Issue 21

Clinical Question

Does restorative proctocolectomy impact the likelihood of live births following in vitro fertilization?

Editor’s Bottom Line

These data confirm that restorative proctocolectomy in women is associated with reduced fertility, but all procedures were performed using an open technique. Laparoscopic approaches may have better outcomes. It is reassuring that proctocolectomy does not appear to affect the success of IVF.

Reference

Pachler FR, Toft G, Bisgaard T, et al. Use and Success of In Vitro Fertilisation Following Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. A Nationwide 17-year Cohort Study. J Crohn’s Colitis. 2019;13(10):1283–86; https://doi.org/10.1093/ecco-jcc/jjz055

Synopsis

Prior studies have found that, likely as a result of adhesions in the pelvic cavity, fertility rates are lower among women who undergo restorative proctocolectomy. To document the impact of this procedure as well as the success of in vitro fertilization (IVF), investigators at two Dutch academic centers studied data from 13,560 women with ulcerative colitis who were 15–49 years of age, including 711 women who had undergone restorative proctocolectomy. The women were registered in two Dutch national registries between 1994 and 2010. Subsets of women who received IVF treatment were identified through the Dutch In Vitro Fertilisation Registry.

Analyses revealed that women who had a restorative proctocolectomy were 3.2 times more likely than those who had not undergone the surgery to receive IVF treatment (adjusted hazard ratio [aHR]: 3.2; 95% Confidence Interval [CI]; 2.5, 4.0]. Overall birth rates—including both IVF and non-IVF births—were 40% lower among those with a restorative proctocolectomy (Birth Rate Ratio: 0.6; 95% CI: 0.5, 0.7) and 31% of children born to those with a restorative proctocolectomy were a result of IVF, compared to 5% of children born to those without a restorative proctocolectomy.

With roughly 20% of IVF treatments resulting in live births in both groups, there was no significant difference in the likelihood of IVF success among those who did or did not undergo restorative proctocolectomy.

Details

Study Design: Population-based cohort
Funding: No external funding was received
Allocation: Not applicable
Setting: National registries
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.