Abstract Background Reproductive health of female patients with ulcerative colitis (UC) after restorative surgery remains a clinical challenge. The laparoscopic or robotic approach towards pelvic surgery seems promising in preserving fertility but the data on actual pregnancies outcomes of these patients are scarce. Therefore, the aim of this study was to analyse the pregnancy course and outcomes of a single center referral cohort. Methods All patients after proctocolectomy with ileal pouch-anal anastomosis (IPAA) followed at one referral IBD centrum were identified through record system and data from all female patients were analysed. Information on age at the time of pelvic surgery, indication for surgery (acute severe UC, chronic active UC, or UC-associated colorectal cancer), type of surgery (one step, two steps, modified two steps surgery), approach (laparotomy, laparoscopy, robotic surgery), reproductive wish and/or pregnancy, pregnancy course and outcome were noted. Results By November 2025, a total of 46 patients with IPAA were followed at one referral centre, 43 of them underwent the pouch surgery by the team from the centre, four patients were operated in other institutions. Out of these 46 patients, fifteen (33%) were women, with a median age at the time of pouch surgery 28yrs (minimal age 5 yrs, maximal age 65 yrs), five patients had indication for colectomy acute severe UC, one had with UC-associated colorectal cancer and 9 had chronically active UC. In all but two patients laparoscopic (12 pts) or robotic (1pt) approach was used; with majority of patients (13 out of 15) with modified two steps restorative pouch surgery. Six women (40%) had no further plans to have (more) children after pouch surgery; the remaining 9 women have not yet had children at the time of surgery. Out of these 9 women, three had active reproductive plans. Out of these 3 women, one (with laparoscopic surgery course complicated by leak) could not conceive naturally and is planning IVF. Two women (both with uneventful laparoscopic surgery) conceived naturally and both had the course of pregnancy complicated by uterus incarceration during the first trimester. This obstetric emergency was managed by multidisciplinary approach combining repeated endoscopic decompressions of the pouch and uterus reposition by obstetrician. Further course of pregnancies in both women was uneventful and both delivered healthy babies by C-section. Conclusion The majority of female patients with UC who necessitate colectomy undergo this procedure at young age with still unfulfilled reproductive wish. Minimally invasive procedures might have reduced the infertility rate but the pregnancies of these patients are associated with the risk of severe complications. Conflict of interest: Mrs. Zelinkova, Zuzana: No conflict of interest Podmanicky, Dusan: No conflict of interest Redecha, Mikulas: No conflict of interest Krizko, Marian: No conflict of interest Kadleckova, Barbora: No conflict of interest
Zelinkova et al. (Thu,) studied this question.
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