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P101. Proctocolectomy and ileal pouch anal anastomosis (IPAA) significantly impairs fertility and pregnancy outcomes in ulcerative colitis (UC) patients

I. Dotan1,2, E. Hezkelovich1, N. Horowitz3,2, J. Klausner4,2, Z. Halpern3,2, M. Rabau5,2, H. Tulchinsky6,2

1Comprehensive pouch clinic, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 4Department of Surgery B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 5Proctology Unit, Department of Surgery B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 6Comprehensive pouch clinic, Proctology Unit, Department of Surgery B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Aim: To evaluate the effects of IPAA on fertility and pregnancy in UC-IPAA patients.

Methods: Female UC patients undergoing IPAA before age 44 who were either married, cohabiting or attempting to become pregnant filled out questionnaires regarding fertility and pregnancy. Demographic and pouch status data were collected from a prospective database.

Results: Twenty-one patients (age 46.3±11 years, 47% Ashkenazi, 12% smokers) had 29 pregnancies, 23 deliveries (1.9±1.1 offspring/patient) before and 13 pregnancies, 10 deliveries (0.6±1.1. offspring/patient) after IPAA, p = 0.003. More spontaneous pregnancies occurred before (24, 83%) compared to after (6, 46%) IPAA, p = 0.046. Time to conception was longer after (32.2±54.2 months) compared to before IPAA (8.6±16.5 months), and more in vitro fertilization (2 vs. 6) was used (p = NS). The number of spontaneous abortions decreased by half after IPAA (6 vs. 3, p = NS). Gestational age significantly decreased (38.1±1.8 weeks after, compared to 40.0±1.5 before IPAA, p = 0.01) and delivery by Cesarean section increased (22 before to 40% after IPAA, p = 0.5). Offspring weight significantly decreased from 3500±500 gr before to 2800±700 gr after IPAA (p = 0.008). More mothers (70%) breastfed after, compared to before (50%) IPAA (p = 0.05).

Conclusions: IPAA in UC patients is associated with an increased risk of infertility, decreased gestational age and decreased offspring weight. Thus, females considering IPAA should be counseled accordingly. Alternative surgical and medical approaches for the treatment of UC should be investigated.