Minor impact on fertility in men with inflammatory bowel disease: A National Cohort Study from Sweden

Background and Aims Colectomy and reconstruction in patients with inflammatory bowel disease (IBD) may adversely affect fertility, but few population-based studies are available. Methods Fertility was assessed in 2,989 women and 3,771 men with IBD and prior colectomy 1964-2014, identified from the Swedish National Patient Register, and 35,092 matched individuals. Results Reconstruction with ileoanal pouch anastomosis (IPAA) was as common as ileorectal anastomosis (IRA) in ulcerative colitis (UC) and IBD-unclassified (IBD-U) while rare in Crohn’s disease (CD). Compared with the matched reference cohort, women with IBD had lower fertility overall after colectomy (HR 0.65, CI 0.61-0.69), with least impact leaving the rectum intact (HR 0.79, CI 0.70–0.90). Compared with colectomy only, fertility in female patients remained unaffected after IRA (HR 0.86, CI 0.63-1.17 for UC, 0.86, CI 0.68-1.08 for IBD-U and 1.07, CI 0.70-1.63 for CD), but was impaired after IPAA, especially in UC (HR 0.67CI 0.50-0.88), and after completion proctectomy (HR 0.65, CI 0.49-0.85 for UC, 0.68, CI 0.55-0.85 for IBD-U and 0.61, CI 0.38-0.96 for CD). In men, fertility was marginally reduced post colectomy (HR 0.89, CI 0.85-0.94), regardless of reconstruction. Conclusions Fertility was reduced in women after colectomy for IBD. The least impact was seen when a deviated rectum was left intact. IRA was associated with no further reduction in fertility, whereas proctectomy and IPAA were associated with the strongest impairment. IRA therefore seems to be the preferred reconstruction to preserve fertility in selected female patients. Fertility in men was only moderately reduced after colectomy.

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“…Information regarding the number of children born to the IBD and reference cohorts was obtained by linkage with the MBR and MGR. 2 , 4 …”

Section: Methodsmentioning

confidence: 99%

“…From several schemes proposed to categorize patients with inconsistent coding in the registers we used a slightly modified variant of the classification promoted by Everhov et al . 2 , 4 , 16 …”

Section: Methodsmentioning

confidence: 99%

Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden

Druvefors

Myrelid

Andersson

et al. 2023

Journal of Crohn's and Colitis

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“…Female IBD patients have reduced fertility compared to the general population, especially those with CD or IBD-U, but to some extent also UC 225 . Male IBD patients of all subtypes have a subtle reduction of fertility as compared to the general population 226 .…”

Section: Fertility -Ipaamentioning

confidence: 99%

Reconstruction after Colectomy for Inflammatory Bowel Disease

Risto

2024

Linköping University Medical Dissertations

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After colectomy there are four options available. The least complicated and most common is to leave the end ileostomy and not go for any reconstructive surgery. Then there is the ileal pouch anal anastomosis (IPAA) in which the rectum is removed, but the anal canal and a small rectal "cuff" is preserved. The pouch is created from the distal ileum and anastomosed to the rectal cuff. In the ileorectal anastomosis (IRA) the rectum is spared, and the distal ileum is anastomosed to the top of the rectum. In the continent ileostomy (CI), also referred to as the Kock pouch, the fecal flow is let out through the abdominal wall, but a pouch and a nipple valve mechanism is created making the stoma continent which needs to be manually emptied.This thesis aims to investigate function, quality of life, satisfaction, complications, and aspects associated with the chance of having reconstructive surgery after colectomy for inflammatory bowel disease (IBD), i.e. ulcerative colitis (UC) or Crohn's disease (CD).

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“…In a recent issue, Druvefors et al examine fertility in men with and without IBD using the Swedish National Register 8 . Their outcome is childbirths, and the authors find that IBD patients have a lower fertility rate (number of births per 1000 person years) compared with matched non‐IBD controls.…”

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confidence: 99%