Effects of prior cesarean delivery on subsequent pregnancy outcomes using assisted reproductive technology: a narrative review

BACKGROUND: Patients commonly struggle with secondary infertility following a prior cesarean section due to factors related to the delivery. Distortions in the pelvic anatomy may complicate subsequent treatment attempts using assisted reproductive technology (ART) on different levels, including the myometrium, endometrium, and cervix, as well as intraperitoneal structures. METHODS: In this narrative review, major databases were searched to examine the effect of a prior cesarean delivery (CD) on pregnancy outcomes from subsequent ART treatments. FINDINGS: Some mechanisms for the detrimental effect of CD on subsequent ART success, such as the development of a cesarean scar defect (CSD), are well-supported by existing evidence. Other putative mechanisms, namely an increase in difficulty of subsequent embryo transfers, are more speculative at this time. CONCLUSION/FUTURE DIRECTIONS: Rigorous standardization of CD technique as well as transparent meticulous reporting may mitigate the detrimental effect of prior CD on subsequent ART success.