Effects of caesarean section on future fertility are minimal

30 April 2014

Birth by caesarean section is unlikely to cause problems with future fertility, according to new research published in Human Reproduction.

Researchers from the London School of Hygiene & Tropical Medicine and the Royal College of Obstetricians and Gynaecologists analysed data for over 1 million, low-risk, first-time mothers who gave birth in English NHS hospitals between 1 April 2000 and 31 March 2012 in order to see how having a caesarean section affected future fertility.

Previous studies had reported that delivery by caesarean section is associated with fewer subsequent pregnancies and babies, as well as longer intervals between pregnancies. This caused concern, particularly as caesarean section has become much more frequent over the last 20 years.

Researchers led by Dr Ipek Gurol-Urganci at the School of Hygiene & Tropical Medicine found that the medical and social circumstances leading to the decision to carry out a caesarean section may be associated with the apparent reduction in fertility, rather than the procedure itself.

Among low-risk first-time mothers, 224,024 (21.4%) were delivered by caesarean section, with less than 4% having an elective caesarean section. All types of caesarean section were associated with a reduced subsequent birth rate, compared with those who had vaginal deliveries, but the size of reduction varied among different groups of women.

The reduction was smallest for elective caesarean section for a breech baby among women who had no other complications during their pregnancy. The reduction in subsequent birth rates was largest for women having an elective caesarean section for a medical indication.

Dr Gurol-Urganci said: "The rates of caesarean section continue to rise in England and so the potential for this procedure to affect fertility is a concern. It is reassuring that this study suggests that having a caesarean section leads to only a very small effect on subsequent fertility for a first-time mother."