['The effect of restorative proctocolectomy (RPC) on fertility and pregnancy in women with ulcerative colitis (UC) was evaluated.', 'Post-RPC female patients with UC who were attempting to become pregnant filled out questionnaires on fertility and pregnancy. Demographic and pouch data of pregnancies ending with delivery were collected from a prospective database.', 'Forty-one women, 44\xa0±\xa010\xa0years of age, completed the questionnaires. The median follow-up period post-RPC was 167 (range, 20-352) months. Before RPC, 26 women had 70 pregnancies and 62 deliveries. After RPC, 17 women had 32 pregnancies and 26 deliveries (P\xa0=\xa00.0035). Post-RPC, 10 (37%) of 27 patients failed to conceive compared with 26/26 successful attempts before RPC (P\xa0=\xa00.0006). The number of offspring per patient was 2.38\xa0±\xa01.27 before, and 0.68\xa0±\xa00.93 after, RPC (P\xa0<\xa00.0001). A higher number of spontaneous pregnancies occurred before (56/62; 90%) than after (15/25; 60%) RPC (P\xa0=\xa00.0004). The time to conception was longer (5.0\xa0±\xa011.6 vs 16.3\xa0±\xa025.1\xa0months; P\xa0=\xa00.039) and there were more in-vitro fertilization procedures (three vs six) post-RPC. The gestation period was similar, but after RPC more deliveries were by Caesarean section (12.9% vs 46.2%; P\xa0=\xa00.0007). Babies born before RPC weighed more than those born after RPC (3.16\xa0±\xa00.61\xa0kg vs 2.79\xa0±\xa00.68\xa0kg, respectively; P\xa0=\xa00.0327).'] Does restorative proctocolectomy impair fertility and pregnancy outcomes in women with ulcerative colitis?