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Gut. 2007 May; 56(5): 735.
PMCID: PMC1942144

Authors' response

We thank you for your interest in our study. Although, as Eglinton noted, the article by Wikland et al1, does not fit our stated inclusion criteria, we found that its exclusion has little impact on our results and further supported our conclusions. Most importantly, after excluding the study by Wikland, the finding that patients with ileal pouch anal anastomosis have a threefold increased relative risk (RR) of infertility is unchanged. However, the estimates of RR of infertility did increase slightly. For the fixed‐effects model in fig 3A, the corrected RR was 3.31 (95% CI 2.47 to 4.44). For the random effects model in fig 3B, the corrected RR was 3.15 (95% CI 2.26 to 4.39).

We were intrigued by Eglinton's hypothesis that the studies of Wikland1 and Scaglia2 demonstrate that it is the pelvic dissection needed for proctocolectomy, and not necessarily pouch construction, that leads to infertility. The data from these two studies are suggestive, but we believe that they do not offer sufficient statistical power to conclude that infertility rates are equivalent in ileostomy versus ileal pouch anal anastomosis. Further studies are needed to better understand the aetiology of infertility in patients with ulcerative colitis after colectomy.


Competing interests: None declared.


1. Wikland M, Jansson I, Asztely M. et al Gynaecological problems related to anatomical changes after conventional proctocolectomy and ileostomy. Int J Colorect Dis 1990. 549–52.52
2. Scaglia M, Bronsino E, Cannini U. et al The impact of conventional proctocolectomy on sexual function. Minerva Chir 1993. 48903–910.910 [PubMed]

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