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, it's important to keep in mind that certain surgeries or medical treatments for IBD 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 wiith pelvic surgery. 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.

Inflammation and fertility

Fertility may be reduced in patients with active Crohn's disease due to decreased ovarian reserve. Anti-Müllerian hormone (AMH) levels have recently 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.

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.

In a large study of women who underwent IVF, the ability to have a live birth was reduced in those women with Crohn's disease and ulcerative colitis compared to the general population of women undergoing IVF. Women with Crohn's disease who had surgery had a further reduced chance of a live birth compared to women with Crohn's disease who did not have surgery. However, surgery did not affect the rate of live births for women with ulcerative colitis.

When it's time to see a fertility specialist

If you've had surgery for IBD and experience irregular menstrual cycles or you've been trying to conceive for three months without success, it may be time to be referred to a fertility specialist. Patients who have not had surgery should see a fertility specialist if they have been unsuccessful after one year of trying to conceive.