This topic is about the potential fertility risks and other complications associated with J-pouch (ileo-anal) reversal surgery. The person considering this surgery had an emergency total colectomy and is currently living with an ileostomy. They are exploring the option of a J-pouch reversal but are concerned about the risks, especially regarding fertility. Here are some insights and advice shared by others:

1. You don't have to rush your decision. Consider delaying the reversal until after having children, as each abdominal surgery carries risks. A failed pouch could lead to a more challenging permanent ileostomy.

2. Research thoroughly about "pouch failure" and long-term outcomes. Use forums and past discussions to gather as much information as possible before making a decision.

3. Undergo a pre-operative fertility assessment:
- Check hormone profiles and have an ultrasound to confirm ovarian function.
- Get an HSG (hysterosalpingogram) X-ray to see if there is any blockage in the fallopian tubes. If there are blockages, the surgeon can attempt to unblock them during the J-pouch surgery.
- Have an ultrasound to map the position of your ovaries to assess the ease of trans-vaginal egg retrieval.

4. If fertility is at risk, consider assisted reproduction options in advance:
- Egg retrieval can be done at the time of J-pouch construction.
- NHS-funded IVF is often available for women undergoing pouch surgery, so discuss your eligibility with your consultant.

5. Many have reported that female infertility rates increase significantly after J-pouch formation, even without obvious anatomical damage. Therefore, it's important to discuss IVF options early on.

6. Keep gathering information from specialists such as a gastroenterologist, colorectal surgeon, and fertility expert, as well as from patient communities. Making an informed and deliberate decision is crucial.