Cesarean delivery scar.

A 35-year-old-woman presented to us for her third IVF treatment cycle. She had had a Cesarean delivery 7/2 months earlier following a successful IVF treatment. She had had an uneventful recovery from the operation. After delivery she had two menstrual periods then decided to start a new IVF treatment cycle. She had her first ultrasound scan on cycle day (CD) 9, which was performed before the luteal start of gonadotrophin releasing hormone (GnRH) treatment. All the scans were performed using a Kretz Voluson 530 ultrasound machine (Kretztechnik, Zipf, Austria) with threedimensional (3D) facilities. The isthmical scar was visible on CD 9, but looked intact. The pituitary down-regulation was achieved after 33 days of GnRH therapy. The patient was scanned weekly, and the scar looked normal. During ovarian stimulation with follicle stimulating hormone (FSH) injections, the scar became conspicuous on ultrasound scans. The scar seemed to contain endometrial tissue, which reacted to ovarian stimulation and started to grow and secrete mucus, enabling clear visualization of the scar. The 3D ultrasound examination (Figure 1) on the day before human chorionic gonadotrophin (hCG) administration and 3 days before egg collection revealed a fenestration throughout the isthmic scar. The patient was scanned 2 days after egg collection and there was no change in the appearance of the scar. After consultation with an obstetrician, we decided to transfer two embryos under ultrasound guidance into the uterine cavity, carefully avoiding transfer into the scar. The patient was informed about the possible risks, and she accepted the decision. Two weeks later she performed a pregnancy test which was positive. Three weeks after embryo transfer she was scanned, and there was a singleton pregnancy in the uterine cavity and the yolk sac was visible. The dehiscence in the uterine scar was not observed. Five weeks after embryo transfer, fetal pole and heartbeat were detected. She had an uneventful elective Cesarean delivery of a healthy male infant at 39 weeks of gestation.