Post-Caesarean section niche-related impaired fertility: hypothetical mechanisms

Vissers, Jolijn; Hehenkamp, Wouter J.K.; Lambalk, Cornelis B.; Huirne, Judith A.F.

doi:10.1093/humrep/deaa094

Cited by 62 publications

(63 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The underlying mechanism that leads to adverse pregnancy outcomes among women with caesarean section after IVF may be attributed to the presence of a scar defect. A more recent review study by Vissers et al presented a series of hypotheses regarding the effect of a CSD on fertility outcomes [ 27 ]. The possible hypotheses relevant to this study are as follows.…”

Section: Discussionmentioning

confidence: 99%

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

Diao

Gao

Zhang

et al. 2021

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Diao

Gao

Zhang

et al. 2021

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…Caesarean scar niche has been suggested to underlie some cases of subfertility ( 13 , 22 ). In our current study we found that six women who had a subsequent pregnancy had caesarean scar niche (13%) and one woman who did not have a subsequent pregnancy had caesarean scar niche (14%) after initial treatment of caesarean scar pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Subsequent Fertility in Women Treated for Caesarean Scar Pregnancy With Hysteroscopy: A 5-Year Follow-Up Descriptive Study in a Tertiary Hospital

et al. 2021

View full text Add to dashboard Cite

ObjectiveThe outcomes of subsequent pregnancies and fertility in women with a history of caesarean scar pregnancy have not been well described. In this study, we followed up 149 women with a history of caesarean scar pregnancy and analysed the effect on their fertility.Methods149 women with a history of caesarean scar pregnancy were followed up for five years. Of them, 53 women had unprotected sexual intercourse attempting to become pregnant again. Data including clinical parameters and treatment options at the time of diagnosis of caesarean scar pregnancy, and the outcomes in subsequent pregnancy were collected. In addition, a questionnaire about the menstrual cycle after treatment was voluntarily completed by these women.ResultsOf the 53 women, 46 (84%) women had a subsequent pregnancy, while seven (14%) women did not. There was no association between the clinical parameters in previous caesarean scar pregnancy or treatment and future fertility. From the questionnaire, there was no difference seen in the length of the menstrual cycle and menses between the two groups. However, a higher number of women with light menstrual bleeding were seen in women without a subsequent pregnancy (67%), compared with women who did (28%). In addition, six women (13%) who had a subsequent pregnancy experienced foetus death in the first trimester.ConclusionWe reported that 14% of women with a history of cesarean scar pregnancy did not have a subsequent pregnancy, after unprotected sexual intercourse for more than two years. Light menstrual bleeding after treatment may be associated with this adverse effect. Our findings need to be further investigated with large sample size.

show abstract

“…It is very important to emphasize that the relief of symptoms was declared by 93.3% of women after operative hysteroscopy vs. 44.4% of women after diagnostic hysteroscopy (p = 0.009). Moreover, the performed logistic regression analysis showed a significantly higher effectiveness of operative hysteroscopy compared to diagnostic hysteroscopy in the reduction of symptoms associated with spotting after sexual intercourse OR ratio (95% CI) 16.500 (2.301-344.405), p-value 0.017. The analysis of the effect of the hysteroscopic treatment and thus the improvement of the quality of life is presented in Table 4.…”

Section: Social Healthmentioning

confidence: 96%

Symptoms and Quality of Life Changes after Hysteroscopic Treatment in Patients with Symptomatic Isthmocele—Preliminary Results

Szafarowska

Biela

Wichowska

et al. 2021

JCM

View full text Add to dashboard Cite

Due to an increasing number of cesarean section deliveries, the common consequences of that surgery are observed more often in the population. One of them is the uterine cesarean scar defect known as niche or isthmocele. Most patients with that aliment are asymptomatic, but some of them can report abnormal uterine bleeding, pelvic pain, subfertility which can be the reason for reduced quality of life (QoL) of the patients. In our study, we analyzed the subjective feelings of changes in the severity of symptoms and quality of life of women with niche after diagnostic and operative hysteroscopy. The patients n = 85 included in the study group completed a follow up questionnaire six months after the procedure. Patients after operative hysteroscopy in comparison to patients after diagnostic procedure reported statistically significant reduction in post-menstruation bleeding/spotting and improvement in the quality of sexual activity. We have also noticed a higher pregnancy rate in the operative group, however, the difference was not statistically significant. According to our study, most women reported a positive effect of hysteroscopy on their QoL in social, psychological, environmental, and health domains.

show abstract

Post-Caesarean section niche-related impaired fertility: hypothetical mechanisms

Cited by 62 publications

References 68 publications

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

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

Subsequent Fertility in Women Treated for Caesarean Scar Pregnancy With Hysteroscopy: A 5-Year Follow-Up Descriptive Study in a Tertiary Hospital

Symptoms and Quality of Life Changes after Hysteroscopic Treatment in Patients with Symptomatic Isthmocele—Preliminary Results

Contact Info

Product

Resources

About