Reproductive and Family Building Considerations for Female Patients with Anorectal And Urogenital Malformations

• Published in: Journal of pediatric surgery Vol. 58; no. 8; pp. 1450 - 1457
• Main Authors: Reppucci, Marina L, Alaniz, Veronica I, Wehrli, Lea A, Torre, Luis de La, Wood, Dan, Wilcox, Duncan T, Appiah, Leslie C., Peña, Alberto, Bischoff, Andrea
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2023
• Subjects: Anorectal malformation; Anorectal Malformations; Cloaca; Common channel cloaca; Female; Fertility; Humans; Pregnancy; Pregnancy Outcome; Urogenital Abnormalities; Urogenital System; Cloaca; Fertility; TCS; Common channel cloaca; IVF; COMIRB; ARM; Anorectal malformation
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.09.004

•Women with anorectal malformations are capable of spontaneous pregnancy but may experience a variety of challenges during conception and delivery.•For those with long common channel cloaca or cloacal exstrophy, fertility may be impaired.•Standard reproductive techniques may be restricted by the anatomy of those with complex anorectal malformations.. Little is known about fertility and pregnancy outcomes in patients with anorectal malformations (ARM), particularly those with long common channel cloaca and cloacal exstrophy who may have impaired fertility. The purpose of this study is to describe pregnancy and offspring data from a cohort of patients with ARM. A retrospective review of female patients with ARM from our database, which includes patients operated on since 1980, was performed as well as a review of the literature. Demographic, operative, and self-reported fertility, obstetric, and offspring data were collected. There were 37 females identified in our database who reported any pregnancy or having children. There were 59 pregnancies, 48 (81.3%) of which resulted in live birth. The most common mode of delivery was cesarean delivery. There were five patients with long channel cloaca (>3 cm) and one with cloacal exstrophy that reported 11 total pregnancies, eight of which resulted in live birth. Four cloaca patients in which the native vagina was pulled through were able to conceive spontaneously. Three patients with cloacal anomalies required in vitro fertilization to conceive; one was unsuccessful. No patients who underwent bowel partial vaginal replacement became pregnant. Women with ARM face many unique challenges in assisted reproduction, pregnancy, and delivery owing to their anatomy and associated anomalies. Women with recto-perineal, recto-vestibular, and cloacas in which the native vagina was pulled through are capable of spontaneous pregnancy. Assisted reproduction, however, may be needed those with more complex anomalies and surgical repairs. IV.