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

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Abstract

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.

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