Aetiology of involuntary infertility following caesarean birth in last pregnancy

Abstract

Objective: In sub Saharan Africa, infertility and caesarean section are important clinical entities in obstetrics and gynaecological practice. The association of infertility with caesarean section commonly performed to prevent maternal/perinatal morbidity and mortality is a source of concern. Our objective was to find out the causes of infertility in women who had caesarean section in their last pregnancy.
Methodology: In this prospective observational study, sixty eight patients presented between January 2004 and December 2009, however 57 fulfilled the study criteria. They were all delivered by caesarean section in the last pregnancy.
Results: The mean age of the 68 patients was 32.2 years with age range of 23 to38 years. The median parity was 2 with a range of 1 to 6. Mean duration of infertility was 2.4 years. Nine (13.2%) of the 68 caesarean sections were repeat section. Forty eight (70.6%) of the 68 caesarean sections were done on an emergent basis. The three leading indications for the index section were prolonged obstructed labour 29(42.6%), severe pre-eclampsia/ eclampsia 11 (16.2%) and failed induction of labour 11(13.2%). Aetiology of infertility in the 57 patients that fulfilled the criteria are tubal occlusion 38(66.7%), intrauterine adhesion 9(15.8%), concomitant tubal occlusion and intrauterine adhesion 7(12.3%) and hyperprolactinaemia in 3(5.3%).
Conclusion: In this study, a significant percentage of indications for the index caesarean section and aetiologies of infertility may be linked to peri-operative genital sepsis resulting in infertility. Timely utilization and accessibility to emergency obstetric care would help decrease the incidence of infertility following caesarean delivery.