Obstetric Outcomes of Nulliparous Women with Pelvic Pain Undergoing Fertility Treatment

Research question: Is there any association between pelvic pain and primary caesarean delivery for patients undergoing assisted reproductive technology (ART) treatment? Design: Retrospective cohort study of nulliparous patients with singleton pregnancies who underwent ART treatment and achieved a live birth between 2012 and 2020. Cases included patients diagnosed with pelvic pain. A 3:1 ratio propensity -scorematched population of patients without a history of pelvic pain was included as the control group. Comparative statistics were performed using chi -squared test and Student 's t -test. A multivariate regression analysis was conducted to evaluate the association between pelvic pain and mode of delivery. Results: One hundred and seventy-four patients with pelvic pain were compared with 575 controls. Patients with pelvic pain reported a signi fi cantly longer duration of infertility compared with controls (18.98 +/- 20.2 months versus 14.06 +/- 14.06 months; P = 0.003). Patients with pelvic pain had a signi fi cantly higher rate of anxiety disorders (115 +/- 21.9 versus 55 +/- 31.6; P = 0.009) and use of anxiolytics at embryo transfer (17 +/- 3.2 versus 12 +/- 6.9; P = 0.03) compared with controls. In addition, patients with pelvic pain had a higher rate of primary caesarean delivery compared with controls (59.8% versus 49.0%; P = 0.01). After adjusting for multiple variables, a signi fi cant association was found between pelvic pain and increased odds of primary caesarean delivery (adjusted OR 1.48, 95% CI 1.02 - 2.1). Conclusion: Patients with pelvic pain have signi fi cantly higher odds of primary caesarean delivery compared with patients without a history of pelvic pain. The infertility outpatient setting may be uniquely positioned to identify patients at risk for undergoing primary caesarean delivery, and could facilitate earlier intervention for pelvic fl oor physical therapy during the preconception and antepartum periods.