帝王切開瘢痕症候群による続発性不妊に対し、子宮鏡下瘢痕部焼灼術を行い妊娠に至った1例

抄録

  Cesarean Scar Syndrome (CSS)is known to cause abnormal genital bleeding and dysmenorrhea, and has recently been reported to contribute to secondary infertility.

  The hypothesis is thought that pooled blood in a cesarean scar defect interrupts the implantation of the embryo. There are some reports that operative therapy is superior to conservative therapy when treating secondary infertility.

  Our case is a 40 year old woman who was gravidity three, parity one, whose previous pregnancy was an emergency cesarean section delivery. The previous baby died from complications due to the trisomy 13. The patient presented with secondary infertility and was introduced to our hospital by another clinic. Her Anti-Mullerian-Hormone (AMH) was 0.16ng/ml and her uterus had uterine myoma 7cm in diameter. So we performed laparoscopic myomectomy followed by Assisted Reproductive Technology (ART). After 2 cycles of IVF-ET, she couldn't get pregnant, so we treated her as a poor responder. Considering her age, we tried to store her ovum and embryo by cryopreservation.

  In addition, she complained of abnormal genital bleeding and we conducted Magnetic Resonance Imaging (MRI). The image showed that there was a clear cesarean scar defect at the lower segment of the uterus.

  Therefore, we suspected CSS and performed hysteroscopic ablation for the lesion. After the operation she got pregnant by the first cycle of ART.

  Detailed medical interview is important to suspect CSS, and hysteroscopic ablation is an effective method for secondary infertility due to CSS.