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Caesarean section and its impact on fertility and time to a subsequent pregnancy in Germany: a database analysis in gynecological practices

  • General Gynecology
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Abstract

Purpose

To analyze the impact of caesarean section (CS) on fertility and time to 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 sterility. The two main outcomes were the first-time diagnosis of female sterility and the time between the first delivery and the next pregnancy within 10 years. A multivariate Cox regression model was used to predict these outcomes on the basis of patient characteristics.

Results

6483 patients were included in the CS group and 6483 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 sterility (p value = 0.0148). CS and polycystic ovary syndrome significantly increased the risk of sterility. 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 a second time.

Conclusions

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

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Acknowledgments

Professional English language editing services were provided by Claudia Jones, MA, Radford, VA, United States.

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Authors and Affiliations

  1. Department of Biology, École Normale Supérieure de Lyon, Lyon, France

    Louis Jacob

  2. Department of Gyn. Endocrinology and Reproductive Medicine, Hospital of Gynecology and Obstetrics University Hospital Gießen und Marburg, Baldingerstraße, 35033, Marburg, Germany

    Katherina Weber, Ingeborg Sechet & Volker Ziller

  3. Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland

    Georg Macharey

  4. Epidemiology, Real World Evidence Solutions, IMS HEALTH GmbH & Co. OHG, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany

    Karel Kostev

Authors
  1. Louis Jacob
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  2. Katherina Weber
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  3. Ingeborg Sechet
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  4. Georg Macharey
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Corresponding author

Correspondence to Karel Kostev.

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Conflict of interest

LJ, VZ, IS, KW, KK and GM have no conflict of interest.

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Jacob, L., Weber, K., Sechet, I. et al. Caesarean section and its impact on fertility and time to a subsequent pregnancy in Germany: a database analysis in gynecological practices. Arch Gynecol Obstet 294, 1005–1010 (2016). https://doi.org/10.1007/s00404-016-4160-4

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  • DOI: https://doi.org/10.1007/s00404-016-4160-4

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