Impact of post-cesarean scar defects and scar diverticulum on the clinical outcomes of in vitro fertilization-embryo transfer
10.3760/cma.j.cn101441-20200421-00231
- VernacularTitle:剖宫产切口瘢痕以及憩室对体外受精-胚胎移植后妊娠结局的影响
- Author:
Hua CHEN
1
;
Nan LU
1
;
Yuezhou YANG
1
;
Ruihuan GU
1
;
Xiaoxi SUN
1
Author Information
1. 复旦大学附属妇产科医院 上海集爱遗传与不育诊疗中心 200011
- Publication Type:Journal Article
- Keywords:
Fertilization in vitro;
Single embryo transfer;
Pregnancy outcome;
Frozen-thawed embryo transfer;
Cesarean scar defects
- From:
Chinese Journal of Reproduction and Contraception
2020;40(6):447-453
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the impact of post-cesarean scar defects and scar diverticulum on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET). Methods:A total of 523 cases, who had a previous delivery, underwent frozen-thawed single blastocyst transfer cycles during January 1 st, 2014 to January 31 st, 2018 in Shanghai Ji Ai Genetics and IVF Institute. Of which, 256 patients who had undergone cesarean section （C-S） surgery prior, along with 267 patients with a history of one vaginal delivery as control group, were admitted into this study. In addition, C-S group was further divided into 3 subgroups according to the different healing conditions of the uterine incision detected by ultrasound, namely, no severe defect subgroup, scar defects subgroup and diverticulum subgroup. The impact of patients with or without C-S history, patients with or without scar defects and diverticulum on the clinical outcomes of FET cycle was analyzed. Results:There was no difference in age, body mass index (BMI) and thickness of endometrium at the day of progesterone conversion between patients with one vaginal delivery (VD group) and patients with C-S history (C-S group). C-S group showed a significant decrease in implantation rate (48.05%), clinical pregnancy rate (46.48%) and live birth rate (38.28%) compared with VD group (58.05%, P=0.023; 56.93%, P=0.014; 51.31%, P=0.022). There was a significant rise in preterm delivery rate （13.26% vs. 1.46%, P<0.001）, and average gestational age at the time of delivery was decreased [(38.12±1.76) weeks vs. (39.02±1.37) weeks, P<0.001], and neonatal birth weight was also significantly lower in C-S group [(3 372.14±374.25) g vs. (3 438.82±337.30) g, P=0.023]. Further analysis was done to address whether C-S severe defects with diverticulum had an impact on the clinical outcomes. Compared with the vaginal delivery group, the implantation rate, the clinical pregnancy rate, the live birth rate, and the gestational age at the time of delivery in severe scar defects subgroup were significantly reduced ( P=0.021, P=0.026, P=0.005 and P=0.009); and in the scar diverticulum subgroup they were more affected ( P=0.004, P=0.003, P=0.004 and P<0.001), the differences were statistically significant. Conclusion:A history of C-S, particularly a poor healing of incision with scar defects and diverticulum, has a significantly negative impact on the clinical outcomes of IVF-ET as well as a negative impact on gestational age at delivery, and increases the risk of premature birth and lower birth weight newborns.
