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[Is There a Link Between Previous Cesarean Delivery and In-Vitro Fertilization Treatment Outcomes?]
Or Touval1, Netanella Miller1, Roni Rahav Koren1
1IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; affiliated with the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Background:
There is evidence of a reduction in fertility rates of approximately 10% following cesarean delivery (CD) compared with vaginal delivery. However, it is challenging to determine whether this decline is directly linked to the procedure itself or if it stems from voluntary infertility. To examine the direct impact of CD on the intrauterine environment, the in vitro fertilization (IVF) outcomes in women with secondary infertility were studied.
Objectives:
To evaluate the impact of delivery mode on IVF treatment outcomes - specifically cumulative live birth rate and cumulative implantation rate-in women newly diagnosed with secondary infertility.
Methods:
A retrospective study was conducted comprising women with a new diagnosis of secondary infertility who sought IVF treatment at Meir Medical Center between 2011 and 2021. Demographic data, previous delivery details, and current treatment characteristics and outcomes were collected. The study population was divided into two groups based on the delivery mode in the previous pregnancy: the vaginal delivery group and the CD group.
Results:
The study included 232 women, 169 in the vaginal delivery group and 63 in the CD group. The CD group had a higher percentage of patients with tubal factor infertility (28.6% vs. 15.4%, p=0.02) and reduced endometrial thickness, although this difference was statistically nonsignificant (9.71 ± 2.20 vs. 10.28 ± 2.26 mm, p=0.08). No differences were observed between the groups in other demographic characteristics, infertility characteristics, treatment parameters, or treatment results. No differences were found in the cumulative live birth rate (22.2% vs. 19.1%, p=0.53) or cumulative implantation rate. Multivariate regression analysis did not find an association between CD and adverse IVF treatment outcomes.
Conclusions:
This study did not find an association between a history of CD and poorer IVF treatment outcomes among women with secondary infertility. However, due to the limited sample size and the retrospective nature of the study, these findings cannot be generalized to the overall population.
