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The risk of infertility in women triples after the most major surgery for the inflammatory bowel disease ulcerative colitis, suggests research published ahead of print in the journal Gut.
The authors base their finding on an extensive trawl of print and online research archives, and a detailed analysis of eight published studies. Infertility was defined as a failure to conceive after 12 months of trying.
Ulcerative colitis is a condition in which sores and inflammation develop along the lining of the large intestine, producing severe diarrhoea and rectal bleeding. It affects around 1 to 2% of the population. Surgical removal of the colon is sometimes needed to alleviate persistent and painful symptoms.
Ileal pouch anal anastomosis is a standard procedure in which the lower section of the large intestine is removed and a surgical pouch artificially created from the small intestine. This is then joined to a short remaining cuff of the rectum to ensure as normal bowel function as possible.
The evidence from the published studies showed that the risk of infertility after drug treatment was around 1 in 7 or 15%.
But this risk tripled to 48% after ileal pouch anal anastomosis. All patients seemed to be at risk of infertility, so there were no obvious factors among the patients or the procedure itself to account for the increased risk.
Based on previous X-ray studies of the fallopian tubes, which transport ripened eggs from the ovary to the womb, the authors suggest that such extensive surgery may scar or block these tubes.
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