The Impact of Previous Caesarean Delivery on IVF/ICSI Outcomes: A Retrospective Cohort Study on experience from Saudi Arabia

Introduction: The mode of prior delivery may significantly affect the success of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) and subsequent pregnancy outcomes. This study evaluates the impact of vaginal delivery (VD), Caesarean section (CS) without scar defect, and CS with scar defect (CSD) on IVF/ICSI outcomes. Materials and Methods In this study, 2284 women who underwent IVF/ICSI between 2020–2023 in Abha City, Saudi Arabia, were stratified into three groups: prior VD (Group I, *n* = 1109), CS without scar defect (Group II, *n* = 742), and CS with CSD (Group III, *n* = 433). Pregnancy outcomes were compared using binary logistic regression, adjusting for confounders. Results In this study, the differences between Groups I and II in live birth rates, implantation success, or clinical/ectopic pregnancy were found to be significant. However, Group III demonstrated significantly lower clinical pregnancy rates (27.9% vs. 63.3%, *p* < 0.05) and implantation success compared to Group I. Subgroup analysis revealed pronounced reductions in implantation, clinical pregnancy, and live birth rates among women ≤ 35 years in Group III versus Group I (*p* < 0.05). Conclusion CSD—but not CS alone—adversely affects IVF/ICSI outcomes, particularly in younger women. These findings underscore the importance of optimizing surgical techniques to prevent CSD formation and preserve fertility. Future studies should investigate strategies to enhance uterine healing post-CS and improve ART success rates.