J., Lavoue, V., Lous, ML., Nyangoh-Timoh, K. (2020). Surgical management of isthmocele symptom relief and fertility. European Journal of Obstetrics & Gynaecology & Reproductive Biology, 245. 

The Pill, lean muscle development & fertility awareness: could contraception be impairing your gains?

Muscle mass growth and the Pill: could contraception be impairing your gains?

It’s no secret that hormonal contraception can impact the body in a variety of ways. While some women may experience positive impacts from birth control, others are left with less than desirable side effects.

If you’re on the pill or another form of hormonal birth control, did you know that it could be negatively impacting your muscle growth?

That’s right, your contraception could be impairing your gains!

The Pill and muscle gains

The Pill may affect your muscle gains by affecting fat metabolism. It’s been shown that the Pill can alter energy levels, and this can slow down fat-burning. An insulin-like growth factor (IGF-1) is known to help build muscle, but the Pill can lower its production, as well as lowering estrogen and testosterone production. What’s more, the Pill can also interfere with growth hormone release—one of its main functions is to stimulate muscle growth. All of these factors combined means that the Pill could potentially have a negative impact on your muscle mass development.

The Pill, training and fitness

The Pill is no stranger to controversy. For example, there’s the long-standing speculation that hormones in birth control could lead to weight gain (which we’ve debunked with science). But one of the most common complaints you’ll hear from women who use oral contraception is that they notice a dip in strength, muscle mass, and general fitness levels after starting the pill.

While it can be difficult to separate out the effects of birth control from all the other factors that influence your training—like diet, stress and sleep—we wanted to find out if there’s any truth to this particular claim. We looked at the evidence to find out what kind of impact hormonal contraceptives can have on your fitness levels and how you might be able to minimise them.

If you’re serious about building muscle, some forms of hormonal birth control could be holding you back.

If you’re a female athlete, training with weights can be a crucial part of your fitness routine. Strength training is essential for building muscle mass and optimising your metabolism. Women need to maintain muscle mass as they age to avoid osteoporosis, frailty, and sarcopenia (loss of muscle mass). The ability to build muscle also declines as we age.

Interestingly a study released last year demonstrated the impact of hormonal contraception on lean muscle mass might be more profound than we have previously realised. It compared two groups of women both on and off hormonal contraception over a 10 week strength building program. The women that were taking hormonal contraception had significantly lower lean muscle mass gains, and higher levels of cortisol (the stress hormone), as well as lower levels of IGF-1.

The reason for the impairment of muscle growth appears to be related to the Pill impairing the anabolic and catabolic hormones that regulate muscle development, and possibly the effects of synthetic progestin on androgen receptors.

“Oral contraceptive use impaired lean mass gains in young women after RET and was associated with lower DHEA, DHEAS, and IGF-1 and higher cortisol”

Reichmann & Lee, 2021

The pill or other hormonal contraceptives may not be suitable for all women who want to build lean body mass or get serious about their fitness. The first step is to evaluate your goals and what you are hoping to achieve with exercise and proper nutrition while taking oral contraception or other types of hormonal birth control. Some forms of contraception could affect gains if you have specific fitness or health goals.

Natural birth control

If you’re concerned with how your birth control may be affecting your muscle mass, it’s important to understand the benefits of non-hormonal contraception. These are methods of avoiding pregnancy that don’t require a prescription or implantation, and they can help you understand and embrace your cycle with no side effects. To begin with, there are two primary types of natural birth control: barrier methods, which prevent sperm from entering the woman’s body (such as condoms), and fertility awareness-based methods, which involve tracking fertile biomarkers and ovulation, so that you know when not to have sex, or to use a barrier method.

These options may seem less convenient than popping a pill or having an IUD implanted in your uterus, but for those who want more control over their hormonal health without any added chemicals like estrogen and progestin from synthetic HBCs, these options may be empowering.

To learn more about the Symptothermal Method of Fertility awareness for contraception, check out our free resources or our comprehensive course Contraception: Naturally.


  • Riechman SE, Lee CW. Oral Contraceptive Use Impairs Muscle Gains in Young Women. J Strength Cond Res. 2021 May 14. doi: 10.1519/JSC.0000000000004059. Epub ahead of print. PMID: 33993156.