The association between prior cesarean section and subsequen
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Rates of cesarean section continue to increase worldwide. Previous work suggests an association between prior cesarean section and reduced fertility in natural and in vitro fertilization treatment cycles.

A retrospective cohort study was performed at a single academic fertility center from January 2012 to April 2020. All women with a history of a live birth undergoing autologous frozen thawed euploid single embryo transfer were identified. Cases included patients with a single prior cesarean section; controls included patients with a single prior vaginal delivery. Only the first embryo transfer cycle was included. The primary outcome was implantation rate. Secondary outcomes included ongoing pregnancy/live birth rate, biochemical pregnancy rate, and clinical miscarriage rate.

A total of 525 patients met inclusion criteria and were included in analysis. Patients with a prior cesarean section had a higher BMI (24.5 + 4.5 vs 23.4 + 4.1, p=0.004) than those in the vaginal delivery cohort; demographic data were otherwise similar. In univariate analysis, the implantation rate was significantly lower in patients with a prior cesarean section (111/200 (55.5%) vs 221/325 (68.0%), p=0.004). After adjusting for relevant covariates, prior cesarean section was associated with 48% lower odds of implantation (aOR 0.52, 95% CI 0.34-0.78, p =0.002). Additionally, after adjusting for the same covariates, prior cesarean section was significantly associated with 39% lower odds of ongoing pregnancy/live birth (aOR 0.61, 95% CI 0.41-0.90, p=0.01). There were no differences in biochemical pregnancy rate or clinical miscarriage rate.

Read more : https://www.ajog.org/article/S0002-9378(21)00206-4/fulltext?rss=yes
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