title: Caesarean section and its impact on fertility and time to a subsequent pregnancy in Germany: a database analysis in gynecological practices.
abstract: To analyze the impact of caesarean section (CS) on fertility and time to pregnancy in German gynecological practices.
  
  
  
  Women initially diagnosed for the first time with a vaginal delivery (VD) or CS between 2000 and 2013 were identified by 227 gynecologists in the IMS Disease Analyzer database. They were included if they were aged between 16 and 40 years, and were not previously diagnosed with female sterility. The two main outcomes were the first-time diagnosis of female sterility and the time between the first delivery and the next pregnancy within 10 years. A multivariate Cox regression model was used to predict these outcomes on the basis of patient characteristics.
  
  
  
  6483 patients were included in the CS group and 6483 in the VD group. Mean age was 30.6 years and the proportion of individuals with private health insurance amounted to 9.0 %. Within 10 years of the index date, 19.5 % of women who delivered by CS and 18.3 % of women who delivered vaginally were diagnosed with sterility (p value = 0.0148). CS and polycystic ovary syndrome significantly increased the risk of sterility. Within 10 years of the index date, 57.9 % of women who underwent a CS and 64.0 % of women who delivered vaginally were pregnant for the second time (p value <0.001). CS, polycystic ovary syndrome, and the deterioration of menstrual cycle significantly decreased the chance of becoming pregnant a second time.
  
  
  
  CS is associated with an increased risk of sterility and a decreased number of subsequent pregnancies in Germany.
authors.affiliation: Department of Biology, École Normale Supérieure de Lyon, Lyon, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Jacob
authors.affiliation: Department of Gyn. Endocrinology and Reproductive Medicine, Hospital of Gynecology and Obstetrics University Hospital Gießen und Marburg, Baldingerstraße, 35033, Marburg, Germany.
authors.forename: Katherina
authors.initials: K
authors.lastname: Weber
authors.affiliation: Department of Gyn. Endocrinology and Reproductive Medicine, Hospital of Gynecology and Obstetrics University Hospital Gießen und Marburg, Baldingerstraße, 35033, Marburg, Germany.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Sechet
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Georg
authors.initials: G
authors.lastname: Macharey
authors.affiliation: Epidemiology, Real World Evidence Solutions, IMS HEALTH GmbH & Co. OHG, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany. kkostev@de.imshealth.com.
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
authors.affiliation: Department of Gyn. Endocrinology and Reproductive Medicine, Hospital of Gynecology and Obstetrics University Hospital Gießen und Marburg, Baldingerstraße, 35033, Marburg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Ziller
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005298:Fertility / Q000502:physiology*; D005858:Germany; D006801:Humans; D011247:Pregnancy; D055815:Young Adult
keywords: Caesarean section; Complications; Fertility; Subsequent pregnancies