see related editorial on page x nature publishing group 1 © 2014 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY THE RED SECTION INTRODUCTION Ulcerative colitis (UC) has a bimodal distribution of age of onset, with the greater peak in the second and third decades of life (1), which coincides with the main period of childbearing. Although a substantial proportion of women with infammatory bowel dis- ease (IBD) express concerns about being infertile (2), evidence suggests that the rate of fertility is no diferent for women with med- ically treated IBD compared with the general population (3–5). In contrast, women with UC who require ileal pouch anal anasto- mosis (IPAA) have up to a threefold increased incidence of infer- tility (6,7). Te weighted mean infertility rate from seven studies was 12% before IPAA and 26% afer IPAA (8). Another study In Vitro Fertilization Is Successful in Women With Ulcerative Colitis and Ileal Pouch Anal Anastomosis Vikas Pabby, MD 1 , Sveta Shah Oza, MD 2 , Laura E. Dodge, MPH 3 , Michele R. Hacker, ScD 3 , Vasiliki A. Moragianni, MD, MS 3 , Katherine Correia, MPH 4 , Stacey A. Missmer, ScD 4, 5, 6 , Janis H. Fox, MD 4 , Yetunde Ibrahim, MD 3 , Alan Penzias, MD 3 , Robert Burakof, MD 7 , Adam Cheifetz, MD 2, 8 and Sonia Friedman, MD, FACG 7, 8 BACKGROUND: Women with ulcerative colitis (UC), who require ileal pouch anal anastomosis (IPAA), have up to a threefold increased incidence of infertility. To better counsel patients who require colectomy, we examined the success rates of in vitro fertilization (IVF) among women who have undergone IPAA. METHODS: This was a retrospective cohort study conducted at the Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. Female patients with UC were identified via ICD-9 codes and cross-referenced with those presenting for IVF from 1998 through 2011. UC patients with IPAA were compared with the following two unexposed groups that underwent IVF: (1) patients with UC, who had not undergone IPAA, and (2) patients without inflammatory bowel disease (IBD). The primary outcome was the cumulative live birth rate. Secondary outcomes included number of oocytes re- trieved, proportion of patients who underwent embryo transfer, pregnancy rate, and live birth rate at first cycle. RESULTS: There were 22 patients with UC and IPAA, 49 patients with UC and without IPAA, and 470 patients without IBD. The cumulative live birth rate after six cycles in the UC and IPAA groups was 64% (95% confidence interval (CI): 44–83%). This rate did not differ from the cumulative live birth rate in the UC without IPAA group (71%, 95% CI: 59–83%; P=0.63) or the group without IBD (53%, 95% CI: 48–57%; P=0.57). CONCLUSIONS: This study demonstrates that in our cohort, women who undergo IPAA achieve live births following IVF at comparable rates to women with UC without IPAA and to women without IBD. SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg Am J Gastroenterol advance online publication, 16 December 2014; doi:10.1038/ajg.2014.400 1 Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; 2 Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; 3 Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; 4 Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA; 5 Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; 6 Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA; 7 Center for Crohn’s and Colitis, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA; 8 These authors contributed equally to this work and share senior authorship. Correspondence: Sonia Friedman, MD, FACG, Center for Crohn’s and Colitis, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA. E-mail: sfriedman1@partners.org