ArticleColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2026
Fertility and mode of delivery after ileal pouch-anal anastomosis for ulcerative colitis: A population-based study.
Article in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Fertility and mode of delivery after ileal pouch-anal anastomosis for ulcerative colitis: A population-based study.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026Article
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Abstract
BACKGROUND AND
aimsFertility and mode of delivery are major concerns for women with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA). Although infertility after IPAA has been attributed to pelvic adhesions, the impact of minimally invasive approaches remains uncertain. Similarly, evidence guiding Caesarean section (CS) versus vaginal delivery is limited.
methodsWe conducted a retrospective, population-based study using Ontario health administrative databases (1994-2022). Female UC patients aged 18-45 years undergoing IPAA were matched by birth year, parity and rural residence to UC controls (without surgery) and non-UC controls. Primary outcome was live birth after IPAA. Subgroup analyses included nulliparous patients and laparoscopic versus open IPAA. Among patients with live births, delivery modes were compared.
resultsWe included 1,094 eligible women with IPAA (median age 32). After IPAA, 13.8% had ≥1 live birth, significantly lower than UC controls (27.2%; RR 0.53, 95% CI 0.46-0.60) and non-UC controls (22.5%; RR 0.53, 95% CI 0.47-0.59). Among nulliparous women, live birth rates remained significantly reduced (18.5% vs. 32.7% in UC controls; RR 0.66, 95% CI 0.57-0.77). Laparoscopic IPAA did not significantly increase live birth rates (13% vs. 10%, RR 1.41, 95% CI 0.75-2.65), though the number of births per patient was higher. CS rates were substantially elevated in women who delivered after IPAA versus controls.
conclusionsIn this population-based study, IPAA for UC was associated with significantly reduced live birth rates compared with both controls. Laparoscopic IPAA did not eliminate fertility disadvantage, though higher birth numbers suggest possible benefit. CS rates were markedly higher after IPAA.
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