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

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.