IBD and Fertility

Getting pregnant with IBD

Most people with IBD receive a diagnosis between the ages of 15 and 30 years old, which coincides with peak years of fertility and pregnancy. So it makes sense that fertility, and getting pregnant, is often a concern for many women who have been diagnosed with Crohn's disease or ulcerative colitis.

The overall fertility rate for women with Crohn's and UC has been reported to be similar to women without IBD. However, data in this area are limited, and studies to better understand fertility in IBD patients are ongoing. It's important to keep in mind that certain surgeries, such as proctocolectomy (removal of the colon and rectum) or proctectomy (removal of the rectum) may impact fertility. So, if you or your partner with IBD plans on becoming pregnant in the future, it's a good idea to talk with a doctor who understands the special care required during this important time in your life.

Surgery related to IBD complications may impact fertility

Pelvic surgery, especially the ileoanal J pouch surgery (IPAA) or a permanent ostomy with removal of the rectum, can decrease fertility. This is due to scarring around the fallopian tubes and ovaries that happens following a pelvic operation. Although older studies say that an IPAA can increase the risk of infertility by three times, newer studies show that fertility rates are much improved with laparoscopic surgery. There is limited data describing the impact of Crohn’s-related surgery on fertility, however chronic inflammation in the pelvis in Crohn’s (even if patients who have not had a pelvic surgery) can result in similar pelvic scarring affecting the fallopian tubes and ovaries.

Inflammation and fertility

Active inflammation in both UC and Crohn’s reduces fertility and increases the risk of early pregnancy loss. In active Crohn's disease, reduced fertility may be due to decreased ovarian reserve. Anti-Müllerian hormone (AMH) levels have been shown to be a good indicator of ovarian reserve and can be a marker of fertility among women of reproductive age. Several studies have shown that women with active Crohn's disease, especially disease affecting the colon, have significantly decreased AMH levels. Similar studies have not been conducted in women with UC so this remains unknown.

Sexual health and fertility

IBD can have a significant impact on both your mental and sexual health. Many women with IBD have issues with sexual dysfunction- this may be due to depression, body image, self-consciousness related to fistulas or ostomies, fears about having IBD symptoms during sex, or pain during sex due to inflammation or prior surgeries. Sexual dysfunction impacts fertility when women are unable to have intercourse consistently enough to become pregnant. If you are having issues with your sexual health, know that you are not alone. Please reach out to your OBGYN and GI doctor so they can help you to address this problem.

Why some women choose not to conceive

Although not a cause of infertility, voluntary childlessness is more common among women with IBD. Women with IBD often choose to have fewer children for a number of reasons, including:

• fear of worsening disease during pregnancy
• concern of passing IBD on to her offspring
• concern of disease recurrence because of pregnancy
• concern regarding increased stress due to a child
• fear of not being able to care for a child

Assisted Reproductive Technology

In vitro fertilization (IVF) is a helpful option for women with IBD who are unable to conceive. Since IVF bypasses the fallopian tubes, any scarring due to prior surgery should not affect the results. IVF is used three times more often in women with UC who have a history of J-pouch surgery.

Studies have found that women with UC and Crohn’s, even UC patients with a history of pelvic surgery, have similar rates of success with IVF compared to the general population. However, success does appear to be reduced in women with UC who have had pouch failure and those with Crohn’s who have a history of CD-related surgery.

When it's time to see a fertility specialist

If you're less than 35 years old and have been trying to conceive* for six months without success, it may be time to be referred to a fertility specialist. IBD patients with a history of surgery involving the pelvis (IBD surgeries such as J pouch surgery or removal of the rectum, or other pelvic surgeries such as those for pelvic endometriosis) and those older than 35 should see a fertility specialist sooner, likely after 3-4 months of trying unsuccessfully. Importantly, there are no specific recommendations for timing of referral to a fertility specialist in women with IBD, and you may need to be referred sooner than what is recommended for women your age without IBD. Make sure to discuss this with your OBGYN early in your pregnancy planning process, so that you have a clear roadmap for next steps should you have difficulty conceiving naturally.

*Trying to conceive means having unprotected intercourse during ovulation. The best way to determine when you’re ovulating is to use a urine ovulation test. You can also use an app to track your ovulation, but this should be in combination with (not instead of) urine testing.