Surgery lowers fertility in women with Ulcerative Colitis.

Date:

07-Jan-2002

Source

GASTROENTEROLOGY

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Article

Ulcerative colitis is one of two forms of inflammatory bowel disease (IBD), the other form being Crohn's disease. Unfortunately, the cause of this form of IBD remains unknown, but diagnosis is still possible through excluding other possible conditions and by a full review of the symptoms. Ulcerative colitis (UC) is a condition in which the moist tissue layer that lines the colon and rectum, called the mucosa, has become inflamed.

The complications of ulcerative colitis may range from mild to even life threatening. Some of the complications seen most frequently in individuals with this condition include hemorrhoids, anal fissures or slits, or abscesses in or around the rectum. These complications are most likely to occur during active colitis episodes. There are other very serious complications that may also occur, but these occur infrequently. It is important to realize that the risk of colon cancer increases in patients with ulcerative colitis when compared to the normal population.

Occasionally the disease progresses to a point where it is necessary for the patient to be hospitalized. In some cases, surgery may be required. In these most severe cases, efforts are made to control the disease with medication first. Usually a drug called cyclosporine is used and often this treatment reduces the need for surgery.1 About 25 to 40 percent of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon, or risk of cancer.2

A recent study, published in the journal Gastroenterology, investigated the fertility rates in women with UC before and after surgery. The authors noted that women with this disease usually have normal fertility when surgery is not involved. The individuals chosen were 343 women with UC, and 661 healthy women used as the control group. The women engaged were ages 25 to 40 years. 85% of the patients agreed to a telephone interview after surgery regarding fertility and were compared to the control group. The interview consisted of questions concerning reproductive behavior and pregnancy waiting times. The ability to become pregnant was significantly reduced after colectomy, contrasted to the control group. Before diagnosis and surgery due to ulcerative colitis, the measure of fertility between the 2 groups was comparable. The authors concluded that “surgery harshly reduces the risk of becoming pregnant, and that women with UC who wish to become pregnant, should talk to their doctor before surgery.3

References

1. Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994; 330:1841-1845.
2. National Institutes of Health (NIH) Publication No. 95-1597, April 1992.
3. OLSEN KO, et al. Ulcerative Colitis: Female Fecundity Before Diagnosis, During Disease, and After Surgery Compared With a Population Sample. GASTROENTEROLOGY. Jan 2002;122:15-19.