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To determine the effect of ileal pouch-anal anastomosis (IPAA) on female fertility, the mechanisms of this effect, andprovide strategies forprevention of infertility post-IPAA.A systematic literature review of all articles investigating IPAA and fertility from 1966 onwards, found searching Medline and Embase databases. Meta-analysis was performed on relevant studies.Sixteen potentially relevant studies were identified. Six studies were excluded initially (duplicate data 1;predominantly not IPAA patients 1; no control group 4). The control groups of the remaining 10 studies were too varied for comparison so the meta-analysis was limited to six studies thatprovided data on infertility bothpre-and post-IPAA. Five of these involvedpredominantly UC patients and one FAP. Infertility rates were 0-38%pre-IPAA and 44-82% post-IPAA. The relative risk of infertility after IPAA is 2.91 ([2.41, 3.52] 95%CI). This increase is most likely the result of tubal dysfunction secondary to adhesions. Oophoropexy, anti-adhesion barriers, and laparoscopic surgery have beenproposed as methods to reduce pelvic adhesions but there is no evidence they have any effect inpreventing infertility.Infertility is increased post-IPAA in female patients. This evidence mandates the careful consideration of fertility in the choice and timing of surgery.