Fertility and Obstetrical Outcomes in Women Born With Anorectal Malformations: A Prospective Cross-Sectional Study

Women with anorectal malformations (ARM) may experience fertility problems and complications during childbirth due to these congenital anomalies and the corrective surgeries they underwent in their childhood. We aim to investigate the outcomes regarding fertility, pregnancy, and childbirth in relation to the type of ARM and the type of treatment these patients underwent in a Dutch cohort.

We performed a prospectively designed cross-sectional study. We included 37 women with rectoperineal fistulas, rectovestibular fistulas, or cloacal fistulas. Information regarding the type of ARM, type of treatment, and presence of genital malformations (consisting of Mullerian anomalies and anomalies of the external genitals) was collected from the medical records. Two questionnaires collected information on the menstrual cycle, fertility, pregnancies, and obstetric history.

Thirty-seven women, of whom 18 were diagnosed with rectoperineal fistula, 14 with rectovestibular fistula, and 4 with cloaca (median age 28, range 19-61 years), completed the questionnaires; 10 conceived successfully, five had tried to conceive unsuccessfully, and 22 had not attempted pregnancy. Of the 10 women who conceived successfully, 24 pregnancies were reported, of which 22 were natural conceptions, 15 resulted in live births, five in a miscarriage, two women were pregnant when completing the questionnaires, and the outcome of two pregnancies was not reported. Of the 15 live births, 12 children were carried to term, while three were born preterm. Except for one woman, deliveries were by Cesarean section. Pregnancies were reported in all three types of ARM irrespective of a Mullerian or external genital anomaly.

Women with anorectal malformations can become pregnant irrespective of the type of ARM and the presence of a Mullerian or external genital anomaly. Of the women who attempted pregnancies, 67 % conceived successfully, and almost all women conceived spontaneously and carried to full term. Our findings regarding fertility and obstetrical outcomes for this patient group are promising.

II.

Prospectively designed, cross-sectional study.