Successful treatment with hysteroscopy for infertility due to isthmocele and hydrometra secondary to cesarean section: A case report

Abstract

BACKGROUND An isthmocele is a scar defect in the uterine wall due to a cesarean section. Its prevalence is unknown, but it has been associated with secondary infertility. Here, we present a case where the patient suffered from an isthmocele that was associated with persistent hydrometra, which developed during in vitro fertilization. CASE SUMMARY The patient underwent hysteroscopic surgery, which successfully resolved the isthmocele as well as the hydrometra. Afterward, two high-quality, euploid embryos, determined by morphological assessment and pre-implantation genetic diagnostic testing, were transferred. This resulted in uterine pregnancy, as determined by serum β-human chorionic gonadotropin levels on day 14 (180 mU/mL) and ultrasound-confirmed presence of a gestational sac with a positive embryocardia at week 6. The pregnancy reached 36 wk without any complications, and the product was born in good health. We report a successful isthmocele treatment in a patient with secondary infertility, in which the isthmocele was the cause of persistent hydrometra. CONCLUSION Hydrometra caused by secondary cesarean is an infertility factor, which can be corrected by hysteroscopy plus ablation of the isthmocele.

Epidemiological analysis of hydrometra and its predictive value in gynecological tumors

“…Loṕez Rivero etal. (25) reported that an isthmocele due to a cesarean section was also associated with persistent hydrometra. In addition, abnormal development of the urogenital tract has been reported to be a cause of hydrometra (26).…”

Link between cesarean section scar defect and secondary infertility: Case reports and review

“…C-section scar defect repairs using minimally invasive approaches are reported to be efficient in achieving reduced clinical symptoms and restore secondary infertility (Gubbini et al, 2011;. López Rivero et al (2019) reported a clinical case of secondary infertility, due to a scar defect with persistent hydrometra that was hysteroscopically corrected to restore fertility. Istvan et al (2017) demonstrated that 80% of the patients diagnosed with a C-section scar defect that had surgical treatments (hysteroscopic and laparoscopic isthmoplasty) became pregnant within 24 months and delivered before 36 months of treatment.…”

Effect of Low-Frequency Electric Pulse Technique Combined with Carboprost Methylate Suppositories on Recovery of Gastrointestinal Function and Postoperative Complications of Patients with Scarred Uterus Undergoing Secondary Cesarean Section

“…Inclusion criteria were as follows: (1) the patients had a history of uterine surgery, and the results of pregnancy ultrasonography met the diagnostic criteria of scarred uterus in Obstetrics and Gynecology [13]; (2) the patients had clear indications of C-section or failed in trail delivery for scarred uterus; (3) the patients were cases of singleton pregnancy; (4) the patients were treated in our hospital throughout the entire process, and no situations such as death, transferring to another hospital, or discontinuation of treatment occurred. Exclusion criteria were as follows: (1) the patients could not communicate with others due to hearing disorders, language disorders, unconsciousness, or mental diseases; (2) the patients quit the treatment, died, changed the treatment regimen, or went missing in follow-up visits; (3) the patients were cases of multiple pregnancy; (4) the intrauterine growth was abnormal with the presence of severe eclampsia, placental adherence, or placenta praevia; (5) the patients had combined liver, kidney, heart and brain dysfunction, pelvic infection, coagulation disorders, or other severe pregnancy complications; (6) the patients had subarachnoid space tissue contraindication; (7) the patients had nipple abnormality; (8) the patients were allergic to the drugs involved in the study.…”

“…Compared with nonscarred uterus, the possibility of the previously mentioned complications in patients with scarred uterus undergoing secondary C-section is significantly increased [ 6 ]. A large number of studies show that scarred uterus is a risk factor for complications such as postpartum hemorrhage, which is the primary cause of postoperative death in patients undergoing C-section [ 7 , 8 ]. Although the consensus of secondary vaginal trial delivery of scarred uterus has appeared in recent years, many patients with scarred uterus still prefer C-section [ 9 ], and therefore, rational application of drug treatment to reduce the incidence of postoperative complications is an important measure to guarantee the health of mothers and infants.…”