Female fecundity before and after operation for familial adenomatous polyposis

Abstract

Background: Knowledge about the fertility of women suffering from familial adenomatous polyposis (FAP) is scarce and inconclusive. The purpose of this study was to investigate the fecundity of women with FAP before and after operation, and to compare the findings with those of a general population database and women with ulcerative colitis. Methods: A questionnaire concerning reproductive experiences and waiting times to pregnancy was sent to all 230 women on the polyposis registers in Denmark, Finland, Sweden and Norway in whom primary surgery had consisted of ileorectal anastomosis or ileal pouch–anal anastomosis. Data on the general population and women with ulcerative colitis came from an existing database. Cox regression and Kaplan–Meier plots were used for analysis. Results: The fecundity of women with FAP before operation and after colectomy with ileorectal anastomosis was similar to that of the general population. However, fecundity dropped to 54 per cent (P = 0·015) following proctocolectomy with ileal pouch–anal anastomosis, although it was greater than the postoperative fecundity of women with ulcerative colitis. Conclusion: The significant reduction in female fecundity after ileal pouch–anal anastomosis should be communicated to young women with FAP before it is decided which surgical option to follow.