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. 2025 Jun 20;40(1):145.
doi: 10.1007/s00384-025-04938-2.

Current status of fertility rates and modes of delivery after restorative proctocolectomy with ileal pouch-anal anastomosis

Hideaki Kimura  1 , Kenichiro Toritani  2 , Reiko Kunisaki  2 , Koki Goto  3 , Hirosuke Kuroki  3 , Kenji Tatsumi  3 , Kazutaka Koganei  3 , Akira Sugita  3 , Itaru Endo  4
Affiliations

Current status of fertility rates and modes of delivery after restorative proctocolectomy with ileal pouch-anal anastomosis

Hideaki Kimura et al. Int J Colorectal Dis. .

Abstract

Purpose: After restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA), fertility rates decline, and cesarean section (CS) has been the preferred mode of delivery. We aimed to assess the current trends and outcomes of pregnancy and delivery in patients who underwent RPC with IPAA.

Methods: This retrospective cohort study included 386 patients who underwent RPC with IPAA for UC between 2007 and 2023. Clinical data were collected through a chart review. Surgical techniques were mainly one- or modified two-stage RPC with stapled IPAA. The fallopian tube traction technique was applied to prevent adhesions. Fertility rates and delivery outcomes were also examined.

Results: Among 83 females of < 40 years of age, 18 attempted pregnancy after surgery. Natural conception was achieved in 14 cases (78%), and 2 cases were conceived through in vitro fertilization, resulting in a total of 16 pregnancies (89%). Among the 15 births, 11 (73%) were vaginal deliveries (VD), and 4 (27%) were CS. The reasons for CS included breech presentation (2 cases), prior CS (1 case), and a history of rectovaginal fistula (1 case). One VD case required episiotomy and the other experienced a perineal tear. However, there were no significant differences in postpartum defecation between the VD and CS groups.

Conclusion: Fertility after RPC with IPAA appears to have improved compared to previous reports, possibly due to the prevention of fallopian tube adhesions. After a stapled IPAA, VD is a feasible option, and CS is not universally required solely because of the history of IPAA.

Keywords: Fertility rate; Ileal pouch-anal anastomosis; Mode of delivery; Restorative proctocolectomy; Ulcerative colitis.

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Conflict of interest statement

Declarations. Ethics approval: This study was approved by Yokohama City University ethics committee (F231200031). Patient consent: Consent was obtained using an opt-out procedure according to the IRB's instructions. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Fallopian tube traction technique. The fallopian tubes and fimbriae were repositioned in front of the ileal pouch to prevent adhesions and bending.
Fig. 2
Fig. 2
Patient flow chart. Among those who attempted pregnancy after surgery, the postoperative natural conception rate was 78% (14 cases), the infertility rate was 22% (4 cases), and the birth rate was 83% (15 cases). UC: ulcerative colitis
Fig. 3
Fig. 3
Cumulative natural conception rate after surgery. Among those who attempted pregnancy after surgery, the cumulative natural conception rates at 5 years and 10 years were 69% and 88%, respectively.
Fig. 4
Fig. 4
Cumulative birth rate after surgery. The cumulative birth rates at 5 years and 10 years were 70% and 85%, respectively.
See this image and copyright information in PMC

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References

    1. Johnson P, Richard C, Ravid A, Spencer L, Pinto E, Hanna M et al (2004) Female infertility after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum 47:1119–1126 - PubMed
    1. Waljee A, Waljee J, Morris AM, Higgins PDR (2006) Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulceraRtive colitis. Gut 55:1575–1580 - PMC - PubMed
    1. Rajaratnam SG, Eglinton TW, Hider P, Fearnhead NS (2011) Impact of ileal pouch-anal anastomosis on female fertility: meta-analysis and systematic review. Int J Colorectal Dis 26:1365–1374 - PubMed
    1. Asztely M, Palmblad S, Wikland M, Hulten L (1991) Radiological study of changes in the pelvis in women following proctocolectomy. Int J Colorectal Dis 6:103–107 - PubMed
    1. Oresland T, Palmblad S, Ellstrom M, Berndtsson I, Crona N, Hulten L (1994) Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy. Int J Colorectal Dis 9:77–81 - PubMed

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