Hysteroscopic findings in cases of secondary infertility after cesarean section

Abstract

Background Cesarean section (CS) is a common procedure nowadays. Although being essential in many conditions, CS has short-term and long-term complications. One of the long-term complications is infertility. Presence of a previous CS raises the possibility of uterine factor as a contributing cause of infertility. Hysteroscopy is the gold standard method to assess the uterine cavity. It can identify some abnormalities missed by hysterosalpingography or ultrasound. Patients and methods A prospective observational study was conducted that included 56 women with complaint of secondary infertility after CS. Office hysteroscopy was done for all women to assess the uterine cavity and to find out any subtle abnormalities in these women. The authors excluded women with clear causes of infertility and medical disorders that may preclude the hysteroscope, such as epilepsy, cardiac diseases, and women with active cervical or uterine infection. Results All participating women did not have an apparent cause of infertility. A total of 25 (44.7%) patients had normal hysteroscopic findings and 31 (55.3%) patients were found to have abnormal findings: nine (16.1%) patients with uterine niche, eight (14.3%) patients with endometrial adhesions, seven (12.5%) patients with endometrial polyp, four (7.1%) patients septate uterus, and three (5.4%) patients with submucous myoma. Conclusion The study showed that a high proportion of patients with secondary infertility after CS have uterine cavity abnormalities that warrant hysteroscopic examination, but further study is needed to evaluate the pregnancy outcome of correction of these abnormalities.