Increased infertility in women has been reported after ileal pouch-anal anastomosis for ulcerative colitis.
However, reported infertility rates vary substantially.
Dr Higgins and colleagues from Michigan performed a systematic review and meta-analysis of the relative risk of infertility post-ileal pouch-anal anastomosis vs medical management.
The research team estimated the rate of infertility post-ileal pouch-anal anastomosis.
The team also identified modifiable risk factors which contribute to infertility.
The researchers searched Medline, EMBASE, Current Contents, meeting abstracts, and bibliographies independently by 2 investigators.
|Infertility increased approximately 3-fold|
The team reviewed titles and abstracts of 189 potentially relevant studies.
The researchers found 8 studies that met the criteria, and all data were extracted independently.
Consensus was achieved on each data point, and fixed-effect meta-analyses, a funnel plot, and sensitivity analyses were performed.
The researchers noted that the initial meta-analysis of 8 studies had significant heterogeneity.
This heterogeneity was due to 1 study with very high preoperative infertility, occurring in 38% of patients.
When the researchers omitted this study, the relative risk of infertility after ileal pouch-anal anastomosis was about 3, with non-significant heterogeneity.
The weighted average infertility rate in medically treated ulcerative colitis was 15% for all 7 studies.
The team observed that the weighted average infertility rate was 48% after ileal pouch-anal anastomosis.
The researchers were unable to identify any procedural factors that consistently affected the risk of infertility.
Dr Higgins' team comments, “Post-ileal pouch-anal anastomosis increases the risk of infertility in women with ulcerative colitis by approximately 3-fold.”
“Infertility, defined as achieving pregnancy in 12 months of attempting conception, increased from 15% to 48% in women post-ileal pouch-anal anastomosis for ulcerative colitis.”
“This provides a basis for counselling patients considering colectomy with ileal pouch-anal anastomosis.”
“Further studies of modifiable risk factors are needed.”