Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2019; 7(6): 753-758
Published online Mar 26, 2019. doi: 10.12998/wjcc.v7.i6.753
Successful treatment with hysteroscopy for infertility due to isthmocele and hydrometra secondary to cesarean section: A case report
Luis Pablo López Rivero, Miguel Jaimes, Felipe Camargo, Esther López-Bayghen
Luis Pablo López Rivero, Miguel Jaimes, Felipe Camargo, Instituto de Infertilidad y Genética México SC, Ingenes México City 05320, México
Esther López-Bayghen, Departamento de Toxicología, Centro de Investigación de Estudios, México City 07360, México
Author contributions: López-Bayghen E and López Rivero LP designed the report; López Rivero LP, Jaimes M and Camargo F collected the patient’s clinical data; López-Bayghen E and López Rivero LP analyzed the data and wrote the paper.
Supported by Conacyt No. PEI-Conacyt 231793.
Informed consent statement: Consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Esther López-Bayghen PhD, Professor, Departamento de Toxicología, Centro de Investigación de Estudios Avanzados del IPN, Ave. IPN 2508, San Pedro Zacatenco, México City 07360, México. ebayghen@cinvestav.mx
Telephone: +52-55-57473800 Fax: +52-55-57473395
Received: November 29, 2018
Peer-review started: November 29, 2018
First decision: January 8, 2019
Revised: February 4, 2019
Accepted: February 26, 2019
Article in press: February 26, 2019
Published online: March 26, 2019
Processing time: 117 Days and 10.4 Hours
Abstract
BACKGROUND

An isthmocele is a scar defect in the uterine wall due to a cesarean section. Its prevalence is unknown, but it has been associated with secondary infertility. Here, we present a case where the patient suffered from an isthmocele that was associated with persistent hydrometra, which developed during in vitro fertilization.

CASE SUMMARY

The patient underwent hysteroscopic surgery, which successfully resolved the isthmocele as well as the hydrometra. Afterward, two high-quality, euploid embryos, determined by morphological assessment and pre-implantation genetic diagnostic testing, were transferred. This resulted in uterine pregnancy, as determined byserum β-human chorionic gonadotropin levels on day 14 (180 mU/mL) and ultrasound-confirmed presence of a gestational sac with a positive embryocardia at week 6. The pregnancy reached 36 wk without any complications, and the product was born in good health. We report a successful isthmocele treatment in a patient with secondary infertility, in which the isthmocele was the cause of persistent hydrometra.

CONCLUSION

Hydrometra caused by secondary cesarean is an infertility factor, which can be corrected by hysteroscopy plus ablation of the isthmocele.

Keywords: In vitro fertilization; Isthmocele; Hydrometra; Case report

Core tip: Scarring associated with cesarean sections has been implicated with infertility. A possible link between cesarean section and infertility is the development of triangle shape scar named isthmocele. Isthmoceles can cause a retrograde passage of mucosanguineous content to the uterine cavity, instigating inflammation. This could lead to the development of hydrometra. We present a case of a woman who had a previous cesarean section and a latter failure to get pregnant by natural means. During the in vitro fertilization (IVF) procedure in our clinic, hydrometra developed. Upon reviewing transvaginal ultrasound, an isthmocele was found. Hysteroscopy correction of the isthmocele abolished hydrometra, and the patient was able to get pregnant by IVF. Physicians and other personnel should keep in mind that isthmocele is a possible cause of secondary infertility, which could be linked to the formation persistent hydrometra.