{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T20:04:55Z","timestamp":1784664295887,"version":"3.55.0"},"reference-count":60,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n The optimal embryo transfer strategy for women with a history of cesarean delivery (CD) remains highly controversial. CD causes uterine microenvironmental damage, especially cesarean scar niche formation and chronic low\u2010grade inflammation, both of which severely impair endometrial receptivity. Supraphysiological hormones during controlled ovarian stimulation (COS) further exacerbate these harmful conditions, creating a \u201cdouble hit\u201d that compromises implantation. This study aimed to compare the reproductive outcomes of fresh embryo transfer (fresh ET) versus a \u201cfreeze\u2010all\u201d frozen\u2010thawed embryo transfer (FET) strategy in this specific population.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A large\u2010scale retrospective cohort study was conducted including women with a history of a single CD undergoing their first or second in\u00a0vitro fertilization (IVF)\/intracytoplasmic sperm injection (ICSI) cycle. To minimize selection bias and balance baseline and embryological covariates, a 1:1 propensity score matching (PSM) was performed. The primary outcome was the live birth rate (LBR) per transfer.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Following PSM, 412 well\u2010matched pairs (\n n<\/jats:italic>\n \u2009=\u2009824\u2009cycles) were analyzed. The FET group was found associated with a significantly higher LBR compared to the fresh ET group (42.2% vs 33.5%; odds ratio [OR] 1.45, 95% confidence interval [CI]: 1.12\u20131.88,\n P<\/jats:italic>\n \u2009=\u20090.006) per transfer. Similarly, the clinical pregnancy rate (CPR, 51.5% vs 41.0%,\n P<\/jats:italic>\n \u2009=\u20090.003) and implantation rate (35.8% vs 28.6%,\n P\u2009<<\/jats:italic>\n \u20090.001) were found associated with the FET cohort, with no significant differences in miscarriage or adverse neonatal outcomes. Multivariate logistic regression found FET to be independently associated with live birth as a protective predictor (adjusted OR 1.48, 95% CI: 1.15\u20131.92,\n P<\/jats:italic>\n \u2009=\u20090.003). Crucially, subgroup analysis found that the superiority of FET was predominantly associated with patients with a sonographically confirmed cesarean scar niche (OR 2.15, 95% CI: 1.45\u20133.20,\n P\u2009<<\/jats:italic>\n \u20090.001), whereas the benefit was marginal in those with an intact scar (\n P<\/jats:italic>\n \u2009=\u20090.125).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n For women with a previous CD, a \u201cfreeze\u2010all\u201d strategy significantly improves LBR and implantation potential compared to fresh ET. This approach is strongly recommended, particularly for patients with a cesarean scar niche, who are the key population benefiting most from FET cesarean.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ijgo.71236","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T19:22:02Z","timestamp":1784661722000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing embryo transfer strategies for women with previous cesarean delivery: A propensity score\u2010matched comparison of fresh versus frozen\u2010thawed cycles"],"prefix":"10.1002","author":[{"given":"Henghua","family":"Xuan","sequence":"first","affiliation":[{"name":"Reproductive Medicine Center Hefei Maternity and Child Health Hospital Hefei China"},{"name":"Reproductive Medicine Center Anhui Women and Children's Medical Center Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhixia","family":"Tang","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center Hefei Maternity and Child Health Hospital Hefei China"},{"name":"Reproductive Medicine Center Anhui Women and Children's Medical Center Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyun","family":"Hong","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center Hefei Maternity and Child Health Hospital Hefei China"},{"name":"Reproductive Medicine Center Anhui Women and Children's Medical Center Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"He","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center Hefei Maternity and Child Health Hospital Hefei China"},{"name":"Reproductive Medicine Center Anhui Women and Children's Medical Center Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"He","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center Hefei Maternity and Child Health Hospital Hefei China"},{"name":"Reproductive Medicine Center Anhui Women and Children's Medical Center Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Cheng","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center Hefei Maternity and Child Health Hospital Hefei China"},{"name":"Reproductive Medicine Center Anhui Women and Children's Medical Center Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajia","family":"Sheng","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center Hefei Maternity and Child Health Hospital Hefei China"},{"name":"Reproductive Medicine Center Anhui Women and Children's Medical Center Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/S0140-6736(18)31930-5","article-title":"Short\u2010term and long\u2010term effects of caesarean section on the health of women and children","volume":"392","author":"Sandall J","year":"2018","journal-title":"Lancet"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/j.ajog.2025.10.029","article-title":"Cesarean delivery: from surgical procedure to system of care","volume":"233","author":"Romero R","year":"2026","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1213\/ANE.0000000000004805","article-title":"The effect of the No Pain Labor & Delivery\u2010Global Health Initiative on cesarean delivery and neonatal outcomes in China: an interrupted time\u2010series 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