Table 3 The pathophysiological basis for the association between uterine niche and fertility
Aetiology | Study | Design | n |
|---|---|---|---|
The altered environment and anatomy of the isthmocervical canal. | AbdullGaffar 2022 [42] | Retrospective review | 22 |
Embryo implantation failure- associated with chronic endometritis, endometriosis, and chronic inflammation in the uterine cavity. | Nobuta 2022 [25] | Retrospective case-control study | 201 |
The absence of endometrium, the presence of adenomyosis, and chronic inflammation in CSD contribute to secondary infertility due to CSS. | Higuchi 2021 [20] | Retrospective cohort study | 84 |
Embryo transfer success can be compromised when there is an Isthmocele and Intracavity fluid. | Lawrenz 2019 [14] | Observational and exploratory clinical study (No strict cohort design) | 495 |
Correlation analysis showed that the levels of inflammatory factors (tumor necrosis factor-a, interleukin-1b, interleukin-6), the size of uterine scar diverticulum, and the myometrial thickness at uterine scar were significantly correlated with subsequent infertility (r = 0.307, 0.083, 0.147, 0.405, 0.291, P < 0.05). | Beilei 2021 [21] | Retrospective cohort study | 60 |
An RMT < 2.5 mm was associated with secondary infertility. | Mohr-Sasson 2023 [24] | Retrospective cross-sectional study | 282 |
Surgical correction of Isthmocele increases RMT, resulting in improved fertility. | Piriyev 2022 [22] | Retrospective cohort study | 28 |
Donnez 2017 [36] | Prospective case series | 38 | |
Tsuji 2020 [23] | Retrospective cohort study | 38 | |
Infertility associated with PCSD, cesarean scar syndrome, is caused by the retention of bloody fluid in the uterine cavity and scarring. When the bloody fluid flows into the uterine cavity, it may cause implantation failure. | Tanimura 2015 [13] | Retrospective cohort study | 22 |