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.
Fertility Factors
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 is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”
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, inflammation of the appendix, and even scar tissue resulting from appendicitis. This in turn waa thought to cause infertility.
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 before the appendix was removed because of the formation of abscesses. For many years, with the slightest indication of appendicitis, doctors preferred to removing the appendix so it wouldn’t rupture or perforate. It was also believed that removing the appendix post-perforation would increase the chances of TFI in young women.3
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. Here, too, there was no long-term impact on their fertility. This is reassuring especially because, during pregnancy, one would err on the side of caution and remove the infection-bearing appendix. That this had no effect on the woman’s fertility or subsequent pregnancies was a significant outcome.5
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 management of both infertility and appendicitis. Women do not need to worry that an appendectomy comes with a long-term downside. Also, removing an appendix before it perforates may not be such a raw deal after all – it may, in fact, better chances of pregnancy later on. Do remember, though, this in no way means that voluntary removal of the appendix is a way to treat fertility!
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