Background: Recent reports suggest that women who have had surgery for ulcerative colitis (UC) may have an increased risk of infertility. The aim was to determine which factors may be associated with infertility in women having colectomy and IPAA.
Methods: A questionaire was mailed to all women who had a IPAA for UC at least one year previously. Information related to fertility, pregnancy and risk factors known to predispose to infertility was collected. Other clinical information was obtained from the Mount Sinai Hospital Inflammatory Bowel Disease data base.
Results: Of 320 women who had IPAA between 1982-1997, 254 (83%) responded. Forty seven (group 1)reported problems with infertility defined as inability to conceive during 1 year without contraception. This group of patients was not significantly different from the others (207 patients, group 2) in relation to mean age at diagnosis of UC (22 vs. 25, NS), mean age at operation (28 vs. 33, NS) and current mean age (36 vs. 40,NS). A similar proportion of women in both groups had a 2-stage procedure (64% vs.66%), leak (13% in both), intra-abdominal sepsis (9% in both) and small bowel obstruction (24% vs 23%). No differences were found in known risk factors including weight change of more than 20 pounds over a period of one year (52% vs. 54%) and smoking status in the past (30% vs. 36%)and present (4% vs 7%), nor were there differences in the rate of hospitalizations due to UC (83% vs. 76%), blood transfusions (45% vs. 48%) or use of steroids (96% vs. 95%), imuran (15% vs. 20%) or cyclosporin (0% vs. 7%). No differeces were found in the rates of gynecological abnormalities or medical illnesses. Before being diagnosed with UC, 34% of group 1 vs. 37%of group 2 had been pregnant although 6% in group 1 vs. 3% in group 2 stated they had problems with infertility then. Despite complaints of infertility, 53% of women in group 1 gave birth, compared to 59% in group 2. Sixteen women in group 1 (34%) reqired medication and 6 (12.8%) required surgery for infertility problems vs. only 8 (4%) and 5 (2.4%) in group 2, respectively.
Conclusions: The infertility rate in women with UC following surgery appears to be increased. However, this study did not reveal any differences in risk factors between the two groups. Thus, further studies are necessary to evaluate factors related to post IPAA infertility.