Caesarean section and subfertility (multiple letters)

Dear Sir,

We read with interest the paper by Murphy et al. reporting an association between Caesarean Section (CS) and subfertility (Murphy et al., 2002). That there is a link between CS and subsequent infertility, has been known for a while (Hemminki, 1996), as has the existence of a relationship between subfertility and subsequent CS (Pandian et al., 2001). Despite rising CS rates, this topic has not been widely studied and Murphy and colleagues’ contribution is most welcome. The prospective nature of their study allows them confidently to suggest that the relationship in the former case is a causal one, with CS contributing in some unknown way to a physiological inability to conceive...