title: The relationship between Caesarean section and subfertility in a population-based sample of 14 541 pregnancies.
abstract: 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 > or =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.
authors.affiliation: Division of Obstetrics and Gynaecology, University of Bristol, St. Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK. d.j.murphy@bristol.ac.uk
authors.forename: D J
authors.initials: DJ
authors.lastname: Murphy
authors.forename: G M
authors.initials: GM
authors.lastname: Stirrat
authors.forename: J
authors.initials: J
authors.lastname: Heron
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000503:physiopathology*; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors