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June 15, 2006

Risk of infertility in women triples after common inflammatory bowel disease surgery, U-M researchers find

ANN ARBOR, MI – The risk of infertility in women triples after the most common major surgery for the inflammatory bowel disease ulcerative colitis, suggests research published online this month in the journal Gut.

The University of Michigan Health System authors base their finding on an extensive search of print and online research archives, and a detailed analysis of eight published studies. Infertility was defined as a failure to conceive after 12 months of trying.

Ulcerative colitis is a condition in which sores and inflammation develop in the lining of the large intestine, producing severe diarrhea and rectal bleeding. It affects around 1 to 2 percent of the population.

Surgical removal of the colon is sometimes needed to relieve persistent and intractable symptoms. Ileal pouch anal anastomosis (IPAA) surgery is a standard procedure in which the entire large intestine is removed and a surgical pouch is created from the small intestine. This is then joined to a short remaining cuff of rectum to ensure as normal bowel function as possible.

The evidence from the published studies showed that the risk of infertility after drug treatment was around 1 in 7, or 15 percent.

The risk of infertility tripled to 48 percent, however, after IPAA. All patients appear to be at risk of infertility, as there were no obvious factors among the patients or the procedure itself before surgery that would identify particular patients with increased risk.

Based on previous studies of X-rays of the fallopian tubes after this surgery, the researchers suggest that healing from this pelvic surgery may scar and block the fallopian tubes, which transport ripened eggs from the ovary to the womb.

Young women with ulcerative colitis who want to bear children in the future may wish to consider more intensive medical therapy rather than the IPAA surgery, or consider alternative forms of colon removal surgery.

Reference: GUT Online First Gut 2006; doi 10.1136/gut.2005.090316.

Written by BMJ Journals



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