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Background & Objective: Secondary infertility resulting from tubal adhesions following cesarean section are not uncommon. The decision to do adhesiolysis or direct IVF/ICSI is to some extent difficult. This study was conducted to evaluate the benefits/risks of either adhesiolysis or direct IVF/ICSI for patients with secondary infertility due to post-cesarean tubal adhesions.Materials & Methods: Three hundred infertile women with post-cesarean adhesion were recruited and divided into 2 groups either laparoscopic adhesiolysis or ICSI procedure.Results: Demographic data of enrolled patients in both groups were comparable. Regarding types of adhesions, mild adhesions were found in (47.65%) cases, moderate adhesions in (24.83%) cases and severe adhesions in (27.52%) cases. Pregnancy rates were found to be higher in cases with mild adhesions (62.67%) when compared to cases with moderate or severe adhesions (28.00%) and (9.33%) respectively. The overall pregnancy rate in group 1 was 67 (44.97%), while it was 83 (55.70%) in group 2. The pregnancy rate was higher in group 2 but didn't reach statistical significance. The cost of the procedure was significantly higher in group 2 but with significantly lower complication rates. Conclusion:Although assisted reproduction gives the patient higher pregnancy rates with less possibility of complications, it should not be considered the first-choice treatment for patients with post-cesarean adhesions, especially in mild and moderate cases.

Background: Caesarean delivery is one of the most common surgical procedures in females. "CS niche" refers to a hypoechoic region with myometrial disruption at the site of prior CS within the isthmus (lower uterine segment) myometrium (defect). A myometrial depression of at least 2 millimetres is considered a niche. A scar defect forms on the anterior wall of the uterine isthmus after hysterotomy or Caesarean delivery. Several pregnancy-and patient-related hypotheses explain why a niche develops. Caesarean scar defect patients had many symptoms. Delayed cervix menstruation causes abnormal uterine bleeding, pelvic pain, vaginal discharge, dysmenorrhea, dyspareunia, and infertility. A niche may cause future obstetric problems. Aim: To assess the relationship between post Caesarean section niche and female subfertility. Subject and Methods: This study was an observational prospective cohort study. The study was carried out at the Department of Obstetrics and Gynecology. Tanta University Hospitals. Results: Intermenstrual bleeding, dysmenorrhea, dysparunea, pelvic pain were statistically significant higher in niche group than no niche group. There is statistically significant lower pregnancy rate in CS with Niche group than CS without niche group. As regard the relation between intramenestrual spotting and ultrasound findings in CS with niche patients; there is statistically significant higher IU fluid collection, niche depth, endometrial thickness and lower RMT in patients with AUB. Conclusion:With increasing cesarean section rates worldwide, it is inevitable that sequelae associated with such surgery is also increasing. It is clear that cesarean scar niche formation is a common complication, the formation of which appears to be multifactorial in nature but associated with poor wound healing, cesarean section technique, and possibly retroflexion of the uterus.