the presence of cesarean section niche has adverse effects on success of ART outcome

A common finding by ultrasound in secondary infertility patients with previous cesarean sections is the presence of niche, which is formally defined as an indentation of the uterine myometrium of at least 2 mm at the site of the caesarean scar. The most common symptom of niche is abnormal uterine bleeding, other symptoms include dysmenorrhea, chronic pelvic pain, dyspareunia, and sub-fertility/infertility.

It has been reported that a niche can reduce the chances of embryo implantation and may lead to spontaneous miscarriages if the implantation is close to or in the niche. The presence of a niche may render the actual embryo transfer procedure technically more difficult, and clinicians need to be aware of its presence and perform the transfer under ultrasound guidance to ensure the catheter bypasses the niche and enters the uterine cavity. Still the impact of c.s niche and its characteristics on outcome of ART is not clear.

Inclusion Criteria:

• All women should have the following:

  • Aged from 18 - 37 years old.
  • Undergoing fresh ICSI cycles.
  • A normal uterus with no anomalies or pathologies.
  • At least one good-quality embryo/blastocyst available for transfer (3 BB and more according to Gardner and Schoolcraft grading system).
  • Easy mockup embryo transfer (i.e. the catheter is smoothly inserted without touching the fundus, no cervix tenaculum is used and the catheter is clean of blood).

Exclusion Criteria:

• Younger than 18 or older than 37 years old.
• Congenital uterine abnormality or pathology.
• Presence of a hydrosalpinx.
• Chronic diseases which are not suitable for pregnancy.
• ICSI cycles with fresh or frozen TESE samples.

It will be carried out in the department of Obstetrics and Gynecology, Zagazig University and in a private center.