Abstract：
OBJECTIVE: Some studies have suggested that cesarean section diverticulum may affect the pregnancy outcomes of assisted reproductive technology through a variety of mechanisms. This study aims to explore whether previous cesarean section and uterine scar diverticulum affect pregnancy outcomes after in vitro fertilization.
METHODS: This retrospective study included 954 infertile women with only one previous delivery who had in vitro fertilization treatment and underwent fresh embryo transplantation for the first time at our center between 2015 and 2019. We first divided the women into two groups by previous vaginal delivery (n = 557) or cesarean section delivery (n = 397), and the latter group included 88 women with cesarean diverticulum and 309 women without cesarean diverticulum. Baseline characteristics were compared and analyzed, and logistic regression analyses were performed to explore the different pregnancy outcomes among the above groups.
RESULTS: Although the live birth rate, clinical pregnancy rate, and mean embryo implantation rate after in vitro fertilization were significantly reduced in patients with previous cesarean section (live birth rate: 26.45% vs. 43.99%, adjusted OR: 0.602, CI: 0.447-0.810; clinical pregnancy rate: 35.26% vs. 49.91%, adjusted OR: 0.724, CI: 0.544-0.962; mean embryo implantation rate: 0.227 ± 0.378 vs. 0.243 ± 0.397, adjusted OR: 0.860, CI: 0.514-1.439), there were no significant differences in pregnancy outcomes between the women with cesarean diverticulum and without cesarean diverticulum (p > 0.05) or between the two groups at different ages. The live birth and clinical pregnancy rates in the women with residual muscle thickness ≤2.2 mm or prolonged menstruation were reduced, but the difference was not statistically significant (p > 0.05).
CONCLUSIONS: This study showed reduced pregnancy and live birth rates after in vitro fertilization in patients with previous cesarean section, while uterine scarring did not adversely affect pregnancy and delivery outcomes after in vitro fertiliazation.
METHODS: This retrospective study included 954 infertile women with only one previous delivery who had in vitro fertilization treatment and underwent fresh embryo transplantation for the first time at our center between 2015 and 2019. We first divided the women into two groups by previous vaginal delivery (n = 557) or cesarean section delivery (n = 397), and the latter group included 88 women with cesarean diverticulum and 309 women without cesarean diverticulum. Baseline characteristics were compared and analyzed, and logistic regression analyses were performed to explore the different pregnancy outcomes among the above groups.
RESULTS: Although the live birth rate, clinical pregnancy rate, and mean embryo implantation rate after in vitro fertilization were significantly reduced in patients with previous cesarean section (live birth rate: 26.45% vs. 43.99%, adjusted OR: 0.602, CI: 0.447-0.810; clinical pregnancy rate: 35.26% vs. 49.91%, adjusted OR: 0.724, CI: 0.544-0.962; mean embryo implantation rate: 0.227 ± 0.378 vs. 0.243 ± 0.397, adjusted OR: 0.860, CI: 0.514-1.439), there were no significant differences in pregnancy outcomes between the women with cesarean diverticulum and without cesarean diverticulum (p > 0.05) or between the two groups at different ages. The live birth and clinical pregnancy rates in the women with residual muscle thickness ≤2.2 mm or prolonged menstruation were reduced, but the difference was not statistically significant (p > 0.05).
CONCLUSIONS: This study showed reduced pregnancy and live birth rates after in vitro fertilization in patients with previous cesarean section, while uterine scarring did not adversely affect pregnancy and delivery outcomes after in vitro fertiliazation.
摘要：
目的：有研究提示剖宫产憩室可能通过多种机制影响辅助生殖技术的妊娠结局。本研究旨在探讨既往剖宫产及子宫瘢痕憩室对体外受精后妊娠结局的影响。
方法：这项回顾性研究包括954名不孕妇女，这些妇女在2015年至2019年期间在我们中心接受了体外受精治疗并首次接受了新鲜胚胎移植。我们首先通过先前的阴道分娩（n=557）或剖宫产分娩（n=397）将妇女分为两组，后一组包括88例剖宫产憩室妇女和309例无剖宫产憩室妇女。比较和分析了基线特征，并进行logistic回归分析,探讨上述组间不同的妊娠结局.
结果：尽管活产率，临床妊娠率,既往剖宫产患者体外受精后的平均胚胎着床率显着降低（活产率：26.45％vs.43.99%,校正OR：0.602，CI：0.447-0.810；临床妊娠率：35.26％49.91%,校正OR：0.724，CI：0.544-0.962；平均胚胎着床率：0.227±0.378vs.0.243±0.397，调整后OR：0.860，CI：0.514-1.439），剖宫产憩室与非剖宫产憩室组妊娠结局差异无统计学意义(p>0.05),不同年龄组妊娠结局差异无统计学意义。残余肌肉厚度≤2.2mm或月经时间延长的妇女活产率和临床妊娠率降低，但差异无统计学意义(p>0.05)。
结论：这项研究表明，既往剖宫产患者体外受精后的妊娠率和活产率降低，而子宫瘢痕并没有对体外受精后的妊娠和分娩结局产生不利影响。
方法：这项回顾性研究包括954名不孕妇女，这些妇女在2015年至2019年期间在我们中心接受了体外受精治疗并首次接受了新鲜胚胎移植。我们首先通过先前的阴道分娩（n=557）或剖宫产分娩（n=397）将妇女分为两组，后一组包括88例剖宫产憩室妇女和309例无剖宫产憩室妇女。比较和分析了基线特征，并进行logistic回归分析,探讨上述组间不同的妊娠结局.
结果：尽管活产率，临床妊娠率,既往剖宫产患者体外受精后的平均胚胎着床率显着降低（活产率：26.45％vs.43.99%,校正OR：0.602，CI：0.447-0.810；临床妊娠率：35.26％49.91%,校正OR：0.724，CI：0.544-0.962；平均胚胎着床率：0.227±0.378vs.0.243±0.397，调整后OR：0.860，CI：0.514-1.439），剖宫产憩室与非剖宫产憩室组妊娠结局差异无统计学意义(p>0.05),不同年龄组妊娠结局差异无统计学意义。残余肌肉厚度≤2.2mm或月经时间延长的妇女活产率和临床妊娠率降低，但差异无统计学意义(p>0.05)。
结论：这项研究表明，既往剖宫产患者体外受精后的妊娠率和活产率降低，而子宫瘢痕并没有对体外受精后的妊娠和分娩结局产生不利影响。
