Impact on Fertility After Failure of Restorative Proctocolectomy in Males and Females With Ulcerative Colitis: A 17-Year Cohort Study.

BACKGROUND: Impact of restorative proctocolectomy failure on fertility has not been studied and is greatly relevant. OBJECTIVE: Evaluate the impact of restorative proctocolectomy failure on birth rate in females and males, along with in vitro fertilization incidence and success. DESIGN: Retrospective registry-based cohort study over 17 years. SETTINGS: Records for parenting a child were crosslinked with patient records. In females, in vitro fertilization records were crosslinked. All data were prospectively registered. PATIENTS: Patients of fertile age with ulcerative colitis between 1994-2010 were identified in Danish national databases. Patients with restorative proctocolectomy and restorative proctocolectomy failure were identified as subgroups. MAIN OUTCOME MEASURES: Birth rate ratios, and in vitro fertilization incidence and success. RESULTS: We included 11939 females and 13569 males with ulcerative colitis. 711 females and 730 males had restorative proctocolectomy; 114 females and 90 males had failure. Birth rate in females with failure was significantly reduced compared with females without (birth rate ratio: 0.50, 95% CI [0.29; 0.82]). In males with failure, birth rate tended to be lower compared with males without (birth rate ratio: 0.74, 95% CI [0.51; 1.05]). In vitro fertilization incidence was similar with and without failure (aHR: 0.98, 95% CI [0.58; 1.67]). In vitro fertilization success was significantly lower with failure compared with ulcerative colitis (aOR: 0.36 95% CI [0.4; 0.92]). LIMITATIONS: Information on patients leading up to restorative proctocolectomy failure is lacking. Failure patients, may have had children during a period with pouch function. Therefore the impact of failure may be underestimated. CONCLUSION: Restorative proctocolectomy failure impairs birth rate, primarily in females. Although in vitro fertilization incidence is similar in females with and without failure, the likelihood for giving birth after in vitro fertilization is reduced. See Video Abstract at http://links.lww.com/DCR/B202.