I read with interest the meta-analysis of infertility post ileal pouch-anal anastomosis (IPAA) published by Waljee and colleagues in the November issue.¹ The article consolidates the increasing evidence that this procedure is associated with a significant decrease in female fertility.

Having recently reviewed the studies in their analysis, however, I was surprised the authors had included data from the following two trials; the first by Wikland et al² assessed 41 patients treated exclusively with conventional proctocolectomy with ileostomy rather than IPAA; the other, by Hudson et al,³ included 20 patients treated with surgery of which only two had IPAA, while the remainder were treated with …