Women with History of C-Sections at Greater Risk of Infertility and vice-versa, finds study

A study published in the American Journal of Obstetrics and Gynecology showed a bidirectional relationship between CD and fecundability. There could be common underlying causes, and the surgical procedure may not or partially have a significant or sole impact on fertility.

This study examined the connection between cesarean delivery and fecundability. This prospective cohort study was based on data from the Norwegian Mother, Father, and Child Cohort Study and the Medical Birth Registry of Norway. The fecundability ratio and risk of infertility were estimated by mode of delivery in the previous delivery among 42,379 women. The relative risk of having a cesarean delivery was also estimated by fecundability among 74,024 women.

Key findings from the study are:

• The proportion of women with infertility was 7.3% among women with a previous vaginal delivery and 9.9% among those with a prior cesarean delivery.
• The adjusted relative risk was 1.21.
• Women with a previous cesarean delivery had a lower fecundability ratio compared to those with previous vaginal delivery.
• When assessing the reverse association, researchers found that women who did not conceive within 12 or more had higher cesarean delivery risk with an adjusted relative risk of 1.57 in comparison to those who conceived within the first two cycles.
• After controlling for sociodemographic and clinical risk factors, the associations remained and were observed across parity groups.

They said, "This study aimed to explore the relationship between cesarean delivery and fecundability. Women with a history of cesarean delivery are at greater risk of infertility. Conversely, women with lower fecundability are more likely to undergo cesarean delivery."

Study strengths include a large sample size, minimised recall bias and investigation of bidirectional relationships.

Reference:

Sima et al. The relationship between cesarean delivery and fecundability: a population-based cohort study. American Journal of Obstetrics and Gynecology. 

Reference:

Sima et al. The relationship between cesarean delivery and fecundability: a population-based cohort study. American Journal of Obstetrics and Gynecology.