1153: Mode of delivery and ovarian reserve – the effect of Cesarean versus vaginal delivery

Abstract

Pelvic surgery has been suggested as a risk factor for decreased ovarian reserve, most probably due to impairment in ovarian blood supply. Cesarean delivery is the most frequent pelvic surgery with increasing rates worldwide, nevertheless, no data exist concerning its effect on ovarian reserve. The aim of this study is to assess the effect of cesarean delivery on ovarian reserve compared to normal vaginal delivery. STUDY DESIGN: A prospective case control study conducted in a single tertiary medical center during June 2018 to April 2019. Study population included: 1.Women with singleton pregnancy that underwent their first cesarean delivery ; 2. Control group consist of pregnant women with normal vaginal delivery. Exclusion criteria included: 1. Known low ovarian reserve 2. Endometriosis 3. Previous pelvic surgery 4. Chronic maternal disease. Ovarian reserve was estimated by Anti Mullarian Hormone (AMH) levels up to a week before and three month after the delivery. Primary outcome was defined as the delta in AMH levels. Data were analyzed in non-parametric tests. RESULTS: During the study period 63 (47%) and 72 (53%) women underwent cesarean delivery and normal vaginal delivery, respectively. Women in the cesarean delivery group were older [34 (31-38) vs. 32 (29-35); p¼0.001], with higher parity [1 (0-2) vs. 0 (0-1); p¼0.001]. Delivery was a week earlier in the cesarean delivery group [38.3 (38.2-39.4) vs. 40.2 (39.1-40.5); p¼0.001]. AMH rates were comparable between the groups before delivery [0.92 (0.51-1.79) vs. 0.95 (0.51-1.79); p¼0.42], and was more than doubled after delivery in both of the groups [2.15 (1.24-3.05) vs. 2.62 (1.05-5.09); p¼0.50]. Median delta AMH levels was was comparable between study and control groups [1.25 (0.61-2.22) vs. 1.59 (0.63-3.41), respectively; p¼0.43]. Linear regression analysis including age, parity, grouping and gestational age at delivery, revealed that only maternal age was significantly associated with delta in AMH levels (B¼-0.22, p¼0.03). CONCLUSION: Cesarean delivery was not associated with a decrease in ovarian reserve as estimated by AMH.