Appendicectomy is associated with increased pregnancy rate: a cohort study

Objective: This study was carried out to determine whether pregnancy rate is reduced after appendicitis or appendicectomy.

Background: The association between appendicectomy, appendicitis, and subsequent fertility is controversial.

Methods: A cohort study was carried out in the Medicines Monitoring database. The cohort of women who underwent appendicectomy and appropriate comparators were followed up until first pregnancy after appendicectomy date. Pathology of the appendix was verified manually. The association between appendicectomy, appendicitis, and pregnancy was determined by Cox regression models.

Results: The age and social deprivation score-matched analyses included 2935 patients who had appendicectomy with 5870 comparators. There were 1277 (43.5%) pregnancies in the appendicectomy cohort and 2319 (39.5%) in the comparator cohort during a mean follow-up of 12.4 (standard deviation: 7.3) years. The adjusted hazard ratios (HRs) for pregnancy rates were 1.20 (95% confidence interval [CI]: 1.10-1.31). In an unmatched cohort analysis (3009 in the appendicectomy cohort and 122,912 in the comparator cohort), the adjusted HRs for pregnancy rates were 1.65 (95% CI: 1.55-1.75). Within the histologically proven appendicitis subset, the adjusted HR was 1.21 (95% CI: 1.08-1.37) in comparison with the matched comparator cohort. In comparison with the group of participants who had appendicectomy for a normal appendix, the HRs were 0.98 (95% CI: 0.83-1.15) for mucosal and catarrhal appendicitis, 0.72 (95% CI: 0.64-0.82) for suppurative appendicitis, and 0.64 (95% CI: 0.50-0.80) for gangrenous appendicitis.

Conclusions: Appendicectomy and early appendicitis were associated with increased pregnancy rates. Young women with early appendicitis had better pregnancy rates than those with advanced appendicitis. Early referral for laparoscopy and appendicectomy is advocated.