Three-fold increased risk of infertility: a meta-analysis of infertility after pouch surgery in ulcerative colitis

Akbar Waljee ¹, Jennifer Waljee ¹, Arden Morris ¹ and Peter D.R. Higgins ^1*

¹ University of Michigan, United States

^* To whom correspondence should be addressed. E-mail: phiggins{at}umich.edu.

Accepted 25 April 2006

Abstract

Background: Increased infertility in women has been reported after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis, but reported infertility rates vary substantially.

Aims: 1) To perform a systematic review and meta- analysis of the relative risk of infertility post-IPAA compared to medical management. 2) To estimate the rate of infertility post-IPAA. 3) To identify modifiable risk factors which contribute to infertility.

Methods: Medline, EMBASE, Current Contents, meeting abstracts, and bibliographies were searched independently by two investigators. The titles and abstracts of 189 potentially relevant studies were reviewed, eight met criteria, and all data were extracted independently. Consensus was achieved on each data point, and fixed-effects meta-analyses, a funnel plot, and sensitivity analyses were performed.

Results: The initial meta-analysis of eight studies had significant heterogeneity (p=0.004) due to one study with very high preoperative infertility (38%). When this study was omitted, the relative risk of infertility after IPAA was 3.17 (2.41-4.18) with non- significant heterogeneity. The weighted average infertility rate in medically treated UC was 15% for all 7 studies, and the weighted average infertility rate was 48% after IPAA (50% if all 8 studies are included). We were unable to identify any procedural factors that consistently affected the risk of infertility.

Conclusions: IPAA increases the risk of infertility in women with ulcerative colitis by approximately three-fold. Infertility, defined as achieving pregnancy in 12 months of attempting conception, increases from 15% to 48% in women post-IPAA for UC. This provides a basis for counseling patients considering colectomy with IPAA. Further studies of modifiable risk factors are needed.

Keywords: ileal pouch-anal anastomosis, infertility, ulcerative colitis

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