Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis

Background: Women with ulcerative colitis are believed to have normal fertility but colectomy and ileal pouch-anal anastomosis (IPAA) may impair fertility. The aim was to compare fertility in patients with ulcerative colitis before and after IPAA with that in the national population. Methods: Some 258 consecutive women who had undergone IPAA for ulcerative colitis were identified. Data were collected by questionnaire and from medical records. The observed number of births was compared with the number expected by indirect standardization by age and calendar year. Fertility from the age of 15 years to colectomy, from the onset of ulcerative colitis to colectomy, and from the 12 months after stoma closure to the time of data collection was investigated. Results: A total of 237 women (92 per cent) responded. From the age of 15 years to colectomy there were 251 deliveries compared with an expected number of 286 (P < 0.05). The number of births from the onset of ulcerative colitis to colectomy was 120, compared with an expected 131 (P > 0.3). From the 12 months after ileostomy closure until data collection there were 34 deliveries, compared with an expected 69 (P < 0.001). Conclusion: There is a considerable reduction in postoperative fertility after restorative surgery for ulcerative colitis.