Female fertility and childbirth after ileal pouch-anal anastomosis for ulcerative colitis

• Published in: British journal of surgery Vol. 94; no. 4; pp. 478 - 482
• Main Authors: Lepistö, A., Sarna, S., Tiitinen, A., Järvinen, H. J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.04.2007; Wiley
• Subjects: Adolescent; Adult; Biological and medical sciences; Case-Control Studies; Cesarean Section - statistics & numerical data; Colitis, Ulcerative - surgery; Colonic Pouches - adverse effects; Delivery. Postpartum. Lactation; Fecal Incontinence - etiology; Female; General aspects; Gynecology. Andrology. Obstetrics; Humans; Infertility, Female - etiology; Infertility, Female - therapy; Medical sciences; Postoperative Complications - etiology; Postoperative Complications - therapy; Pregnancy; Pregnancy Complications - etiology; Proctocolectomy, Restorative - adverse effects; Surveys and Questionnaires; Medicine; Treatment; Fertility; Surgery; Digestive diseases; Intestinal disease; Female; Delivery; Birth; Inflammatory disease; Ileal pouch-anal anastomosis; Ulcerative colitis
• DOI: 10.1002/bjs.5509
• ISSN: 0007-1323

Background: The aim of this study was to calculate the probability of becoming pregnant after ileal pouch–anal anastomosis (IPAA) for ulcerative colitis, and to evaluate complications during pregnancy and childbirth. Methods: A questionnaire was posted to 160 women with an IPAA and to 160 controls. The probability of becoming pregnant after IPAA was calculated by the Kaplan–Meier method. Results: Of 54 women who had undergone IPAA surgery, 36 (67 per cent) succeeded in becoming pregnant naturally, compared with 49 (82 per cent) of 60 controls. The probability of pregnancy after 2 years of trying was 56 per cent in the IPAA group and 91 per cent in the control group (P < 0·001). Women in the IPAA group needed infertility investigations more often (24 versus 10 per cent; P = 0·044). In all, 39 (72 per cent) women in the IPAA group and 53 (88 per cent) in the control group bore a child. Twenty‐one of 39 women in the IPAA group and 13 of 53 in the control group had a caesarean section (P = 0·005). Anal incontinence after delivery occurred more often in the control group. Conclusion: Women with an IPAA mostly suffer a reduction in the probability of conception rather than complete infertility. Because complications during pregnancy and delivery were rare, caesarean section should be based mainly on obstetric indications. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Frequency of childbirth is reduced