Tohoku J. Exp. Med., 2022 November, 258(3)

Decreased Fertility in Women with Cesarean Scar Syndrome Is Associated with Chronic Inflammation in the Uterine Cavityy

Yuri Nobuta,¹ Shunichiro Tsuji,¹ Jun Kitazawa,¹ Tetsuro Hanada,¹ Akiko Nakamura,¹ Rika Zen,¹ Tsukuru Amano¹ and Takashi Murakami¹

¹Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan

Chronic inflammation in cesarean scar defect contributes to secondary infertility in women with cesarean scar syndrom; however, it remains unclear about the situation of inflammation in uterine cavity in women with cesarean scar syndrome. This ambidirectional cohort study aimed to explore the effect of inflammation in the uterine cavities of women with cesarean scar syndrome on infertility at a single university hospital. The frequency of chronic endometritis in infertile patients was retrospectively compared between the cesarean scar syndrome group and non-cesarean scar syndrome group. The frequency of endometriosis was also investigated in patients with cesarean scar syndrome who underwent laparoscopy. The level of tumor necrosis factor-α and interleukin-1β in the uterine cavity was prospectively evaluated in the cesarean scar syndrome group and in women with a history of cesarean section (control group) using an enzyme-linked immunosorbent assay. There was a significant difference in the incidence of chronic endometritis between the cesarean scar syndrome and non-cesarean scar syndrome groups (65.8% and 46.0%, respectively, p = 0.0315). Endometriosis was detected in 51 (70%) patients with laparoscopy. Tumor necrosis factor-α and interleukin-1β levels in the cesarean scar syndrome group were significantly higher than those in the control group (p = 0.0002 and p = 0.0217, respectively). Our findings suggest that one cause of secondary infertility in women with cesarean scar syndrome is embryo implantation failure-associated chronic endometritis, endometriosis, and chronic inflammation in the uterine cavity.

Keywords —— cesarean section; chronic; endometritis; infertility; scar

© 2022 Tohoku University Medical Press

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Tohoku J. Exp. Med 2022, 258, 237-242.

Correspondence: Shunichiro Tsuji, M.D., Ph.D., Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.

e-mail: tsuji002@belle.shiga-med.ac.jp