Fertility concerns, pregnancy outcomes and Fertility Quality of Life of female patients of the Adult Colorectal Research Registry with ARM are presented. Females born with ARM have risk factors for infertility, including Mullerian anomalies and adhesive disease or iatrogenic damage to reproductive structures from complex reconstructive surgeries [13]. Consistent with existing literature, patients with anorectal malformations can achieve pregnancy, however assisted reproduction and alternative family building may be needed in those with complex anomalies who desire parenthood. Almost all patients in this cohort delivered by cesarean-section which is consistent with prior report by Chan et al. [5]. Participants with recto-perineal and recto-vestibular fistulas reported a recommendation to deliver by cesarean-section due to concern that vaginal birth could pose a risk to the PSARP repair. Although these risks have not been established, most experts agree that these patients are candidates for a vaginal delivery if they have an adequate perineal body [14].
In this cohort, 40% of the patients reported fertility concerns, with less than half of them being seen by a fertility specialist and approximately 9% undergoing fertility treatment. This study highlights several important aspects in the management of patients born with ARM. Multidisciplinary teams should include a gynecologist or fertility specialist to address fertility potential and concerns, if future parenthood is desired. Early education about the potential impact of congenital malformations on fertility is especially important for continuity and transition of care.
Patients without fertility concerns did not report any fertility problems, though interestingly these patients also had Mullerian anomalies and extensive surgical histories. For example, patients who had a hysterectomy, resection of Mullerian structures with oophorectomy, or who had fertility treatment with IVF or surrogacy, reported no fertility issues or concerns. This survey did not assess desire for fertility. It is unclear if those without fertility concerns want future fertility or parenthood. Future studies should explore desire for parenthood, fertility intentions and understanding in how medical and surgical history affects fertility. Regardless of family planning intentions, patients and families should be fully informed of the impact ARM diagnosis, treatment, and associated anomalies has on fertility.
Among patients with fertility concerns, FertiQoL score in patients with ARM was higher when compared to a reference population of male and females experiencing fertility problems. FertiQoL was developed for patients seeking fertility treatment. In this study, FertiQoL was administered to all patients with fertility concerns including those with and without fertility problems seeking treatment. This study cohort is quite different than the reference population which may account for higher FertiQoL scores. Prior research has shown that higher scores are associated with secondary fertility. More research is needed to validate and assess the survey in patients at risk for infertility or with fertility concerns.