Previous caesarean section is associated with lower subsequent in vitro fertilization live birth rates

Abstract

This retrospective cohort study examines the association between previous mode of delivery and subsequent live birth rate in women who become pregnant after in vitro fertilization (IVF) or intra cytoplasmic sperm injection (ICSI) after their first delivery. The study included 112 women with a previous caesarean section and 418 women with a previous vaginal delivery, and a total of 1588 embryo transfers between January 2005 and June 2016 (Leiden University Medical Centre, the Netherlands). The mean age was 35 years and mean number of embryos transferred per attempt, 1.18. The study population included a total of 429 pregnancies resulting in 296 live births. The crude odds ratio for a subsequent live birth per embryo transfer was 0.60 (CI; 0.44 to 0.83, p ¼ 0.002) in women with a previous caesarean section compared to women with a previous vaginal delivery. After adjustment for age, fresh/frozen-thawed embryo transfer and quality of the embryo, the odds ratio was 0.64 (CI; 0.46 to 0.89, p ¼ 0.01). It was concluded that in subfertile women trying to achieve a subsequent pregnancy with IVF or ICSI, a history of caesarean section was associated with a reduced live birth rate per embryo transfer compared to women with a history of one previous vaginal delivery.

Effect of a prior cesarean delivery on pregnancy outcomes of frozen‐thawed embryo transfer: A retrospective cohort study in a freeze‐all setting

“…The present study finding is in agreement with the reports by Wang et al and van den Tweel et al, 16,17 but contradicts the other two studies. 14,15 Compared with women with only prior VD, the odds of live birth was reduced by 22% in those with a CD history, which was higher than the 10% decrease shown in women who conceived spontaneously 12 but lower than the 36% decrease reported by van den Tweel et al 17 Unlike previous investigations mainly on fresh embryo transfer, our study was meticulously conducted in FET cycles to rule out the detrimental effect of supraphysiologic E 2 levels on endometrial receptivity for implantation and placental development during COS. 18,20,21 Analyses were restricted to first transfers in a freeze-all setting, thus minimizing the potential bias from embryo selection and repeated implantation failure. In addition, our study was strengthened by the large sample size of over 2000 patients within a single institution, where clinical practice and laboratory conditions remained consistent during the study period.…”

“…10,11,13 With the advent and development of ART for infertility treatment, a few studies have also tried to determine the impact of CD on IVF/ICSI success with conflicting results. [14][15][16][17] In 2016, Patounakis et al 14 conducted a prospective cohort study of 194 patients undergoing fresh IVF/ICSI cycles. Despite the significantly longer time to perform embryo transfer and increased occurrence of blood/mucus on the catheter, they observed no difference in clinical pregnancy (41% vs 49%) or live birth rates (32% vs 39%) between patients with a CD history and those with only previous VD.…”

“…11,13 Nonetheless, only few studies to date have evaluated the association between previous mode of delivery and ART reproductive outcomes. [14][15][16][17] Conflicting conclusions were reached with limitations in inadequate statistical power and failure to adjust for confounders.…”

Reproductive and pregnancy outcomes following embryo transfer in women with previous cesarean section: A systematic review and meta‐analysis

“…Ten studies with 13 696 participants were included in quantitative synthesis and meta-analysis (Figure 1). 12,[16][17][18][19][20][21][22][23][24] Nine studies featured historical cohort analysis comparing infertile women with a previous cesarean delivery to women with a previous spontaneous delivery, scheduled to a fresh or frozen ET. 1,12,16,17,[19][20][21][22][23][24] One study had a prospective design (Table 1).…”

“…12,[16][17][18][19][20][21][22][23][24] Nine studies featured historical cohort analysis comparing infertile women with a previous cesarean delivery to women with a previous spontaneous delivery, scheduled to a fresh or frozen ET. 1,12,16,17,[19][20][21][22][23][24] One study had a prospective design (Table 1). 18 Inclusion and exclusion criteria for qualified studies are described in Table 2.…”