Inflammatory bowel disease in pregnancy

Ferguson and colleagues correctly point out that a threefold
reduction in female fecundity has been reported following restorative
proctocolectomy with ileal pouch-anal anastomosis. What was not made
clear, however is that this is secondary to the pelvic dissection
necessary to remove the rectum and not to pouch surgery per se.
Conventional proctocolectomy with permanent ileostomy results in a a
similar reduction in fertility(1;2) whereas colectomy in which there is no
pelvic dissection does not (3). Females of reproductive age who require
surgery for ulcerative colitis and wish to have children should therefore
be advised to consider subtotal colectomy with preservation of the rectum
in order to preserve their fertility. A completion proctectomy with or
without ileoanal pouch formation can be undertaken at a later date. Tubal
occlusion is often the cause of infertility following restorative
proctocolectomy (4) and affected patients should be referred early for In
vitro fertilisation.

Reference List

1. Wikland M, Jansson I, Asztely M, Palselius I, Svaninger G,
Magnusson O et al. Gynaecological problems related to anatomical changes
after conventional proctocolectomy and ileostomy. Int.J.Colorectal Dis.
1990;5:49-52.

2. Scaglia M, Bronsino E, Canino V, Hulten L. [The impact of
conventional proctocolectomy on sexual function]. Minerva Chir 1993;48:903
-10.

3. Olsen KO, Juul S, Bulow S, Jarvinen HJ, Bakka A, Bjork J et al.
Female fecundity before and after operation for familial adenomatous
polyposis. Br J Surg 2003;90:227-31.

4. Cornish JA, Tan E, Teare J, Teoh TG, Rai R, Darzi AW et al. The
effect of restorative proctocolectomy on sexual function, urinary
function, fertility, pregnancy and delivery: a systematic review.
Dis.Colon Rectum 2007;50:1128-38.

Competing interests:
None declared