EFFECT OF AN ISTHMOCELE ON IVF OUTCOME IN INFERTILE PATIENTS UNDERGOING STIMULATED IVF TREATMENT

Abstract

This study was performed to investigate the effect of an isthmocele after previous cesarean section delivery on IVF outcome in infertile women undergoing IVF in stimulated cycles. Retrospective cohort study. A total of 104 infertile patinets who underwent IVF in controlled ovarian stimulation (COS) cycles between May 2018 and April 2020 was included in this study. Of 104, sixty-one patients had no isthmocele, a cesarean scar (group 1) but forty-three had an existing isthmocele. Twenty-three patients of 43 had a small isthmocele with residual myometrial thickness (RMT) of 3mm or more (group 2) and 20 had a large isthmocele with RMT less than 3mm (group 3). COS results and IVF outcome were compared among the three groups. Analysis of variance (ANOVA) was used to compare the mean values among three groups. Chi-square test and Fisher's exact test were used for the comparisons of fraction. Statistical significance was defined as P<.05. The demographic characteristics of subjects were comparable among the three groups. There were also no differences in the three groups with respect to the number of oocytes retrieved, mature oocytes retrieved, fertilized oocytes and grade 1 or 2 embryos. However, intracavitary fluid (ICF) in the day of oocyte retrieval was more frequently developed in group 3 (large isthmocele group), compared with group 1 or 2 (P = .005 vs group 2, and P < .001 vs group 1). Clinical pregnancy rate (CPR) in group 3 was significantly lower than in group 1 (P = .028) and also lower than in group 2 with a borderline significance (P = .080). Miscarriage rate was similar in three groups. CPR was significantly lower in IVF treatment group with developing ICF than in group without development of ICF (P < .001). Large isthmocele was associated with developing ICF and had an adverse effect on the IVF outcome in infertile patients undergoing IVF in COS cycles.