A study in the medical journal Gut indicates that infertility occurs in 48% of women who undergo j-pouch (ileal pouch-anal anastomosis) surgery to treat ulcerative colitis (UC). This is presumably due to the scarring in the fallopian tubes that may occur after such extensive surgery. The risk of infertility after j-pouch has been in question for several years because many studies showed widely varying rates of infertility.
This is particularly alarming for young women considering j-pouch surgery. IBD is a disease of young persons, and this means that many young women who underwent j-pouch surgery over the last 20 years may find themselves infertile. My UC was so advanced after 10 years of disease that I had to have j-pouch surgery 7 years ago. The risk of infertility was unknown even at that time and was never discussed with me. However, in my case, it would not have mattered--my colon was rapidly turning cancerous and I had no choice but surgery.
For young women, this high risk of infertility is a serious one that must be considered carefully before surgery. I hope that gastroenterologists and colo-rectal surgeons do not underestimate this risk, and will take the time to explain it to their female patients. This may result in some women willing to suffer with their UC because they are unwilling to risk their ability to conceive a child (risk of infertility after medical treatment for UC is about 15%). That may not be a popular choice with physicians, but for a surgery that is supposed to raise the quality of life, the high risk of infertility that goes with it may not be an acceptable one for some women.