Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Reproductive Medicine Associates of New York, New York, NY.
Reproductive Medicine Associates of New York, New York, NY.
Am J Obstet Gynecol. 2021 Sep;225(3):287.e1-287.e8. doi: 10.1016/j.ajog.2021.03.026. Epub 2021 Mar 30.
The rates of cesarean deliveries continue to increase worldwide. Previous work suggests an association between a previous cesarean delivery and reduced fertility in natural conception and in vitro fertilization treatment cycles. To our knowledge, there is no published research that explored the relationship between a previous cesarean delivery and the clinical outcomes after in vitro fertilization and the subsequent transfer of a single frozen-thawed euploid embryo.
This study aimed to investigate the relationship between the previous mode of delivery and subsequent pregnancy outcomes in patients undergoing a single frozen-thawed euploid embryo transfer after in vitro fertilization.
A retrospective cohort study was performed at a single academic fertility center from January 2012 to April 2020. All women with a history of a live birth undergoing autologous, frozen-thawed single euploid embryo transfers were identified. Cases included patients with a single previous cesarean delivery; controls included patients with a single previous vaginal delivery. Only the first embryo transfer cycle was included. The primary outcome was the implantation rate. Secondary outcomes included ongoing pregnancy and live birth rates, biochemical pregnancy rate, and clinical miscarriage rate.
A total of 525 patients met the inclusion criteria and were included in the analysis. Patients with a previous cesarean delivery had a higher body mass index (24.5±4.5 vs 23.4±4.1; P=.004) than those in the vaginal delivery cohort; the rest of the demographic data were otherwise similar. In a univariate analysis, the implantation rate was significantly lower in patients with a previous cesarean delivery (111/200 [55.5%] vs 221/325 [68.0%]; P=.004). After adjusting for the relevant covariates, a previous cesarean delivery was associated with a 48% reduction in the odds of implantation (adjusted odds ratio, 0.52; 95% confidence interval, 0.34-0.78; P=.002). In addition, after adjusting for the same covariates, a previous cesarean delivery was significantly associated with a 39% reduction in the odds of an ongoing pregnancy and live birth (adjusted odds ratio, 0.61; 95% confidence interval, 0.41-0.90; P=.01). There were no differences in the biochemical pregnancy rates or clinical miscarriage rates.
This study demonstrated a marked reduction in implantation and ongoing pregnancy and live birth associated with a previous cesarean delivery in patients undergoing a single euploid embryo transfer. Our work stresses the importance of reducing the primary cesarean delivery rates at a national level and elucidating the mechanisms behind the substantially lower implantation rates after a cesarean delivery.
全世界剖宫产率持续上升。既往研究表明，既往剖宫产与自然受孕和体外受精治疗周期的生育力降低有关。据我们所知，尚无研究探讨既往剖宫产与体外受精后单个冷冻解冻整倍体胚胎移植后的临床结局之间的关系。
本研究旨在探讨既往分娩方式与体外受精后单个冷冻解冻整倍体胚胎移植后患者后续妊娠结局的关系。
这是一项在 2012 年 1 月至 2020 年 4 月于单家学术生育中心进行的回顾性队列研究。所有有活产史且行自体冷冻解冻单个整倍体胚胎移植的患者均被纳入研究。病例组包括既往有单次剖宫产的患者，对照组包括既往有单次阴道分娩的患者。仅纳入首次胚胎移植周期。主要结局是着床率。次要结局包括持续妊娠率和活产率、生化妊娠率和临床流产率。
共有 525 名符合纳入标准的患者被纳入分析。既往剖宫产患者的体重指数（24.5±4.5 vs 23.4±4.1；P=.004）高于阴道分娩组，其余人口统计学数据相似。单因素分析显示，既往剖宫产患者的着床率显著降低（111/200 [55.5%] vs 221/325 [68.0%]；P=.004）。调整相关协变量后，既往剖宫产与着床率降低 48%相关（校正优势比，0.52；95%置信区间，0.34-0.78；P=.002）。此外，调整相同协变量后，既往剖宫产与持续妊娠和活产的几率降低 39%显著相关（校正优势比，0.61；95%置信区间，0.41-0.90；P=.01）。生化妊娠率和临床流产率无差异。
本研究表明，在接受单个整倍体胚胎移植的患者中，既往剖宫产与着床率和持续妊娠率及活产率显著降低有关。我们的工作强调了在全国范围内降低初次剖宫产率的重要性，并阐明了剖宫产术后着床率显著降低的机制。
