Can delivery mode influence future ovarian reserve? Anti-Mullerian hormone levels and antral follicle count following cesarean section: a prospective cohort study

Abstract

Background The incidence of Cesarean has increased in recent years. The purpose of this study is to evaluate the effect of cesarean section on ovarian reserve . This is a prospective cohort study from January 2016 to November 2017. Inclusion criteria included singleton primigravid pregnant women whose gestational age was above 37 weeks. Exclusion criteria included history of infertility, pelvic surgery, underlying chronic diseases, any adverse pregnancy outcome and postpartum complication in current pregnancy and hormonal medication within six months of delivery. Anti-Mullerian hormone was measured at the admission time for delivery. The type of delivery was determined based on obstetrics indications. Six months after delivery, antral follicle count was performed and anti-Mullerian hormone was measured again. Result(s) First blood sample was taken from 730 women. After excluding 550 women, the second blood sample was taken from 180 participants. The mean of first anti-Mullerian hormone in women with cesarean and vaginal delivery were 1.01 ng/mL (95% CI 0.82 to 1.18) and 1.18 ng/mL (95% CI 0.96 to 1.40) respectively ( P = 0.211). The mean of second anti-Mullerian hormone in women with cesarean and vaginal delivery were 4.77 ng/mL (95% CI:3.91 to 5.63) and 4.92 ng/mL (95% CI: 4.01 to 5.82) respectively ( P = 0.818). No statistically significant difference existed in total AFC between cesarean and vaginal delivery groups (MD: 0.41, 95% CI: − 1.05 to 1.89, P = 0.576). Conclusion Antral follicle count and anti-Mullerian hormone, six month after delivery, are not affected by delivery mode even after adjusting for women’s age, baseline Anti-Mullerian hormone, body mass index, gestational age at delivery, breastfeeding, postpartum menstruation, neonatal sex and weight. Based on our best knowledge, this is the first report that investigates the effects of delivery mode on ovarian reserve. Decreased fertility following cesarean has been shown in some previous studies but most of them had assessed this association based on the incidence of subsequent pregnancy. Since subsequent pregnancy can be influenced by several confounding factors, we investigated the effect of cesarean on fertility using its impact on anti-Mullerian hormone levels and antral follicle count. We hope that this study will be a beginning of more detailed studies in this field. We believe that this link is yet to be studied.

The impact of Cesarean section on female fertility: a narrative review

“…Since the mode of delivery affects future fertility, it is also necessary to determine whether there is any change in hormone profiles. There appear to be no significant changes in levels of anti-Mullerian hormone and atrial follicle count after CS [19].…”

Intra-cavitary fluid resulted from caesarean section but not isthmocele compromised clinical pregnancy after IVF/ICSI treatment

“…The decline in pregnancy rate is related to many factors, including ovarian reserve, embryo quality, endometrium receptivity, and cross-talk between embryo and endometrium. Ovarian reserve indices such as anti-Müllerian hormone (AMH) and antral follicle count (AFC) are not affected by delivery mode [ 14 ]. Most of the patients can achieve good-quality embryos as reported in Chinese patients [ 15 ].…”

The consequences of cesarean section and vaginal delivery on ovarian reserve in infertile women

“…Today, the increasing frequency of cesarean section raises concerns with the studies showing some negative effects on fertility (7)(8)(9). However, these studies had limitations, such as the older age of the cesarean section group, the co-morbidities of the cesarean section group, and the non-homogeneous distribution of the groups (10,11).…”