title: Female infertility after ileal pouch-anal anastomosis for ulcerative colitis.
abstract: OBJECTIVE
  Although ulcerative colitis commonly affects young females, the impact of ulcerative colitis and its treatment on female fertility have not been well studied. The purpose of this survey was to examine the impact of ulcerative colitis and ileal pouch-anal anastomosis on female reproductive ability.
  
  
  METHODS
  Demographic, reproductive history, and disease history information were obtained via a questionnaire mailed to females who had pelvic pouch surgery or nonoperative management for ulcerative colitis. Based on age at diagnosis, age at surgery, and marital status, 153 females who had pelvic pouch surgery and 60 females who had nonoperative management for ulcerative colitis were identified for inclusion. Patients were asked if they attempted to become pregnant, when relative to their diagnosis or surgery, and if they were successful. Married or cohabiting females aged 18 to 44 years who failed to become pregnant during 12 months of unprotected intercourse were defined as infertile.
  
  
  RESULTS
  The infertility rate was significantly higher in females who had pelvic pouch surgery compared with females managed nonoperatively (59/153 (38.1 percent) vs. 8/60 (13.3 percent), respectively; P < 0.001). There was no difference in female fertility after diagnosis with ulcerative colitis compared with before diagnosis (odds ratio, 0.68; P = 0.23). In contrast, there was a 98 percent reduction in fertility after pelvic pouch surgery compared with before surgery (odds ratio, 0.021; P < 0.0001). By logistic regression, increasing age was the only factor associated with failure to become pregnant after surgery (odds ratio, 1.136 per additional year of age; P = 0.027).
  
  
  CONCLUSIONS
  Females with ulcerative colitis who are managed nonoperatively have normal fertility, which suggests that ulcerative colitis and medical therapy do not decrease female reproductive ability. After pelvic pouch surgery for ulcerative colitis, female fertility is significantly decreased and this problem should be discussed routinely with patients considering this procedure.
authors.affiliation: IBD Research Unit, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Johnson
authors.forename: Carole
authors.initials: C
authors.lastname: Richard
authors.forename: Anat
authors.initials: A
authors.lastname: Ravid
authors.forename: Leia
authors.initials: L
authors.lastname: Spencer
authors.forename: Eleanor
authors.initials: E
authors.lastname: Pinto
authors.forename: Mary
authors.initials: M
authors.lastname: Hanna
authors.forename: Zane
authors.initials: Z
authors.lastname: Cohen
authors.forename: Robin
authors.initials: R
authors.lastname: McLeod
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012099:Reproductive Techniques; D011795:Surveys and Questionnaires