PURPOSE:
Although ulcerative colitis commonly affects young females, the impact of ulcerative colitis and its treatment on female fertility have not been well studied. The purpose of this survey was to examine the impact of ulcerative colitis and ileal pouch-anal anastomosis on female reproductive ability.
METHODS:
Demographic, reproductive history, and disease history information were obtained via a questionnaire mailed to females who had pelvic pouch surgery or nonoperative management for ulcerative colitis. Based on age at diagnosis, age at surgery, and marital status, 153 females who had pelvic pouch surgery and 60 females who had nonoperative management for ulcerative colitis were identified for inclusion. Patients were asked if they attempted to become pregnant, when relative to their diagnosis or surgery, and if they were successful. Married or cohabiting females aged 18 to 44 years who failed to become pregnant during 12 months of unprotected intercourse were defined as infertile.
RESULTS:
The infertility rate was significantly higher in females who had pelvic pouch surgery compared with females managed nonoperatively (59/153 (38.1 percent) vs. 8/60 (13.3 percent), respectively; P < 0.001). There was no difference in female fertility after diagnosis with ulcerative colitis compared with before diagnosis (odds ratio, 0.68; P = 0.23). In contrast, there was a 98 percent reduction in fertility after pelvic pouch surgery compared with before surgery (odds ratio, 0.021; P < 0.0001). By logistic regression, increasing age was the only factor associated with failure to become pregnant after surgery (odds ratio, 1.136 per additional year of age; P = 0.027).
CONCLUSIONS:
Females with ulcerative colitis who are managed nonoperatively have normal fertility, which suggests that ulcerative colitis and medical therapy do not decrease female reproductive ability. After pelvic pouch surgery for ulcerative colitis, female fertility is significantly decreased and this problem should be discussed routinely with patients considering this procedure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
C Willoughby S Truelove (1980) ArticleTitleUlcerative colitis and pregnancy Gut 21 469–74
M Hudson G Flett TS Sinclair PW Brunt A Templeton NA Mowat (1997) ArticleTitleFertility and pregnancy in inflammatory bowel disease Int J Gynecol Obstet 58 229–37
K Olsen S Juul I Berndtsson T Oresland S Laurberg (2002) ArticleTitleUlcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample Gastroenterology 122 15–9
K Olsen M Joelsson S Laurberg T Oresland (1999) ArticleTitleFertility after ileal pouch-anal anastomosis in women with ulcerative colitis Br J Surg 86 493–5
R Sharpe S Franks (2002) ArticleTitleEnvironment, lifestyle and infertility-an inter-generational issue. Nat Cell Biol (Suppl 4) S33–40
Dulberg CS, Stephens T. The prevalence of infertility in Canada 1991–1992: analysis of three national surveys. The Royal Commission on New Reproductive Technologies July 1992.
InstitutionalAuthorNameAnonymous (2002) ArticleTitle Physiopathological determinants of human infertility. Hum Reprod Update 8 435–47
GB Maroulis (1991) ArticleTitleEffect of aging on fertility and pregnancy Semin Reprod Endocrin 9 165–75
DR Meldrum (1993) ArticleTitleFemale reproductive aging-ovarian and uterine factors Fertil Steril 59 1–5
KY Liang SL Zeger (1986) ArticleTitleLongitudinal data analyses using generalized linear models Biometrika 73 13–22
EH Stephen A Chandra (1998) ArticleTitleUpdated projections of infertility in the United States: 1995-2025 Fertil Steril 70 30–4
MP Diamond ML Freeman (2001) ArticleTitleClinical implications of post-surgical adhesions Hum Reprod Update 7 567–76
VC Karande DE Pratt DS Rabin N Gleicher (1995) ArticleTitleThe limited value of hysterosalpingography in assessing tubal status and fertility potential Fertil Steril 63 1167–71
JS Seiler (1987) ArticleTitlePelvic pathology affecting fertility Int J Fertil 32 208–12
T Oresland S Palmbald M Ellstrom I Berndtsson N Crona L Hulten (1994) ArticleTitleGynecologic and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy Int J Colorectal Dis 9 77–81
Asztley M, Palmblad S, Wikland M, Hulten L. Radiological study of changes in the pelvis in women following proctocolectomy. Int J Colorectal Dis 1991:103–7.
KO Olsen S Juul S Bulow et al. (2003) ArticleTitleFemale fecundity before and after operation for familial adenomatous polyposis Br J Surg 90 227–31
M Wikland I Jansson M Asztley et al. (1990) ArticleTitleGynecologic problems related to anatomical changes after conventional proctocolectomy and ileostomy Int J Colorect Dis 5 49–52
C Augood K Duckitt AA Templeton (1998) ArticleTitleSmoking and female infertility: a systematic review and meta-analysis Human Reprod 13 1532–9
AJ Muir LJ Edwards LL Sanders et al. (2001) ArticleTitleA Prospective evaluation of health-related quality of life after ileal pouch anal anastomosis for ulcerative colitis Am J Gastroenterol 96 1480–5
VW Fazio GM O’Riordain IC Lavery et al. (1999) ArticleTitleLong-term functional outcome and quality of life after stapled restorative proctocolectomy Ann Surg 230 575–84
Farquhar C, Vandekerckhove P, Watson A, Vail A, Wiseman D. Barrier agents for preventing adhesions after surgery for subfertility. Cochran Database of Systematic Reviews, 1st Quarter 2003; CD000475.
ACKNOWLEDGMENTS
The authors thank Ellen Greenblatt, Andy Willan, and Brenda O’Connor for assistance.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by a grant from the Maternal Research Unit, Sunnybrook and Women’s College Health Sciences Centre. Dr. Johnson was supported by the Lew Dunn Scholarship. Dr. Richard was supported by a fellowship from the Crohn’s and Colitis Foundation of Canada.
About this article
Cite this article
Johnson, P., Richard, C., Ravid, A. et al. Female Infertility After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis. Dis Colon Rectum 47, 1119–1126 (2004). https://doi.org/10.1007/s10350-004-0570-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-0570-7