title: The Efficacy of Assisted Reproduction in Women with Inflammatory Bowel Disease and the Impact of Surgery-A Nationwide Cohort Study.
abstract: In this study, we analyze the chance of a live birth and the impact of inflammatory bowel disease surgery in women with Crohn's disease (CD) or ulcerative colitis (UC) who have undergone assisted reproductive technology (ART) treatments.
  
  
  
  This is a nationwide cohort study based on the Danish health registries. We compare all women with and without CD or UC who received a first time ART treatment from January 1, 1994 to June 30, 2012 with follow-up until December 31, 2013. Our outcome was live birth per woman within 18 months after the first ART treatment. We adjusted for multiple covariates and looked specifically at CD and UC surgeries before ART.
  
  
  
  In all, 381 women with UC, 158 women with CD, and 50,321 women without inflammatory bowel disease received first time ART treatments. In women with UC, the adjusted odds ratio (OR) of a live birth was 0.82 (95% confidence interval [CI], 0.57-1.17). In women with CD, the adjusted OR of a live birth was 0.58 (95% CI, 0.32-1.03). In women with CD having previous CD surgery versus no CD surgery, the adjusted OR of a live birth was significantly decreased (0.29, 95% CI, 0.13-0.65). In women with UC with previous UC surgery, the similar OR was 0.81 (95% CI, 0.47-1.40).
  
  
  
  In women with CD surgery, the chance of a live birth within 18 months after initiation of ART treatment was significantly decreased. This knowledge should help patients make decisions regarding pregnancy planning.
authors.affiliation: *Center for Crohn's and Colitis, Department of Medicine, Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA; †Harvard Medical School, Boston, MA; ‡Centre for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; and §Department D, Centre of Andrology and Fertility Clinic, Odense University Hospital, and Research Unit of Human Reproduction, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Sonia
authors.initials: S
authors.lastname: Friedman
authors.forename: Pia Veldt
authors.initials: PV
authors.lastname: Larsen
authors.forename: Jens
authors.initials: J
authors.lastname: Fedder
authors.forename: Bente Mertz
authors.initials: BM
authors.lastname: Nørgård
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D050498:Live Birth; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D012042:Registries; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D055815:Young Adult