Surgery for Ulcerative Colitis Triples Infertility Risk

A last-resort surgical treatment for ulcerative colitis triples the risk of infertility for female patients, according to a new study.

Researchers from the University of Michigan (U-M, Ann Arbor, MI, USA) conducted a meta-analysis of eight major studies of ileal pouch-anal anastomosis (IPAA) from 1989 to 2004. Overall, the medical infertility rate in those eight studies was 19.9%, while the infertility rate after IPAA was 50.1%.

However, one study, conducted by researchers at the Cleveland Clinic (OH, USA) and published in 2004, had a higher infertility rate (38%) among medically treated patients than any of the other studies and contributed to highly significant heterogeneity among the studies. When the Cleveland study was excluded, the researchers reported, the heterogeneity become non-significant. Among the remaining seven studies, the medical infertility rate was 14.6%, compared with a rate after IPAA of 48%. The difference amounts to a relative risk of infertility for IPAA patients of 3.17, compared with those getting medical management of their colitis. The findings were reported in the June 2006 edition of Gut.

"The approval of Remicade [infliximab] for chronic maintenance in moderate-to-severe ulcerative colitis has led patients and physicians to closely re-examine the risks and benefits of colectomy in comparison with medical therapy,” wrote Dr. Peter Higgins, M.D., Ph.D., and colleagues.

IPAA is a complex surgical procedure developed to avoid a permanent stoma (opening for collecting waste) in cases where the entire colon and rectum need to be removed. This procedure is most often used to treat patients with chronic ulcerative colitis and inherited syndromes associated with colon cancers.



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