Currently, cesarean deliveries (CD) are common. Many couples electively choose C-section to deliver their child. However, cesarean deliveries have some possible complications like uterine or pelvic scarring, abnormalities placenta, and uterine rupture. Consequences of these lead to difficulty to conceive in the future. If the complications are serious, then such couples often require assisted reproductive technology to conceive in the future.
IVF is the most common assisted reproductive technology. The reasons for subfertility following C-section include increased age, obesity, prior history of infertility, or voluntary infertility. Even a cesarean section scar can also impact women’s fertility. In such cases, a woman can choose IVF for future pregnancy. Clinical experts have found no difference in pregnancy outcomes between patients with a history of CD versus those with only prior vaginal deliveries in case of IVF treatment.
Embryo transfer is the final step involved in the IVF process. Alteration of any reproductive anatomy because of surgical history hinders embryo transfer. Scientific evidence reported that embryo transfer takes a long time for patients who have a history of cesarean deliveries. A research study had shown embryo transfers performed on patients with a prior CD took 30 seconds longer. Another significant observation during embryo transfers performed on patients with a prior CD was embryo transfer catheters were more likely to have blood or mucus on the catheter. Despite these apparent difficulties in embryo transfers, pregnancy outcomes were not different between priors history of CD versus vaginal deliveries.
CD doesn’t need to always cause subfertility. But according to the clinical estimation 42%–58% of women who have a prior history of a CD often have a problem of anterior lower uterine segment defect. Routine transvaginal ultrasound or saline sonogram can detect the defect within the hysterotomy site. IVF experts also reported that they faced difficulty in passing the embryo transfer catheter into the uterus in several patients who had done prior CD. To solve this problem, requiring additional clinical manipulation could contribute to uterine irritation and potentially impacting embryo implantation.
A retrospective cohort study was designed to evaluate the impact of a previous C-section on fertility outcomes in women undergoing IVF/ICSI. In this study, the enrolled participants were distributed into two groups to compare the outcome. 796 had had a previous C- section and 997 a previous vaginal delivery among the enrolled participants. The study result revealed a lower live birth rate and a higher miscarriage rate among women who had a previous C-section compared to the women with a previous vaginal delivery.
In general, a woman should wait at least 6 months before getting pregnant again after a C-section. This is the minimum gap between two pregnancies. But some experts suggest it’s better to wait 12 to 15 months, while others say 18 to 24 months for complete recovery after a C-section. But the age of the patient is also a considerable factor to pursue IVF.