Fertility success rates in patients with secondary infertility and symptomatic cesarean scar niche undergoing hysteroscopic niche resection

Shlomo B. Cohen, Jerome Bouaziz, Alexandra Bar On, Raoul Orvieto

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Cesarean-induced niche can cause symptoms such as abnormal postmenstrual bleeding, pain, and associated infertility. Although hysteroscopic niche resection is generally considered an effective treatment to control abnormal uterine bleeding, the impact of surgical resection on fertility outcomes is still uncertain. In the present study, we aimed to evaluate the fertility outcomes of symptomatic patients following hysteroscopic niche resection. The design in this retrospective cohort study is Canadian Task Force classification II-2 and it is carried out in a tertiary medical center (Tel-Hashomer) and a private medical center (Herzliya), both in Israel. We included all patients who underwent a niche resection between 2011 and 2015 following at least one year of infertility. From 2011 to 2015, 39 patients with a symptomatic niche and secondary infertility were treated by hysteroscopic niche resection. The patients’ mean age was 37.2 (34–41) years, mean number of gestations was 7.04 (1–16), and mean parity 5.1 (1–14). The mean number of previous cesarean sections was 3.4 (1–6). Before the surgery, 32 patients attempted and failed to conceive spontaneously and seven patients underwent in vitro fertilization (IVF) treatment and failed. One year after the hysteroscopic resection, 18 patients conceived (14 spontaneously and four following IVF), leading to a cumulative pregnancy rate of 46.15%. Among the patients who failed to conceive after at least two IVF cycles prior to the hysteroscopic resection, 42.8% conceived following surgery (three patients out of seven). Hysteroscopic niche resection should be considered an effective treatment in patients suffering from secondary infertility. Précis Hysteroscopic niche resection is a safe option for patients with symptomatic secondary infertility, resulting in acceptable fertility rates.

Original languageEnglish
Pages (from-to)912-916
Number of pages5
JournalGynecological Endocrinology
Volume36
Issue number10
DOIs
StatePublished - 2 Oct 2020
Externally publishedYes

Keywords

  • Cesarean niche
  • hysteroscopy
  • infertility

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Obstetrics and Gynecology

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