Obstetric outcomes of nulliparous women with pelvic pain undergoing fertility treatment

Abstract

Research QuestionTo evaluate the association between pelvic pain disorders and primary caesarean delivery for patients undergoing assisted reproductive technology treatment. DesignRetrospective cohort study of nulliparous patients with singleton pregnancies who underwent assisted reproductive technology treatment and achieved a live birth from 2012-2020. Cases included patients with prior diagnoses of pelvic pain disorders. A 3:1 ratio propensity score matched population of patients without pelvic pain was included as Controls. Comparative statistics were performed using chi-square and students t-test. A multivariate regression analysis was conducted to evaluate the association between pelvic pain patients and mode of delivery. Results174 pelvic pain patients were compared to 575 controls. Pelvic pain patients reported a significantly longer duration of infertility (18.9±20 months vs. 14.0±14 months, p=0.003) compared to controls. Pelvic pain patients had a significantly higher rate of anxiety disorders (115±21.9 vs. 55±31.6, p= 0.009) and use of anxiolytics at embryo transfer (17±3.2 vs. 12±6.9, p=0.03). Pelvic pain patients had a higher rate of primary caesarean delivery compared with controls (59.7% vs. 49.1%, p=0.01). After adjusting for multiple variables, there was a significant association between pelvic pain patients and increased odds of primary caesarean delivery (aOR = 1.48, CI 95%; 1.02-2.1). ConclusionPelvic pain patients have significantly greater odds of primary caesarean delivery when compared to patients without pelvic pain history. The infertility outpatient setting may be uniquely positioned to identify patients at risk for undergoing primary caesarean delivery and could facilitate earlier intervention for pelvic floor physical therapy during the preconception and antepartum periods.