- 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.
- 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).
- Systematic review and meta-analysis (4,423,544 participants; 21 articles).
- First mode of delivery and subsequent fertility compared.
- Funding: None.
- Based on the limitations of original studies.
- Studies are heterogeneous.