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Am J Obstet Gynecol. 1987 Aug;157(2):379-83.

Primary cesarean section and subsequent fertility.

Abstract

The incidence of infertility after primary cesarean section (study group) was compared to an age- and parity-matched control group who underwent vaginal delivery during 1978 at The New York Hospital. Secondary infertility occurred in 17/291 (5.8%) of the study group and 5/279 (1.8%) of the control group (p less than 0.03). Excluding those who practiced contraception and those who underwent sterilization, this difference is still significant (p less than 0.02). Excluding those patients with a history of infertility prior to the 1978 birth, there was still a trend to increased subsequent infertility in the cesarean section group although this difference did not reach statistical significance (p less than 0.06). The patients with infertility did not have a higher incidence of postpartum endomyometritis, prolonged rupture of the membranes, or abnormal placentation. The causes of the secondary infertility could not always be directly related to cesarean section; the concept of an "infertility threshold" will be discussed.

PIP:

There has been speculation that postoperative endomyometritis, pelvic adhesions, and uterine cavity damage following cesarean section may predispose to subsequent infertility. To explore this possibility, the incidence of infertility after cesarean section was compared to that in an age and parity-matched control group who underwent vaginal delivery during 1978 at the New York Hospital. The incidence of infertility was 17/291 (5.8%) in the study group and 5/279 (1.8%) in the control group--a significant difference (p0.03). The difference remained significant (p0.02) when patients using contraception or having undergone sterilization were excluded from the analysis; then the incidence of infertility was 17/220 (7.7%) in the study group and 5/224 (2.2%) in the control group (p0.02). When all patients with a history of previous infertility were excluded, 13/204 (6.4%) of women who underwent cesarean section developed secondary infertility compared with 5/224 (2.2%) of those with a vaginal delivery (p0.06). The patients with infertility did not have a higher incidence of postpartum endomyometritis, prolonged rupture of the membranes, or placental abnormalities than controls. Only 4 of the 17 study patients with infertility had verified tubal or intrauterine disease as the sole cause of infertility. The other 13 women had a cause that either was not clearly related to cesarean section or was unknown. It is suggested that there may be an infertility threshold in which the added stress of cesarean section (peritubal adhesions or intrauterine injury) pushes women with other nonsurgical infertility factors over the threshold. This threshold concept could explain the paradox of increased inferlity after cesarean section unexplained by obvious postsurgical morbidity.

PMID:
3618689
[Indexed for MEDLINE]
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