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Prior cesarean delivery and live birth after frozen-thawed embryo transfer without hydrometra: a retrospective cohort
Shogo Nishii1, Shoko Katsumata1, Yuko Takayanagi1
1Kameda IVF Clinic Makuhari, Makuhari Techno-Garden D, 3F, 1-3 Nakase, Mihama-ku, Chiba 261-8501, Japan.
Objective:
To assess whether prior cesarean delivery was associated with live birth after the first subsequent frozen-thawed embryo transfer among women with a previous assisted reproductive technology-conceived live birth and no apparent hydrometra.
Design:
Single-center retrospective cohort study.
Subjects:
A total of 450 women treated from 2018 to 2025, including 159 with a previous cesarean delivery and 291 with a previous vaginal delivery.
Exposure:
Previous cesarean delivery compared with previous vaginal delivery.
Main Outcome Measures:
Live birth per embryo transfer was the primary outcome. Multivariable logistic regression, propensity score matching with conditional logistic regression, and analyses restricted to single embryo transfer and blastocyst transfer were performed. Cesarean scar characteristics and obstetric outcomes were also examined.
Results:
Live birth rates were 40.3% after cesarean delivery and 41.2% after vaginal delivery (crude odds ratio, 0.96; 95% confidence interval, 0.65-1.42). The adjusted odds ratio was 1.18 (95% confidence interval, 0.77-1.81). After 155 pairs were matched, the conditional odds ratio was 1.10 (95% confidence interval, 0.67-1.80; exact McNemar P = 0.801). Intracavitary fluid was detected in 10 of 170 women with a previous cesarean delivery (5.9%) and in none of the 307 women with a previous vaginal delivery. A cesarean scar niche, defined as an indentation of at least 2 mm in depth, was present in 66 of 159 women (41.5%), and live birth rates were similar irrespective of niche status. Across the primary and sensitivity analyses, no clear association was observed between prior cesarean delivery and live birth.
Conclusion:
Among women with no apparent hydrometra, a history of cesarean delivery alone was not predictive of live birth after the first subsequent frozen-thawed embryo transfer. The confidence intervals remained compatible with potentially lower or higher odds of live birth; therefore, the findings do not establish equivalence or the absence of an effect. Delivery history should be interpreted alongside imaging findings of scar-related pathology.
