Caesarean section defects may affect pregnancy outcomes after in vitro fertilization-embryo transfer: a retrospective study

Abstract

Background Caesarean section rates are rising worldwide. One adverse effect of caesarean section reported in some studies is an increased risk of subfertility. Only a few studies have assessed the relationship between the previous mode of delivery and in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) reproductive outcomes. In this study, we primarily investigated the impact of a history of caesarean section with or without defects on IVF/ICSI-ET outcomes compared to a vaginal delivery history. Methods This retrospective study included 834 women who had a IVF or ICSI treatment at our centre between 2015 and 2019 with a delivery history. In total, 401 women with a previous vaginal delivery (VD) were assigned to the VD group, and 433 women with a history of delivery by caesarean section were included, among whom 359 had a caesarean scar (CS) without a defect and were assigned to the CS group and 74 had a caesarean section defect (CSD) and were assigned to the CSD group. Baseline characteristics of the three groups were compared and analysed. Binary logistic regression analyses were performed to explore the association between clinical outcomes and different delivery modes. Results There were no significant differences in the live birth rate, biochemical pregnancy rate, clinical pregnancy rate, mean implantation rate or abnormal pregnancy rate between the CS and VD groups However, the live birth rate and mean implantation rate in the CSD group were significantly lower than those in the VD group (21.6 vs 36.4%, adjusted OR 0.50 [0.27–0.9]; 0.25 ± 0.39 vs 0.35 ± 0.41, adjusted OR 0.90 [0.81–0.99]). Among women aged ≤ 35 years, the subgroup analyses showed that the live birth rate, biochemical pregnancy rate, clinical pregnancy rate, and mean implantation rate in the CSD group were all significantly lower than those in the VD group (21.4 vs 45.8%, adjusted OR 0.35[0.15 ~ 0.85]; 38.1 vs 59.8%, adjusted OR 0.52[0.24–0.82]; 31.0 vs 55.6%, adjusted OR 0.43[0.19–0.92]; 0.27 ± 0.43 vs 0.43 ± 0.43, adjusted OR 0.85[0.43 ± 0.43]). For women older than 35 years, there was no statistically significant difference in any pregnancy outcome among the three groups. Conclusions This study suggested that the existence of a CS without a defect does not decrease the live birth rate after IVF or ICSI compared with a previous VD. However, the presence of a CSD in women, especially young women (age ≤ 35 years), significantly impaired the chances of subsequent pregnancy.

Pregnancy and Perinatal Outcomes of Patients With Prior Cesarean Section After a Single Embryo Transfer in IVF/ICSI: A Retrospective Cohort Study

“…Patients with CSD were associated with a significantly lower rate of subsequent live birth (aOR: 0.609, 95%CI: 0.476~0.778, P <0.001) and clinical pregnancy (aOR: 0.779, 95%CI: 0.623~0.973, P =0.027), as well as a higher likelihood of miscarriage (aOR:1.407, 95%CI: 1.03~1.923, P =0.032) compared with those without defect at the site of the cesarean incision. The results were in agreement with previous studies ( 21 , 35 ). The existence of CSD could lead to poor pregnancy outcomes in patients undergoing IVF.…”

“…( 20 ) observed no difference in live birth rate (40.59% vs 45.38%, P =0.466) between the CD and VD groups, however, there was imbalanced maternal age. Diao ( 21 ) et al. also revealed no significant difference in live birth rate (33.1% vs36.4%, OR: 0.86, 95%CI: 0.64~1.16, P >0.05) with thinner endometrial thickness in the CD group.…”

The consequences of cesarean section and vaginal delivery on ovarian reserve in infertile women

“…With the increasing cesarean rate, the consequences of the mode of delivery on fertility is a more striking issue, and some studies have suggested that cesarean section may cause negative reproductive outcomes (7)(8)(9). However, some studies suggest that there was no such relationship (10,11,22).…”

“…While the rate predicted by the World Health Organization for cesarean section was between 10% and 15% in the 1980s, it is over 40% in some regions today (6). Today, the increasing frequency of cesarean section raises concerns with the studies showing some negative effects on fertility (7)(8)(9). However, these studies had limitations, such as the older age of the cesarean section group, the co-morbidities of the cesarean section group, and the non-homogeneous distribution of the groups (10,11).…”

Previous caesarean delivery and the presence of caesarean scar defects could affect pregnancy outcomes after in vitro fertilization frozen-thawed embryo transfer: a retrospective cohort study

“…A previous study reported that CD without defects does not decrease the live birth rate after IVF compared with previous VD. However, the presence of CSD in women, especially young women (age ≤ 35 years), significantly impairs the chances of subsequent pregnancy in patients undergoing IVF-ET [ 13 ]. The effect of CD on IVF pregnancy outcomes is uncertain and only a few studies to date have evaluated the association between CD/CSD and frozen-thawed embryo transfer (FET) pregnancy outcomes.…”