ArticleHuman reproduction (Oxford, England)2020
Post-Caesarean section niche-related impaired fertility: hypothetical mechanisms.
Article in Human reproduction (Oxford, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 46 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Uterine Inflammatory Characteristics Following Cesarean Delivery
Effect of Prior Caesarean Delivery on ICSI Outcome
Who cites it
46 citing papers in PubMed, 3 syntheses or guidelines pooled it, 108 citations in OpenAlex.
- Exploring uterine niche: a systemic review on secondary infertility rates, pathophysiological correlations, impact on assisted reproduction technology (ART), and the efficacy of surgical interventions.BMC pregnancy and childbirth · 2025Pooled it
- High live birth rates after laparoscopic isthmocele repair in infertility: a systematic review and meta-analysis.Frontiers in endocrinology · 2025Pooled it
- Association of caesarean scar defect with risk of abnormal uterine bleeding: results from meta-analysis.BMC women's health · 2024Pooled it
- Adjunctive azithromycin prophylaxis protects women from uterine cesarean scar defect: A randomized controlled trial.Acta obstetricia et gynecologica Scandinavica · 2022Trial
- 'The good idea': a commentary on a decade of barbed sutures in cesarean surgery.Annals of medicine · 2026Review
- Prostaglandin E2-mediated aging microenvironment fuels pathogenic fibrosis in cesarean section scar defect.EMBO molecular medicine · 2026Article
- Determinants of First-Trimester Residual Myometrial Thickness After Previous Cesarean Delivery: A Retrospective Cohort Study.Medicina (Kaunas, Lithuania) · 2026Article
- Commentary on ‟Frozen embryo transfer outcomes in patients with prior cesarean delivery: a focus on endometrial lining parameters".F&S reports · 2026Article
- Improvement in Th1/Th2 balance and endometrial receptivity after hysteroscopic surgery in patients with cesarean scar disorder: a case report.Maternal health, neonatology and perinatology · 2026Article
- Frozen embryo transfer outcomes in patients with prior cesarean delivery: a focus on endometrial lining parameters.F&S reports · 2026Article
- Reproductive outcomes following assisted reproductive technology after previous caesarean section: data from the Swiss National Registry.Frontiers in endocrinology · 2026Article
- Uterine closure after cesarean delivery: surgical technique, biological rationale, and clinical implications.American journal of obstetrics and gynecology · 2026Review
- Platelet-Rich Plasma in Postpartum Wound and Scar Repair: A Narrative Review of Clinical Evidence, Patient-Centered Outcomes, and Translational Challenges.International journal of women's health · 2026Review
- A Systematic Review on Caesarean Niche and Postmenstrual Spotting Syndrome: The Scar That Speaks.Cureus · 2025Review
- Effect of cervical changes on the cesarean scar topography after primary cesarean sections: an observational study.BMC pregnancy and childbirth · 2025Observational
- Article
- High Risk of Chronic Endometritis in Isthmocele-A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2025Review
- Diagnostic yield of transvaginal ultrasonography versus saline: infused sonohysterography in the evaluation of post-cesarean section uterine niche.Journal of ultrasound · 2025Article
- The role of placental hormones and metabolites in modulating uterine circulation in physiological and pathological pregnancies.Frontiers in endocrinology · 2025Review
- Pregnancy outcomes in women with cesarean section scar defects and secondary infertility after vaginal repair: a multicenter observational cohort analysis.Frontiers in medicine · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Caesarean section can result in an indentation of the myometrium at the site of the Caesarean scar, called a niche. Niches can cause symptoms of abnormal uterine blood loss, dysmenorrhoea, chronic pelvic pain and dyspareunia and are possibly related to subfertility. Various other explanations for the cause of subfertility after Caesarean section have been proposed in the literature, such as uterine pathology, intra-abdominal adhesions and women's reproductive choices. Not all niches cause symptoms and the relation with subfertility and a niche in the uterine scar still needs further study since direct evidence is lacking so far. Based on the limited available evidence, and in combination with observations made during sonographic hysteroscopic evaluations and laparoscopic niche repair, we propose and discuss three hypothetical mechanisms: (i) the environment for sperm penetration and implantation may be detrimental; (ii) there could be a physical barrier to embryo transfer and implantation; and (iii) psychogenic factors may reduce the likelihood of pregnancy. Several innovative surgical treatments have been developed and are being implemented for niche-related problems. Promising results are reported, but more evidence is needed before further implementation in daily practice. The additional value of niche resections should be compared to expectant management or fertility therapies, such as ART, in randomized controlled trials. Therefore, our suggested hypotheses should, for the time being, not be used for justification of any specific procedures outside clinical trials.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.