Caesarean section and impact on fertility in subsequent pregnancies in Germany: a database analysis in gynecological practices

Purpose: To analyze the impact of caesarean section (CS) on complication risks during subsequent pregnancy in German gynecological practices.

Methods: Women initially diagnosed for the first time with a vaginal delivery (VD) or CS between 2000 and 2013 were identified by 227 gynecologists in the IMS Disease Analyzer database. They were included if they were aged between 16 and 40 years, and were not previously diagnosed with female infertility. The two main outcomes were the first-time diagnose of female infertility and the time between the first delivery to the next pregnancy within 10 years. A multivariate Cox regression model was used to predict these outcomes on the basis of patient characteristics.

Results: 6,483 patients were included in the CS group and 6,483 in the VD group. Mean age was 30.6 years and the proportion of individuals with private health insurance amounted to 9.0%. Within 10 years of the index date, 19.5% of women who delivered by CS and 18.3% of women who delivered vaginally were diagnosed with infertility (p-value = 0.0148). CS and polycystic ovary syndrome significantly increased the risk of infertility. Within 10 years of the index date, 57.9% of women who underwent a CS and 64.0% of women who delivered vaginally were pregnant for the second time (p-value< 0.001). CS, polycystic ovary syndrome and the deterioration of menstrual cycle significantly decreased the chance of becoming pregnant for a second time.

Conclusions: CS is associated with an increased risk of infertility and a decreased number of subsequent pregnancies in Germany.