Link between cesarean section scar defect and secondary infertility: Case reports and review

Abstract

The objective was to study clinical cases and understand the link between cesarean section scar defect with hydrometra and secondary infertility. A retrospective case series from an assisted reproductive center and infertility treatment clinic in the United Arab Emirates. We had five patients with secondary infertility diagnosed with cesarean section scar defect with persistent hydrometra based on high resolution transvaginal ultrasound assessment. The patients underwent surgical repair for the cesarean section scar defect followed by infertility treatment. Transvaginal ultrasound examination showed a normal endometrial cavity with triple lining endometrium and absence of hydrometra; and clinical pregnancy was the main outcome measure. Surgical correction of cesarean section scar defect was successfully performed in the cases presented. The patients had their fertility restored. Clinical studies revealed that cesarean section scar defect may lead to abnormal uterine bleeding, dysmenorrhea, pre-/post-menstrual spotting, heavy or prolonged menses, pelvic pain and secondary infertility. Theoretically, an inflammatory response, such as a wound healing process in the uterus due to hydrometra associated with scar defect may impair embryo implantation. The clinical case studies presented here are based on the correct diagnosis of the cesarean section scar defect with hydrometra and its successful surgical repair. The patients in our study had their symptoms resolved and attained clinical pregnancy.

Emerging data on diagnosis and management of uterine isthmoceles: a rapid review

“…Data extraction was performed on the 100 articles that met inclusion criteria. These included four systematic reviews [3 [12][13][14][15][16][17][18]; two randomized control trials [19 ]; 12 video articles [62][63][64][65][66][67][68][69][70][71][72][73], 10 case reports [74][75][76][77][78][79][80][81][82][83]; one case series [84]; and 21 conference abstracts [64,. Excluding the conference abstracts, 25 countries were represented as the country of correspondence of the first author of the remaining 79 publications.…”

Reproductive factors and subsequent pregnancy outcomes in patients with prior pregnancy loss

“…Of the 1955 women with PL, 20.46% had a previous live birth, of which 32.91% were delivered by cesarean section, which increased the risk of subsequent infertility in women with PL, but had no effect on the ongoing pregnancy and live birth in subsequent pregnancies. In recent years, the relationship between cesarean scar uterus and subsequent secondary infertility has been gradually recognized, but the specific mechanism is not clear [ 20 , 21 ]. Nobuta et al found that a cause of secondary infertility in women with cesarean scar syndrome may be chronic inflammation of the uterine cavity [ 22 ].…”

Isthmocele and Infertility

“…Literature analysis shows that various mechanisms have been proposed to explain how the collection of endouterine fluid (hydrometra) associated with isthmocele may interfere with the embryo implantation process in uterine tissue [78,79]. Previous studies have demonstrated that surgical intervention to correct defects in the cesarean scar can effectively restore uterine anatomy to a normal condition, thus preventing the accumulation of fluid within the endometrial cavity [80].…”