Does Cesarean Section Scar Defect (Niche) Affect Implantation Rate?

Does Cesarean Section Scar Defect (Niche) Affect Implantation Rate?

Cesarean scar defects (CSDs), i.e. deficient uterine scars following a cesarean section, involve discontinuity at the site of a previous Cesarean section scar. These anatomical defects have been reported to be associated with postmenstrual spotting, chronic pelvic pain and infertility. Few case series have suggested improved fertility (most probably by improving implantation of embryos) The aim of this study is to prospectively record embryonal implantation rate during IVF in patients with CSDs, and to evaluate the effect of hysteroscopic repair of CSDs on fetal implantation during IVF.

150 patients undergoing IVF after cesarean section will be recruited. demographic, clinical and treatment data will be collected. ultrasound and hysteroscopic evaluation of the CSD will be performed. IVF treatment will be provided. In case of failure of IVF treatment, patients will be randomized to hysteroscopic repair of CSD versus second IVF treatment

Inclusion Criteria:

• Patients undergoing IVF after cesarean section

Exclusion Criteria:

• Patients who underwent CSD repair
• Patients with low ovarian reserve
• Patients with hydrosalpinges, endometriosis, adenomyosis, submucous fibroids or polyps