Surgical management of uterine niche in a patient with secondary infertility and successful pregnancy outcome

T. Ramani Devi; C. Archana Devi; Swati Nethaji; E. Kaviya

doi:10.18203/2320-1770.ijrcog20253117

Authors

T. Ramani Devi Department of Obstetrics and Gynecology, Ramakrishna Medical Centre LLP, Tiruchirappalli, Tamil Nadu, India
C. Archana Devi Department of Obstetrics and Gynecology, Ramakrishna Medical Centre LLP, Tiruchirappalli, Tamil Nadu, India
Swati Nethaji Department of Obstetrics and Gynecology, Shwetha Speciality Hospital, Tiruchirappalli, Tamil Nadu, India
E. Kaviya Department of Obstetrics and Gynecology, Thirumala Speciality Clinic, Sholinghur, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253117

Keywords:

Uterine niche, Secondary infertility, Residual myometrial thickness, IVF failure, Laparoscopic niche repair, Reproductive outcome

Abstract

Uterine niche or caesarean scar defect is a known cause of secondary infertility and implantation failure. Surgical repair can restore uterine anatomy and improve fertility outcomes in selected patients. This case report presents a 38-year-old woman with a history of one lower segment caesarean section and two failed in vitro fertilization (IVF) cycles presented with secondary infertility. Ultrasound showed a prominent uterine niche. She underwent DHL with niche repair followed by controlled ovarian stimulation and intracytoplasmic sperm injection (ICSI). Frozen embryo transfer of two day 3 embryos resulted in a viable pregnancy. An elective repeat caesarean section was performed at 36 weeks + 4 days, resulting in the birth of a healthy infant. Laparoscopic niche correction may improve fertility outcomes in patients with uterine scar defects contributing to infertility, particularly those with prior IVF failures.

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