At first glance, it reads like a strange and quirky medical myth. Why would a seemingly purposeless little organ impact a very critical area like fertility? Infertility is traumatic as is, and then to find out a bout of appendicitis in childhood may be to blame can be devastating. Thankfully, medical science is now finding that the link may be a tenuous one. After years of research that indicated an appendectomy may decrease the chances of pregnancy, recent studies seem to swing the other way. So, can removing the appendix actually up your chances of getting pregnant? Let’s start right from the beginning and find out.
In a fertile female body, the fertilization process begins about half way through the menstrual cycle when an egg is released into the Fallopian tube. Like the Darwinian “survival of the fittest,” only one sperm out of 150 million will travel to the right Fallopian tube, penetrate the egg, and fertilize it. While infertility is defined in multiple ways by health and medical professionals, the clinical definition according to the Word Health Organization
Infertility in women can occur if any one of the parts of the reproductive system does not function as desired. This can include:
- Ovulation disorders in the ovaries
- Obstructions in the Fallopian tube, not allowing the egg and sperm to meet
- Endometriosis, where the tissue lining the inside of the uterus grows outside the uterus
- Other complications like fibroids and polyps
Tubal factor infertility (TFI), as a result of fallopian tube blockages, account for 25–30% of infertility cases.1 Till recently, an appendectomy was also thought to be one of the causes of TFI. But what’s the connection, you may ask. A clear path and healthy Fallopian tubes are critical for the sperm to reach the egg and fertilize it. The Fallopian tubes can be damaged or blocked by pelvic inflammations,
Appendicitis And Fertility
When a woman is unable to conceive after 12 months or more of effort, doctors typically would check for any abnormalities in the ovaries, uterus, tubes, etc. Many times, the reasons would be frustratingly unclear. Some studies, in the course of collecting data from women with primary or secondary infertility, found a common thread emerging – subjects had some form of invasive surgery for appendicitis.2 Several women diagnosed specifically with tubal infertility also had had their appendix removed.
Appendectomy can be performed in two ways – removal of a normal appendix at the onset of symptoms like belly button aches, nausea, etc. or removal of the appendix after it perforates or ruptures due to delayed diagnosis. Sometimes, the condition could deteriorate further
New Thinking on Appendicitis And TFI
So there seemed a logic to the science of it – invasive surgery of one kind may cause collateral damage to nearby organs. Now that can’t be faulted, can it? Turns out, this may not be the case here – there’s no conclusive evidence to prove that a perforated appendix may mean infertility! Also, even if the tubes were to get dented or blocked by scar tissue, simple laparoscopic surgery could restore the tubes.4
While seeking a pattern to establish an appendectomy–pregnancy link, researchers also looked at women who had an appendectomy performed during their pregnancy.
Removing an appendix in childhood, in anticipation of perforation, may actually better a girl’s chances of pregnancy, with studies showing an increased fertility rate among test subjects.6 Other data-based studies also corroborate that appendicitis performed prior to perforation possibly keeps the tubes clean and reduces infections, leading to healthier Fallopian tubes and, therefore, greater chances of pregnancy.7
These studies offer important insights for the treatment and
|↑1||Zou, Shi-En, Yi Jin, Yi-Ling Ko, and Jin Zhu. “A new classification system for pregnancy prognosis of tubal factor infertility.” Int J Clin Exp Med 7, no. 5 (2014): 1410-1416.|
|↑2||Mueller, Beth A., Janet R. Daling, Donald E. Moore, Noel S. Weiss, Leon R. Spadoni, Bruce V. Stadel, and Michael R. Soules. “Appendectomy and the risk of tubal infertility.” New England Journal of Medicine 315, no. 24 (1986): 1506-1508.|
|↑3||Forsell, P., and R. Pieper. “Infertility in young women due to perforated appendicitis?.” Acta chirurgica scandinavica. Supplementum 530 (1985): 59-60.|
|↑4||Appendicitis and female infertility, Harvard Health Publications.2009.|
|↑5||Viktrup, Lars, and Poul Hée. “Fertility and long-term complications four to nine years after appendectomy during pregnancy.” Acta obstetricia et gynecologica Scandinavica 77, no. 7 (1998): 746-750.|
|↑6||Andersson, Roland, Mats Lambe, and Reinhold Bergström. “Fertility patterns after appendicectomy: historical cohort study.” BMJ 318, no. 7189 (1999): 963-967.|
|↑7||Wei, Li, Thomas MacDonald, and Sami Shimi. “Association between prior appendectomy and/or tonsillectomy in women and subsequent pregnancy rate: a cohort study.” Fertility and Sterility (2016).|