{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:11:16Z","timestamp":1793394676364,"version":"4.5.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cesarean sections are becoming more common worldwide. One of the long-term complications of cesarean section is a cesarean scar defect or isthmocele. The presence of isthmocele is associated with infertility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This systematic review and meta-analysis examined the effect of laparoscopic isthmocele repair on the reproductive outcomes of patients with and without infertility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>We searched MEDLINE, EMBASE, and the Cochrane CENTRAL databases in April 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>The study included cohort studies, case-control studies, and case series reporting reproductive outcomes after laparoscopic isthmocele repair among women with or without diagnosed infertility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>The meta-analysis examined rates of live birth, pregnancy, and miscarriage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>The search identified 866 records and 17 articles were included. Clinical pregnancy rates after isthmocele resection were 62% (95% confidence interval (CI) 54-69%) in women with infertility, compared to 33% (95% CI: 16-57%) in women without infertility and 36% in women with unknown fertility status (36%, 95% CI: 21\u201355%). Live birth rates were 72% (95% CI: 54\u201385%) among those with infertility, 78% (95% CI: 46\u201394%) among those without infertility, and 61% (95% CI: 42\u201377%) with unknown fertility status. Women with and without infertility had low miscarriage rates of 10% (95% CI: 6\u201316%) and 7% (95% CI: 3\u201318%), respectively. The prevalence of co-existing endometriosis was 29% (95% CI: 22\u201337%). The statistical heterogeneity of the studies ranged from 0 to 86%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Laparoscopic isthmocele repair has demonstrated the potential to improve reproductive outcomes, specifically in cases where infertility is linked to isthmocele-related factors, such as challenges during embryo transfer or impaired implantation. However, further well-designed multicenter trials must confirm these findings and provide stronger evidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:uri>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:uri>, identifier (CRD42024548864).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1507482","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T06:41:46Z","timestamp":1744699306000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["High live birth rates after laparoscopic isthmocele repair in infertility: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Angela","family":"Vidal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Geiger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vithusha","family":"Vinayahalingam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janna","family":"Pape","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marietta","family":"Gulz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Karrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"von 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