Published online Mar 26, 2019. doi: 10.12998/wjcc.v7.i6.753
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
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.
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 byserum 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.
Hydrometra caused by secondary cesarean is an infertility factor, which can be corrected by hysteroscopy plus ablation of the isthmocele.
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.