The impact of surgical therapies for inflammatory bowel disease on female fertility

Lee, Sang‐Min; Crowe, Megan; Seow, Cynthia H.; Kotze, Paulo Gustavo; Kaplan, Gilaad G.; Metcalfe, Amy; Ricciuto, Amanda; Benchimol, Eric I; Kuenzig, M Ellen

doi:10.1002/14651858.cd012711.pub2

Cited by 33 publications

(33 citation statements)

References 146 publications

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“…The median stool frequency after delivery was 6 (range, 4-10) times per day in the CS group and 6 (5)(6)(7)(8)(9)(10)(11)(12) in the VD group (p = 0.22). There were four patients with an increased stool frequency in the CS group and one in the VD group (p = 0.39).…”

Section: Pouch Function and Postpartum Complicationsmentioning

confidence: 96%

“…Although the previous IPAA is stated as a relative indication for CS [10], the guidelines of the European Crohn's Colitis Organization stated that the appropriate delivery mode should be determined together with gastroenterologists, surgeons, and obstetricians [11]. In an observational study published in the Cochrane Library, the incidence of CS after IPAA significantly increased because of recommendations from colorectal surgeons, although not from obstetricians [12]. Presently, although several clinical situations need multidisciplinary care, no international clinical guidelines regarding the delivery mode for women after IPAA have been proposed by gastroenterological or obstetrical societies.…”

Section: Introductionmentioning

confidence: 99%

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Delivery Mode after Ileal Pouch-Anal Anastomosis among Pregnant Women with Ulcerative Colitis

Goto

Uchino

Horio

et al. 2021

J Anus Rectum Colon

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Objectives:The appropriate and recommended delivery mode after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) has not been sufficiently evaluated. This study was designed to compare the delivery outcomes associated with cesarean section (CS) and vaginal delivery (VD) after IPAA. Methods: We conducted a questionnaire-based survey of female patients who underwent IPAA for UC between July 1987 and May 2018. Additionally, we reviewed clinical data and collected information regarding pouch function and postpartum complications. Results: In total, 45 patients had 68 deliveries, including 64 CS deliveries and four VDs. Fecal incontinence worsened in seven patients, including six CS patients and one VD patient. The Wexner scores of these patients before and after delivery were 5.4 ± 0.4 and 14.8 ± 1.0, respectively (p = 0.005). Four patients in the CS group and one in the VD group (p = 0.32) had increased stool frequency. Bowel obstructions developed during 11/64 (17.2%) deliveries, and one patient required surgical intervention. One patient with four VDs (three before IPAA and one after IPAA) developed vaginal fistula 5 months after the final VD. Information on episiotomies could not be obtained. Conclusions: Pouch function can decline even after CS. Notably, bowel obstruction can develop after CS. However, we cannot recommend a particular delivery method after IPAA. Further analyses to elucidate the relationship between CS and postoperative complications or vaginal fistula and episiotomy in VDs should be conducted.

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Section: Pouch Function and Postpartum Complicationsmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Delivery Mode after Ileal Pouch-Anal Anastomosis among Pregnant Women with Ulcerative Colitis

Goto

Uchino

Horio

et al. 2021

J Anus Rectum Colon

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“…Research has found that the laparoscopic approach results in improved fertility rates when compared to open surgery, likely due to reduced scarring of the fallopian tubes [59,60]. IBD surgery also appears to have a negative impact on pregnancy-related outcomes, including risks of miscarriage, need for assisted reproductive technology, delivery via caesarean section, and occurrences of stillbirth and preterm births, but there are conflicting results and poor-quality evidence [61]. Specifically, there is controversy on the need for cesarean section post-IPAA to prevent anal sphincter injury [56].…”

Section: The Impact Of Sexual Dysfunction On Fertilitymentioning

confidence: 99%

Sexual Function After Colorectal Surgery in Women

Keller¹,

Ky-Miyasaka²

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Concepts• When considering pelvic cancer in women, the focus has traditionally been on curing the cancer. As therapy has improved and there are more long-term survivors, sexual function and its impact on quality of life has become a key concern of these women. • Pelvic surgical dissection in women for benign conditions like inflammatory bowel disease can also severely affect postoperative sexual function and affect quality of life. • Measuring female sexual function can be challenging.The Pelvic Floor Disorders Consortium (PFDC) Working Group (which includes many members from the American Society of Colorectal Surgeons) is a cross-disciplinary collaboration that has evaluated these questionnaires and published recommendations on their use. • Depending on individual patient's needs, a multidisciplinary approach to improving quality of life for this group of patients is recommended. The team may include the colorectal surgeon; psychologist, psychiatrist, or appropriate counselor; sex therapist; pelvic floor physical therapist; oncologist; radiation oncologist; geriatrician; nutritionist; and exercise physiotherapist.

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“…However, even if IBS itself does not seem to physically influence fertility, the medications which are commonly prescribed to treat this disorder could definitely affect one individual's ability to procreate. An unwanted surgical procedure or malnutrition resulting from IBS may provoke various sexual dysfunctions that may finally lead to infertility [17].…”

Section: Irritable Bowel Syndrome and Infertilitymentioning

confidence: 99%

A Review of the Complex Relationship between Irritable Bowel Syndrome and Infertility

et al. 2020

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Irritable bowel syndrome (IBS) is a gastrointestinal disease that negatively affects up to 20% of the population. Infertility is defined as a disorder of the reproductive system described by lack of success in achieving pregnancy after more than a year of regular unprotected sexual intercourse. The main purpose of our review was to analyze the available literature regarding the IBS-infertility connection. Another secondary purpose of the present paper was to find out if oxidative stress may be the missing puzzle that may explain this possible correlation. After analyzing the available literature we concluded that oxidative stress is a plausible mediator of the connection between both female and male fertility and IBS. However, the data lacks in direct evidence to confirm this hypothesis. Nevertheless, it is recommended that certain levels of oxidative stress should not be exceeded in order to decrease IBS symptoms and increase the odds of conception given that generation of reactive oxygen species (ROS) is an aftermath of metabolically active cells. Therefore, reducing the oxidative stress by living a healthier lifestyle with a balanced diet, rich in micronutrients, limited in caffeine and alcohol, avoiding smoking and maintaining a normal body mass index with regular physical exercise may promote fertility and help diminishing IBS symptomatology. Studies with measurements of biological samples are needed in order to assess the complex relationship between oxidative stress, IBS and infertility.

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The impact of surgical therapies for inflammatory bowel disease on female fertility

Abstract: Analysis 2.1. Comparison 2 Laparoscopic versus open surgery, Outcome 1 Infertiltiy at 12 Months..

Cited by 33 publications

References 146 publications

Delivery Mode after Ileal Pouch-Anal Anastomosis among Pregnant Women with Ulcerative Colitis

Delivery Mode after Ileal Pouch-Anal Anastomosis among Pregnant Women with Ulcerative Colitis

Sexual Function After Colorectal Surgery in Women

A Review of the Complex Relationship between Irritable Bowel Syndrome and Infertility

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