Design: A prospective study.

Setting: Hysteroscopic ambulatory clinic.

Patients or Participants: Study population included women that underwent diagnostic hysteroscopy with cesarean uterine scar (study group) that were compared to those without (controls). Women six months from delivery, breastfeeding, with abnormal finding on hysteroscopy or uterine scar other than cesarean were excluded.

Interventions: A syringe was attached to the outlet of the diagnostic hysteroscope and the first 5 cc of 0.9% normal saline fluid used for hydro-dissection were collected. The samples were analyzed for inflammatory factors levels, including: GM-CSF, IFN-gamma, IL-1, IL-2, IL-5, IL-6, IL-7. IL-13, IL-15, IL-17, IL-17F, IL-22, IL-23, IL-31, IL-36 and TNF-alpha. Transvaginal ultrasound was performed after hysteroscopy for women in the study group to characterize the uterine scar. Primary outcome was defined as the difference in the inflammatory factors level.

Measurements and Main Results: 80 women met inclusion criteria, of them 29(36%) had history of CD and 51(64%) had no uterine scar. Women’s demographic and clinical characteristics were comparable between groups. No difference was found in the level of any of the 17 factors collected. Sub-analysis by infertility indication to perform the procedure to all other indications, found IL 33 significantly higher in the infertility group (p=0.02). While comparing only women in the CD group, IL 33 was found to be 25 times higher in the infertility group [61.23(19.84-169.44) vs. 4.61(0-33.72) pg/ml; p=0.004]. This difference was not demonstrated in women without CD (p=0.29).

Conclusion: Women undergoing evaluation due to infertility with history of uterine scar have significantly higher level of inflammatory marker IL33.