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Human Reproduction, Vol. 17, No. 7, 1914-1917, July 2002
© 2002 European Society of Human Reproduction and Embryology

The relationship between Caesarean section and subfertility in a population-based sample of 14 541 pregnancies

D.J. Murphy1,3, G.M. Stirrat1 and J. Heron2 the ALSPAC Study Team2

1 Division of Obstetrics and Gynaecology and 2 Division of Paediatric and Perinatal Epidemiology, University of Bristol, Bristol, UK

BACKGROUND: There has been a threefold increase in the rate of Caesarean section over the past 25 years. The long-term consequences of Caesarean section may include subsequent subfertility. METHODS: We investigated the relationship between Caesarean section and subfertility within a cohort of 14 541 pregnant women. RESULTS: A history of previous Caesarean section was associated with an increased risk of taking >1 year to conceive from the time of planning a pregnancy, adjusted odds ratio (OR) 1.53 [95% confidence interval (CI) 1.09, 2.14]. This association was stronger for women of parity >=>=2, adjusted OR 2.97 (95% CI 1.72, 5.10). Nulliparous women with a history of subfertility were at increased risk of delivery by Caesarean section, adjusted OR 1.56 (1.22, 2.00) and OR 2.33 (1.64, 3.30) for durations of >1 and >3 years respectively. CONCLUSIONS: These findings suggest a complex relationship between Caesarean section and subfertility where subfertility may both precede and be a consequence of Caesarean section.

Key words: Caesarean section/population-based study/subfertility

3 To whom correspondence should be addressed at: Division of Obstetrics and Gynaecology, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK. E-mail: d.j.murphy{at}bristol.ac.uk


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