Ulcerative colitis procedure tied to decreased fertility in women

NEW YORK (Reuters Health) – Women with ulcerative colitis (UC) who undergo proctocolectomy with ileal pouch-anal anastomosis are at risk for less fertility after the procedure than before, according to a report published in the January issue of Gastroenterology.

Dr. Kasper Olsen, from Aarhus University Hospital in Denmark, and colleagues compared the reproductive ability of 290 female UC patients before and after colectomy with that of 661 similar-aged women drawn from the general population.

Prior to diagnosis and prior to surgery, UC patients were as fertile as women in the general population. After the procedure, however, UC patients were significantly less able to conceive than women in the general population.

"It was previously thought that women who have undergone colectomy might be less able to conceive after surgery, but there was no evidence," Dr. Olsen said in a statement.

The decision to perform surgery may be a reflection of greater disease severity, the authors note. Thus, disease severity, and not the procedure per se, may actually be responsible for the decreased fertility. However, other severe disease states, such as perforated appendicitis, do not influence fertility so it is more likely due to the procedure itself.

Female patients of reproductive age should be made aware of the fertility risks associated with the procedure. In addition, women who cannot conceive following surgery should be "referred early to a gynecologist to allow for investigations and the possibility of in vitro fertilization," the researchers emphasize.

Gastroenterology 2002;122:000-000.

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