The Pregnancy Outcomes Of IVF/ICSI In Previous Cesarean Section Population

Objective: To investigate whether cesarean section(CS)affects the clinical outcomes of IVF/ICSI in infertile women,and the effects of different embryo number,embryo type and embryo transfer time on the clinical outcomes of women with scar uterus,so as to provide evidence for the clinical decision of embryo transfer strategies for women with CS.Methods: This study retrospectively studied 1,793 ovarian stimulation cycles from January 2015 to December 2016 when they performed IVF/ICSI in the Reproductive Center of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.According to the way of previous delivery,women were divided into cesarean section(CS)group and vaginal delivery(VD)group.Propensity Score Matching(PSM)was performed based on baseline factors such as age,BMI,oocytes retrieved.After PSM,pregnancy outcomes were analyzed:implantation rate(IR),clinical pregnancy rate(CPR),abortion rate(AR),multiple gestation rate(MR),ectopic pregnancy rate(ER).Maternal and neonatal outcomes were also included: gestational age,birth weight,the risk of premature birth,low birth weight,gestational hypertension,gestational diabetes mellitus,placenta previa,placenta accreta,premature rupture of fetal membranes,postpartum hemorrhage,twin to twin transfusion syndrome,neonatal jaundice,stillbirth,and neonatal defects.We further validated the results by multivariate Logistic regression.The pregnancy outcomes,maternal and neonatal outcomes of embryo number(SET vs DET),embryo types(cleavage stage embryo vs blastocyst)and embryo transfer opportunities(fresh embryo transfer versus frozen embryo transfer)were also analyzed.Results:1.Among 1793 cycles,796 cycles divided into CS group and 997 cycles divided into VD group.PSM was given based on baseline,resulting in 538 cycles in each group at a 1:1 ratio match.After matching,the LBR of CS group was significantly lowerthan VD group(30.1% vs 38.1%,P=0.006),and the abortion rate(AR)was significantly higher(25.9% vs 17.5%,P=0.025).There was no significant difference in CPR(42.4% vs 46.8%),IR(32.9% vs 37.1%),MR(33.8% vs 37.7%)and ER(3.1% vs1.2%)between the two groups.No significant difference can be found in maternal and neonatal outcomes between the two groups.Further adjusted for confounding factors,the LBR of CS group was still significantly lower than VD group(OR=0.64,95%CI=0.49-0.84).2.Of the 796 cycles of IVF/ICSI with a history of CS,412 cycles were single embryo transfer(SET)and 384 cycles were double embryo transfer(DET).PSM was performed for baseline,and 246 cycles were included in each group after matching at a 1:1 ratio.Compared with the DET group,LBR(30.5% vs 33.3%)was comparable,while MR(2.9% vs 45.8%,P < 0.001)was significantly lower,and IR(42.3% vs 31.7%,P=0.005)was significantly higher in SET group.There was no significant difference in CPR(42.3% vs 43.5%),ER(0.0% vs 3.7%),AR(27.9% vs19.6%).Gestational age(38.2+1.8 vs 37.5+1.9,P=0.037)and neonatal birth weight(3283.2+539.3 vs 3000.3+573.6,P=0.001)were significantly higher in the SET group than in the DET group.The incidence of premature delivery(9.6% vs27.2%,P=0.005)was significantly lower.3.Among the 796 cycles of IVF/ICSI with a history of cesarean sections,468 cycles had cleavage stage embryo transfer(B1group)and 328 cycles had blastocyst transfer(B2 group).The baseline was given a PSM,and resulted in 132 cycles in each group after matching at a 1:1 ratio.There was no significant difference between the two groups in LBR(31.1% vs 29.5%),MR(19.6% vs 17.5%),IR(33.5% vs 40.1%),CPR(38.6% vs 43.2%,P=0.453),AR(19.6% vs 28.1%)and ER(0.0% vs 3.5%).There was no significant difference in maternal and neonatal outcomes between the two groups.4.Of the 796 cycles of IVF/ICSI with a history of CS,450 cycles underwent fresh-cycle embryo transfer(C1 group)and 346 cycles underwent frozen-cycletransfer(C2 group).After matching at a 1:1 ratio on baseline,24 cycles were included in each group.There was no significant difference in LBR(16.7% vs 33.3%),CPR(25.0% vs 37.5%),IR(19.4% vs 28.1%),AR(16.7% vs 0.0%),ER(16.7% vs 11.1%)between the two groups.There was no significant difference in maternal and neonatal outcomes as well.Conclusion:1.CS reduced the LBR of IVF/ICSI and increased the AR,but it had no significant effect on obstetric or neonatal outcomes;2.As to women with CS,SET significantly reduces the rate of MGR among CS women.At the same time,significantly increases the risk of premature birth and low birth weight in DET women.3.There was no significant difference in pregnancy outcomes and maternal-neonatal outcomes of previous CS women who underwent IVF/ICSI;4.There was no significant difference in pregnancy outcome and maternal-neonatal outcome between fresh-cycle embryo transfer and frozen-cycle embryo transfer in CS women,however the sample size was too small and further study was needed.