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

Abstract

The aim of this study was to explore whether the presence of intra-cavitary fluid (ICF) influences the pregnancy outcomes of patients with caesarean section (CS) in embryo transfer cycles. A total of 8494 transferred cycles of 4924 women were enrolled in this retrospective study and separated into three subgroups by previous delivery method and the presence of intra-cavity fluid, a caesarean group with ICF (CS-ICF, n = 649), a caesarean group without ICF (CS-noICF, n = 3207), and the remaining 4638 cycles without ICF were included in the vaginal delivered group (VD, n = 4638). Baseline characteristics and clinical outcome were compared. Propensity score matching (PSM) was conducted to adjust confounding factors between groups. Patients in the CS-ICF group were of younger age (36.49 ± 4.19 vs 37.34 ± 4.25, 37.32 ± 4.86, P < 0.001), had better ovary reserve, and had more blastocyst transferred compared with the CS-noICF and VD groups. However, cycles in the CS-ICF group achieved unsatisfactory clinical pregnancy outcomes. PSM analysis for comparability and differences in clinical outcomes still existed. The clinical pregnancy rate was significantly lower in the CS-ICF group than in the CS-noICF group (35.1% vs 41.7% for CS-noICF group, 48.1% for VD group, P < 0.001). Subgroup analysis of fresh embryo transferred cycles, the differences in clinical outcomes disappeared after PSM analysis, while the clinical pregnancy rate was still lowest among the three matched groups of FET cycles (36.4% vs 50.3% for VD group, P < 0.001). The presence of intra-cavitary fluid (ICF), but not necessarily the isthmocele, significantly compromises the clinical pregnancy rate in patients with previous CS undergoing IVF/ICSI treatment.

Fungal-bacteria interactions provide shelter for bacteria in Caesarean section scar diverticulum

“…In addition, the co-occurrence network of fungal communities and the stability of the bacterial-fungal cross-domain network in the CSD group are poorer than those in the CON group, indicating that the cervical microbiota stability is disrupted in CSD, resulting in local microbial-immune imbalance. A previous study confirmed that persistent exudation in CSD is a crucial factor affecting embryo implantation [7]. Several studies have shown that microbial dysbiosis can affect local immune balance and cause inflammation [36, 37].…”

“…A niche can reduce the chances of embryo implantation and increase the likelihood of spontaneous miscarriages if the implantation occurs close to or in the CSD [6]. Our previous studies have shown that the persistent effusion of CSD is a key cause of failed embryo implantation [7].…”

Predictors for persistent endometrial cavity fluid from fresh to subsequent frozen embryo transfer

“…In our study, patients with cesarean section history were more likely to have persistent ECF compared with those without. The impaired local mucosal function of the uterus in women who underwent cesarean deliveries can lead to the occurrence of endometrial inflammation and impaired decidualization [18] . In addition, cesarean section scar will destroy the continuity of local uterine muscle fibers, and interfere with uterine contraction, which affects the discharge of uterine fluid and leads to uterine fluid accumulation [19] .…”

Interaction between Cervical Microbiota and Host Gene Regulation in Caesarean Section Scar Diverticulum

“…The universal primers 341F (5′-CCTACGGGNGGCWGCAG-3′) and 805R (5′-GACTACHVGGGTATCTAATCC-3′) were used for 16s rRNA genes sequencing ( 30 ). DNA extraction and library construction were as described in our previous study ( 7 ). In short, according to the manufacturer's instructions, we used Magpure Soil DNA LQ kit (MAGEN, D6356-02) to conduct a total DNA extraction.…”

“…The spontaneous pregnancy rate in CS women has decreased by 15%, and even with assisted reproductive technology, the embryo implantation and live birth rates are significantly lower ( 6 ). Our previous research revealed that persistent effusion is the major factor affecting fecundity in CSD women ( 7 ).…”