Introduction
Preterm birth is one of the leading causes of neonatal morbidity,
mortality, and severe long-term disability1. With the
advance in infertility treatment, conception after in vitro
fertilization (IVF) procedures has been recognized as a substantial
increase in preterm delivery risk2. The increase in
preterm delivery risk after IVF is found mainly due to the higher rate
of multiple pregnancies, but also due to advanced maternal age,
nulliparity, and co-morbidity2-6. However, some data
demonstrate that adverse outcomes, preterm delivery included, occur in
infertile women regardless of the mode of conception, IVF, or
spontaneous, suggesting that infertility may be the underlying
cause7.
While the body of studies exists on pregnancy rate and outcome in
infertile women after IVF conception, there are scarce studies on
pregnancy outcome of spontaneous conception after reproductive
surgery8. The main reason exists in the opinion that
reproductive surgery should only be performed as an initial part of
infertility evaluation to increase implantation and pregnancy rates
after IVF9. However, evidence shows that careful
selection of patients for reproductive surgery enables couples to
conceive spontaneously and yields high cumulative pregnancy rates and
good outcomes8-10.
In the absence of obvious indication for IVF/ISCI procedure (like a male
factor of infertility, bilateral tubal factor, or need for
preimplantation genetic diagnostic), the usual approach to infertility
treatment at our institution is, firstly, to restore fertility with
reproductive surgery. Thus, every woman without any clear indication for
IVF/ICSI undergo diagnostic or operative laparoscopy and, in the case of
pathology found on transvaginal ultrasound, also a hysteroscopy. The
usual overall pregnancy rate after reproductive surgery has been around
50%10. Women, who do not conceive spontaneously after
reproductive surgery are advised to undergo IVF procedure.
Since the IVF/ICSI procedure has been supposed to be the known factor
for preterm delivery4, we aimed to explore an
association between the mode of conception, spontaneous or IVF/ICSI, and
preterm delivery in a cohort of infertile women after reproductive
surgery. We hypothesized that in infertile women after reproductive
surgery, the mode of conception is not associated with preterm delivery
risk. Also, the opinion is that any infertility treatment is associated
with a higher risk of preterm delivery6. Thus, we
aimed to explore the effect of reproductive surgery on preterm delivery
as a treatment-related adverse outcome. We hypothesized that preterm
delivery in infertile women is not a reproductive surgery
treatment-related adverse outcome.