OBJECTIVE: Rising cesarean section (CS) rate increase the possibility of pelvic adhesions. A recognized type is ventral adhesions between the anterior wall of the uterus and anterior abdominal wall. The current study aims to estimate the link between post CS ventral uterine adhesions and female fertility.
DESIGN: A case control study included patients undergoing laparoscopy for secondary infertility after previous CS.
MATERIALS AND METHODS: Patients were described as "cases" if there were abnormal adhesions between the uterus and anterior abdominal wall, while "control" patients had no such adhesions. Lysis of pelvic adhesions was done up to the maximum restoration of anatomical relationship between different pelvic organs. Patients were followed for 6 months after the procedure waiting for pregnancy to occur. Quantitative variables were presented in terms of mean and standard deviation. They were compared using a Student's t test. Qualitative variables were presented as frequency and percentage. Chi-square test was used for comparison between groups. For analysis, p <0.05 was considered to be significant.

RESULTS: The study included 167 cases (study group) and 40 patients in the control group. Adhesions between the uterus and anterior abdominal wall were mainly grade 2. Satisfactory uterolysis was achieved in 56% of cases. Pregnancy occurred in 71% of cases. Among a total of 134 patients who got pregnant over the 6 months follow up period, 88.1% were cases and only 12 % were control (P=0.000). The extent of uterine adhesions had a definite effect on the occurrence of pregnancy; most cases had either grade 1 or 2. Associated severe adnexal adhesions were commoner in patients who didn’t get pregnant than pregnant ones (19 % vs. 0.2%).
CONCLUSIONS: Ventral adhesions between the uterus and anterior abdominal wall secondary to CS seem to have a significant impact on fertility and can be successfully treated by laparoscopic uterolysis.