Does Colectomy Affect Fertility in Men and Women With IBD?

Colectomy may affect the fertility of women with inflammatory bowel disease (IBD), according to a study published in the Journal of Crohn’s and Colitis.

Researchers aimed to determine whether colectomy and further reconstructive surgical procedures would reduce fertility in men and women with IBD.

For the analysis, researchers conducted a cohort study using data from the Swedish National Patient Register (NPR). The study authors assessed the fertility of 2989 women and 3771 men with IBD who underwent colectomies and were of fertile age (15-45 years old).

Fertility among women and men with IBD was compared with matching reference sub-cohorts, using Cox regression and adjusting for covariates. Researchers used the Andersen-Gill proportional hazards regression model for recurrent births, which accounts for reduced fertility following each pregnancy.

Chi-square tests were used to analyze proportional differences among people with ulcerative colitis (UC), Crohn disease (CD), or unclassified IBD (IBD-U). Analyses also compared the uses of ileal pouch anal anastomosis (IPAA), ileorectal anastomosis (IRA), and continent ileostomy (CI).

Overall, women with IBD vs the matched reference cohort had lower fertility after colectomy (HR, 0.65; CI, 0.61-0.69). Cases involving a deviated rectum experienced the smallest effect (HR, 0.79; CI, 0.70-0.90). IRA did not affect fertility in women (HR, 0.86; CI, 0.63-1.17, UC; HR, 1.07; CI, 0.70-1.63, CD; and HR, 0.86; CI, 0.68-1.08, IBD-U).

Fertility in women with IBD was impaired after IPAA, particularly in patients with UC (HR, 0.67; CI, 0.50-0.88) and following proctectomy (HR, 0.65; CI, 0.49-0.85, UC; HR, 0.61; CI, 0.38-0.96, CD; and HR, 0.68; CI, 0.55-0.85, IBD-U). Colectomy did not have a significant effect on fertility in men with IBD.

Study limitations include multiple revisions to the International Classifications of Disease system during the study’s duration, which may have led to potential differences in coding the same condition.

“IRA therefore seems to be the preferred reconstruction to preserve fertility in selected female patients,” the study authors wrote. “Fertility in men was only moderately reduced after colectomy.”