Surgery for Inflammatory Bowel Disease Has Unclear Impact on Female Fertility: A Cochrane Collaboration Systematic Review

Sangmin Lee; Megan Crowe; Cynthia H Seow; Paulo G Kotze; Gilaad G Kaplan; Amy Metcalfe; Amanda Ricciuto; Eric I Benchimol; M Ellen Kuenzig

doi:10.1093/jcag/gwaa010

Surgery for Inflammatory Bowel Disease Has Unclear Impact on Female Fertility: A Cochrane Collaboration Systematic Review

J Can Assoc Gastroenterol. 2020 Mar 21;4(3):115-124. doi: 10.1093/jcag/gwaa010. eCollection 2021 Jun.

Authors

Sangmin Lee¹, Megan Crowe², Cynthia H Seow^{1

3}, Paulo G Kotze⁴, Gilaad G Kaplan^{1

3}, Amy Metcalfe^{1

3

5}, Amanda Ricciuto⁶, Eric I Benchimol^{2

7

8}, M Ellen Kuenzig⁷

Affiliations

¹ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
² School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ IBD Outpatients Clinic, Colorectal Surgery Unit, Catholic University of Paraná (PUCPR), Curitiba, Brazil.
⁵ Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁶ Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Children's Hospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario and CHEO Research Institute, Ottawa, Ontario, Canada.
⁸ Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

Background and aims: Surgical treatment of inflammatory bowel disease (IBD) may impair female fertility. We conducted a systematic review to determine the risk of infertility and pregnancy outcomes in women with IBD who underwent surgery.

Methods: We identified studies evaluating the impact of IBD surgery on infertility and pregnancy outcomes. Risk ratios (RR) and 95% confidence intervals (CIs) were pooled when data were presented using contingency tables. Odds ratios (OR) were pooled when raw numbers were not provided. GRADE was used to evaluate the certainty of evidence.

Results: Sixteen observational studies were included, comparing women with and without surgery, open and laparoscopic surgery and before and after surgery. All studies were of low quality. The effect of surgery on infertility at 12 months (RR 5.45, 95% CI 0.41 to 72.57) was uncertain. Similarly, the fertility effects of laparoscopic versus open surgery method were unclear (RR 0.70, 95% CI 0.38 to 1.27). The impact of IBD surgery on pregnancy outcomes should be interpreted with caution. Surgery was associated with miscarriage (OR 2.03, 95% CI 1.14 to 3.60), use of assisted reproductive technologies (RR 25.09, 95% CI 1.56 to 403.76) and caesarean section (RR 2.23, 95% CI 1.00 to 4.95), but not with stillbirth (RR 1.96, 95% CI 0.42 to 9.18), preterm birth (RR 1.91, 95% CI 0.67 to 5.48), low birth weight (RR 0.61, 95% CI 0.08 to 4.83) or small for gestational age (RR 2.54, 95% CI 0.80 to 8.01).

Conclusion: The effect of surgical therapy for IBD on rates of female infertility and pregnancy-related outcomes was uncertain due to poor quality of existing literature.

Keywords: Crohn’s disease; Fertility; Infertility; Inflammatory bowel disease; Surgery; Ulcerative colitis.