Does mode of delivery affect future fertility?

  • Eur J Obstet Gynecol Reprod Biol

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Fertility rates decline after cesarean delivery (CD) compared with vaginal delivery.

Why this matters

  • Fertility rates have been declining in developed and developing countries.
  • Complications from operative delivery or unfavorable experiences during delivery may contribute to lower fertility rates.
  • These data may be used to discourage primary elective CD.

Key results

  • Probability of subsequent fertility (after adjusting for confounding factors) was decreased by:
    • 13% after emergency cesarean birth (5 studies).
    • 10% after primary cesarean birth (9 studies).
  • Decreased fertility was seen for subsequent pregnancy after primary CD compared with spontaneous vaginal delivery:
    • Relative risk: 0.91 (95% CI, 0.88-0.94).
  • Decreased fertility was seen for subsequent pregnancy after emergency CD compared with spontaneous vaginal delivery:
    • Relative risk: 0.87 (95% CI, 0.85-0.90).

Study design

  • Systematic review and meta-analysis (4,423,544 participants; 21 articles).
  • First mode of delivery and subsequent fertility compared.
  • Funding: None.

Limitations

  • Based on the limitations of original studies.
  • Studies are heterogeneous.