title: Management of secondary infertility following cesarean section: Report from the Subcommittee of the Reproductive Endocrinology Committee of the Japan Society of Obstetrics and Gynecology.
abstract: OBJECTIVE
  The aim of this study was to examine the current status and management of secondary infertility following cesarean section in Japan.
  
  
  METHODS
  A two-step questionnaire survey was performed in 1092 facilities, including teaching hospitals and artificial reproductive technology clinics, registered with the Japan Society of Obstetrics and Gynecology. In our questionnaires, we obtained data about symptoms, clinical findings, diagnostic methods, and pregnancy outcomes. Treatments were sorted into three groups, namely typical infertility treatment (group A), conservative treatment (group B), and operative treatment (group C).
  
  
  RESULTS
  Of the 1092 facilities, 616 (56%) sent back reply forms to the first questionnaire; 56 (32%) of 176 facilities answered the second questionnaire, and 189 cases were able to be analyzed after completion of the two questionnaires. The commonest symptom was abnormal uterine bleeding during the follicular phase (91 cases; 48% of the 189 eligible cases), and the commonest clinical finding was fluid pooling in the area of cesarean scar dehiscence during the ovulatory phase (142 cases; 75%). The most commonly used diagnostic method was transvaginal ultrasound (153 cases, 81%). The pregnancy rate was 33% in group A, 50% in group B, and 60% in group C. In patients with abnormal uterine bleeding, painful symptoms and fluid pooling at the cesarean scar dehiscence, the pregnancy rate was significantly higher in group C (64%) than in group A (16%; P = 0.0063).
  
  
  CONCLUSIONS
  We recommend operative treatment for secondary infertility following cesarean section with painful symptoms and fluid pooling at the site of cesarean scar dehiscence.
authors.affiliation: Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan.
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Tsuji
authors.affiliation: Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Kimura
authors.affiliation: Department of Obstetrics and Gynecology, Toyama Prefectural Central Hospital, Toyama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanimura
authors.affiliation: Department of Obstetrics and Gynecology, Hokkaido University, Hokkaido, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kudo
authors.affiliation: Department of Obstetrics and Gynecology, Chiba University, Chiba, Japan.
authors.forename: Makio
authors.initials: M
authors.lastname: Shozu
authors.affiliation: Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Narahara
authors.affiliation: Department of Obstetrics and Gynecology, Yamaguchi University Hospital, Yamaguchi, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Sugino
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D007564:Japan; D014599:Uterus / Q000000981:diagnostic imaging*
keywords: cesarean scar dehiscence; cesarean scar syndrome; secondary infertility