Caesarean section (CS) rate and its relatively new long-term sequela; scar niche have increased in clinical practice. Although niche-related symptoms are not life-threatening consequences after CS, they can cause long-term morbidities including subfertility and infertility. The aim of the present study to assess the better evaluation of cesarean scar niche in patients with secondary infertility and to correlate the appearance of the scar with the associated symptoms. Patients and methods: A crosssectional study involved 100 women with secondary infertility and a history of at least one CS. Results: The current study revealed the mean age of cases was 28.12 (±3.54 SD), mean BMI was 29.2 (± 3.56 SD) and the mean Number of children was 2.1 (±0.56 SD).There were 45 cases with 1 Previous CS, 30 cases with 2 previous CS, 25 cases with 3 previous CS, 12 cases with previous failed ICSI, 35 cases with Previous miscarriage, 16 with Previous curettage, 10 with Previous preterm labour due to tender scar. There was insignificant correlation between features of niche by diagnostic hysteroscopy with duration of secondary infertility.There was significant correlation between dimensions of niche by Saline Infusion Sonohysterography with niche-related symptom “post-menstrual spotting with the volume being the most predictive parameter. There were insignificant correlation between different shapes of niche by Saline Infusion Sonohysterography and niche-related symptoms.There was insignificant correlation between dimensions of niche by Saline Infusion Sonohysterography and duration of secondary infertility. Conclusion: There are no specific anatomical characteristics for Cesarean Section scar niche in secondary infertility patients. Niche volume, depth, and width are good predictor factors for postmenstrual spotting in those patients with scar niche.

Cesarean Scar; Sonohysterography ; Hysteroscopy