Secondary Infertility Post-Cesarean

Well it looks like the experts have finally weighed in on secondary infertility after a cesarean delivery.

Subfertility link to cesarean 'may not be causal'
Source: Fertility and Sterility 2006; 85: 90-5

Investigating whether cesarean delivery is independently associated with later subfertility.

The observation that women who undergo a cesarean are less likely to have further pregnancies than other women probably does not reflect a cause-and-effect relationship, research findings suggest.

While it is biologically plausible that the surgery involved in a cesarean section may affect future conception, women who undergo this mode of delivery also differ in many respects from those who do not, including their history of primary infertility, which could confound the association.

For their study, Gordon Smith (Cambridge University, UK) and co-workers studied the relationship of cesarean delivery with later subfertility, with adjustment for potential confounders. They used retrospective data from a cohort study of more than 100,000 women who had their first baby between 1980 and 1984.

Compared with women who had a spontaneous vertex delivery, those who had a planned cesarean section were significantly more likely to not have a second birth during follow-up, with a relative risk of 1.21. Adjustment for maternal and obstetric characteristics, however, attenuated this association to a relative risk of just 1.07, which was no longer significant.

"These data suggest that the association between cesarean birth and subsequent subfertility is more likely to be caused by confounding than by a causal relationship," the researchers conclude.

Well duh. Though some of us certainly do know that despite normal ovulation pre-cesarean and infrequent or no ovulation post-cesarean (though for me it took two cesareans to truly obliterate my ovulation), there are many many women who choose to not have more children because of the negative emotional impact of the surgery. I could list many women whom I have talked to personally who are terrified of another cesarean. Being post cesarean in today's obstetrical quagmire that ACOG has put birthing women in allows only two options, elective repeat cesarean section or homebirth - with or without midwifery care.

Finally, let us never forget the women who cannot become pregnant without it being life-threatening (for instance, a friend of mine experienced embolic thrombosis as a result of cesarean surgery - she risks her life to even fly).