title: The impact of cesarean birth on subsequent fertility.
abstract: OBJECTIVE
  Recently, the rate of cesarean delivery has increased to 25-30% of all births, the highest rate ever reported in the USA. Primary cesarean deliveries, especially elective procedures, mainly contribute to this increase. Currently, controversy concerning elective cesarean delivery is an area of growing debate. Women should be well informed about the benefits and risks of on-demand cesarean delivery. This may be problematic, however, due to the limited current scientific data on the benefits and risks. One of the issues causing debate is the association between cesarean section and subsequent infertility. In the present review, we aim to analyze the evidence for the impact of cesarean delivery on subsequent fertility.
  
  
  RESULTS
  Cesarean section has been reported to be associated with decreased subsequent fertility. Recent studies, which have tried to explain this association, suggest that this is most probably voluntary or due to some other biases, or possible confounding factors, which are due to organic or psychosocial effects of an emergency cesarean section or labor preceding the cesarean delivery.
  
  
  CONCLUSIONS
  Elective cesarean section does not appear to cause infertility. What we need now, however, are more qualitative studies to determine the contribution of cesarean section per se on fecundity.
authors.affiliation: Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey. eoral@superonline.com
authors.forename: Engin
authors.initials: E
authors.lastname: Oral
authors.forename: Koray
authors.initials: K
authors.lastname: Elter
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005298:Fertility; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D036801:Parturition; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000209:etiology; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000523:psychology; D014481:United States