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 18 February 2018

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News

Reduced fertility after restorative proctolectomy with ileal pouch anal anastomosis

Women who try to get pregnant both before and after restorative proctocolectomy and ileal pouch anal anastomosis operation, are less fertile after the operation than before, reports October's issue of Surgery.

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Restorative proctocolectomy and ileal pouch anal anastomosis (RP/IPAA) has become the gold standard surgical therapy for the majority of patients with mucosal ulcerative colitis and familial adenomatous polyposis.

Dr Remzi and colleagues in Ohio, America evaluated the fertility rates before and after RP/IPAA, and compared them with the reproductive data of the general United States population, in order to determine surgical parameters that might influence subsequent fertility.

The researchers mailed questionnaires to 300 women of reproductive age who underwent RP/IPAA between 1983 and 2001.

The participants completed the forms regarding their reproductive function before and after the procedure and sent them back.

Before operation 38% of patients were unsuccessful in conceiving.
After operation 56% of patients were unsuccessful
Surgery

The researchers were able to obtain additional information from the pelvic pouch database.

The research group then took a group of age-matched historical control subjects from the United States general population and used their reproductive information for comparison.

The associations between changes in fertility and surgical parameters were also investigated.

The median age at surgery was 28 years.

Out of 300 women, 206 attempted to conceive.

Dr Remzi and colleagues found that before operation 48 (38%) of 127 patients were unsuccessful after 1 year of unprotected intercourse, whereas after operation, 76 (56%) of 135 patients were unsuccessful.

The group showed that this infertility rate was higher after operation than before.

For the subgroup of 56 women who tried to get pregnant both before and after operation, the infertility rate was higher after operation than before (69% vs 46%).

In addition, the researchers found that a higher percentage of these patients who had an intraoperative transfusion were infertile after operation compared to patients who did not have an intraoperative transfusion (54% vs 21%).

There was an increase in the infertility rate after RP/IPAA.

Dr Remzi concluded, "Intraoperative blood transfusion had a negative impact on the fertility rate after operation in patients who tried to conceive both before and after RP/IPAA."

Surgery; 2004: 136 (4): 795
12 October 2004

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