Sriranganathan Danujan, Poo Stephanie, Segal Jonathan P
Department of Medicine, Hammersmith Hospital, College Imperial Healthcare NHS Trust, London, UK.
Department of Gastroenterology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK.
Colorectal Dis. 2022 Aug;24(8):918-924. doi: 10.1111/codi.16123. Epub 2022 Apr 8.
Ileal pouch-anal anastomosis is a restorative option for patients with ulcerative colitis (UC) requiring surgery. The primary outcome of this study was the relative risk of infertility in women with UC undergoing restorative proctocolectomy (RPC) compared to the same patients before undergoing RPC. Infertility was defined as the inability to conceive after 1 year of regular sexual intercourse without contraception.
A systematic review and meta-analysis were performed to include all relevant articles from 1946 from MEDLINE, Embase and Cochrane Central Register of Controlled Trials. Studies included reported on the fertility rate of a cohort with UC and also reported the rate after RPC in those within the cohort who underwent surgery. This study was registered on PROSPERO (CRD42021259745).
Thirteen studies met the inclusion criteria and accounted for 793 patients pre-pouch and 802 post-pouch. The mean and median age of the patients at analysis was 36.8 and 32.7 years respectively; and the median duration of follow-up following ileal pouch-anal anastomosis was 110.4 (68-139) months. Our results highlight that following RPC the relative risk of infertility is 4.17 (95% CI 1.99, 8.74) compared with patients before RPC who had UC.
The findings of this meta-analysis provide an update on a previous meta-analysis published over a decade ago and results remain congruent. This suggests that despite advancements in surgical techniques the risk to fertility remains similar to a decade ago. However, further high quality studies are needed to try and decipher independent risk factors associated with a decrease in infertility.
回肠储袋肛管吻合术是需要手术的溃疡性结肠炎（UC）患者的一种恢复性治疗选择。本研究的主要结局是与接受恢复性直肠结肠切除术（RPC）前的同一患者相比，接受RPC的UC女性患者不孕的相对风险。不孕被定义为在无避孕措施的规律性交1年后无法受孕。
进行了一项系统评价和荟萃分析，纳入了1946年以来来自MEDLINE、Embase和Cochrane对照试验中央注册库的所有相关文章。纳入的研究报告了UC队列的生育率，以及该队列中接受手术者术后的生育率。本研究已在PROSPERO（CRD42021259745）注册。
13项研究符合纳入标准，共纳入储袋手术前793例患者和术后802例患者。分析时患者的平均年龄和中位年龄分别为36.8岁和32.7岁；回肠储袋肛管吻合术后的中位随访时间为110.4（68 - 139）个月。我们的结果表明，与术前患有UC的患者相比，RPC后不孕的相对风险为4.17（95%CI 1.99，8.74）。
这项荟萃分析的结果更新了十多年前发表的一项荟萃分析，结果仍然一致。这表明尽管手术技术有所进步，但对生育能力的风险仍与十年前相似。然而，需要进一步的高质量研究来试图解读与不孕率降低相关的独立危险因素。
