High live birth rates after laparoscopic isthmocele repair in infertility: a systematic review and meta-analysis

Angela Vidal; James Geiger; Vithusha Vinayahalingam; Janna Pape; Marietta Gulz; Tanya Karrer; Michael D Mueller; Michael von Wolff

doi:10.3389/fendo.2025.1507482

High live birth rates after laparoscopic isthmocele repair in infertility: a systematic review and meta-analysis

Front Endocrinol (Lausanne). 2025 Apr 15:16:1507482. doi: 10.3389/fendo.2025.1507482. eCollection 2025.

Authors

Angela Vidal¹, James Geiger², Vithusha Vinayahalingam³, Janna Pape¹, Marietta Gulz⁴, Tanya Karrer⁵, Michael D Mueller⁴, Michael von Wolff¹

Affiliations

¹ Division of Gynecological Endocrinology and Reproductive Medicine, Women's University Hospital, Inselspital Bern, University of Bern, Bern, Switzerland.
² Division of Reproductive Endocrinology and Infertility, University Hospital Basel, Basel, Switzerland.
³ Department of Gynecology and Obstetrics, Hospital Wolhusen, Luzern, Switzerland.
⁴ Department of Gynecology and Obstetrics, Bern University Hospital, University of Bern, Bern, Switzerland.
⁵ Medical Library, University Library of Bern, University of Bern, Bern, Switzerland.

Abstract

Background: Cesarean sections are becoming more common worldwide. One of the long-term complications of cesarean section is a cesarean scar defect or isthmocele. The presence of isthmocele is associated with infertility.

Objectives: This systematic review and meta-analysis examined the effect of laparoscopic isthmocele repair on the reproductive outcomes of patients with and without infertility.

Search strategy: We searched MEDLINE, EMBASE, and the Cochrane CENTRAL databases in April 2024.

Selection criteria: The study included cohort studies, case-control studies, and case series reporting reproductive outcomes after laparoscopic isthmocele repair among women with or without diagnosed infertility.

Data collection and analysis: The meta-analysis examined rates of live birth, pregnancy, and miscarriage.

Main results: The search identified 866 records and 17 articles were included. Clinical pregnancy rates after isthmocele resection were 62% (95% confidence interval (CI) 54-69%) in women with infertility, compared to 33% (95% CI: 16-57%) in women without infertility and 36% in women with unknown fertility status (36%, 95% CI: 21-55%). Live birth rates were 72% (95% CI: 54-85%) among those with infertility, 78% (95% CI: 46-94%) among those without infertility, and 61% (95% CI: 42-77%) with unknown fertility status. Women with and without infertility had low miscarriage rates of 10% (95% CI: 6-16%) and 7% (95% CI: 3-18%), respectively. The prevalence of co-existing endometriosis was 29% (95% CI: 22-37%). The statistical heterogeneity of the studies ranged from 0 to 86%.

Conclusions: Laparoscopic isthmocele repair has demonstrated the potential to improve reproductive outcomes, specifically in cases where infertility is linked to isthmocele-related factors, such as challenges during embryo transfer or impaired implantation. However, further well-designed multicenter trials must confirm these findings and provide stronger evidence.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier (CRD42024548864).

Keywords: Cesarean section; Cesarean section scar defect; isthmocele; laparoscopic niche resection; reproductive outcomes.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Birth Rate*
Cesarean Section* / adverse effects
Female
Humans
Infertility, Female* / etiology
Infertility, Female* / surgery
Laparoscopy* / methods
Live Birth* / epidemiology
Pregnancy
Pregnancy Rate