Laparoscopic isthmocele repair: impact on secondary infertility after cesarean sections

Objective: study the effect of uterine isthmocele repair on cases with secondary infertility, abdominal pain and abnor-mal uterine bleeding.
Setting: Zinat Alhayat hospital in Benha from June 2019 to January 2021.  
Methods: Cases recruited from those who complained from secondary infertility and delivered by cesarean section and presented with infertility and abnormal uterine bleeding in examination a lower segment cs defect was evident by vag-inal ultrasound 
Total number of 50 cases divided into two groups 
Group one laparoscopic isthmocele repair group 25 cases (laparoscopic repair of scar defect done)
Group two controls conservative management group 
Cases given chance for spontaneous pregnancy at month one 
Second and third month cases given induction of ovulation with a fixed protocol of letrozole 2.5 mg twice daily from day 2 for 5 days and HMG Meriofert injection 75 u at day 3, 5, 7 of menstrual cycle.
Then follicular maturation follicular maturation was moni-tored with vaginal ultrasound 
Primary outcome measures: pregnancy rate by the end of 3 month
Secondary outcomes: resolution of abnormal uterine bleed-ing and abdominal pain.     
Results: regarding the total pregnancy rate at the end of the third month following surgery there were 15 pregnant cases out of 25 in the isthmoplasty group compared to 3 out of 25 in controls with p value of 0.0004 with a high statistically significant difference.
Regarding pain scores above 6 points there was one out of 25 in cases compared to 10 out of 25 in controls with p value 0.002.
Regarding abnormal uterine bleeding there were 2 out of 25 in cases compared to 12 out of 25 in controls with p value of 0.001 and a high statistical difference.
Conclusion: cesarean scare defect repair sig-nificantly improve infertility and clinical preg-nancy rate through laparoscopy.