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The Influence of Cesarean Delivery on Ovarian Reserve: a Prospective Cohort Study


To assess the association between cesarean delivery and ovarian reserve, as compared to vaginal delivery. A prospective case control study conducted at a single tertiary medical center between June 2018 and June 2019. Study population included women with singleton pregnancy that underwent first cesarean delivery that were compared to women undergoing normal vaginal delivery. Women with low ovarian reserve, endometriosis, previous pelvic surgery, chronic maternal disease, and active labor were excluded. Ovarian reserve was estimated by Anti-Mullerian hormone (AMH) levels that was determined twice for each participant: up to a week before and 3 months after delivery. Primary outcome was defined as the delta in AMH levels. Data were analyzed by non-parametric tests. During the study period, 135 women were enrolled, of them 63 (47%) underwent cesarean delivery and 72 (53%) had vaginal delivery. Women in the cesarean delivery group were older (34 (31–38) vs. 32 (29–35); p = 0.001); nevertheless, AMH levels measured before delivery were comparable between the two groups (0.92 (0.51–1.79) vs. 0.95 (0.51–1.79) pg/mL; p = 0.42). AMH levels measured after delivery were more than doubled in the study and control groups (2.15 (1.24–3.05) vs. 2.62 (1.05–5.09); p = 0.50), and delta AMH levels were also found comparable (1.25 (0.61–2.22) vs. 1.59 (0.63–3.41), respectively; p = 0.43). Linear regression analysis including age, mode of delivery, gestational age at delivery, and delta hemoglobin levels revealed that only maternal age was significantly associated with delta in AMH levels (B =  − 0.09, p = 0.04). Cesarean delivery does not decrease ovarian reserve as estimated by AMH.

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Data will be available upon request.


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We acknowledge the Endocrine Laboratory Team of Sheba Medical Center for their cooperation.

Author information

Authors and Affiliations



Aya Mohr-Sasson- conceptualization; formal analysis; investigation; methodology; project administration; writing – original draft.

Jigal Haas- methodology, investigation, review and editing.

Sonya Bar-Adon- investigation.

Maya Shats- investigation.

Roni Hochman- data collecting, investigation.

Raoul Orvieto- methodology; review and editing.

Shali Mazaki-Tovi- methodology, writing—editing.

Eyal Sivan- methodology; project administration; supervision; writing—review and editing.

Corresponding author

Correspondence to Aya Mohr-Sasson.

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Ethics Approval

The study protocol was approved by the Institutional Review Board (ID 5125–18 SMC) on the 30th of May 2018 and was registered at the National Institutes of Health (NCT02821702). All women signed written informed consent to participate in the study.

Consent to Participate

All participants signed informed consent before participating in the study.

Consent for Publication

All authors gave consent for publication.

Conflict of Interest

The authors declare no competing interests.

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Mohr-Sasson, A., Haas, J., Bar-Adon, S. et al. The Influence of Cesarean Delivery on Ovarian Reserve: a Prospective Cohort Study. Reprod. Sci. 29, 639–645 (2022).

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  • Cesarean delivery
  • Fertility
  • Anti-Mullerian hormone
  • Ovarian reserve
  • Vaginal delivery