diagnosis guide
If you’ve just received a medical diagnosis, or you’re concerned that something in your present or past health history might be jeopardizing your fertility, check here for quick info on common medical conditions and how they can affect conception and pregnancy.
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Crohn's Disease
What It Is
A chronic inflammatory disease of the gastrointestinal tract. Crohn’s disease usually involves extreme inflammation at the end of the small intestine (terminal ileum) and the beginning of the colon, which is in the right side of the pelvis.
Who Gets It
Around half of the 1 million Americans affected by inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, are women.
Symptoms
If you have IBD, you likely have severe abdominal pain along with severe chronic diarrhea and possible rectal bleeding.
How It's Diagnosed/Detected
Transabdominal bowel sonography (TABS) is used to detect intestinal complications in Crohn's disease.
How It Affects Fertility (And Pregnancy)
Because the bowel is so close to so many other structures in the pelvic area, it’s not uncommon for the right fallopian tube or even the right ureter to be caught up in this inflammatory mass. If the fallopian tube is involved, infertility can be the result. Surgery to treat Crohn’s disease can cause misaligned ovaries due to scar tissue that built up after the surgery; the misalignment makes it harder for the egg to reach the fallopian tubes. In that case in vitro fertilization might be a good alternative to achieving pregnancy.
Treatment
Medication is the first line of treatment for IBD, with surgery reserved for more severe cases. Many different drugs are used to treat IBD, and the risks for women who hope to get pregnant now—or in the future—vary. Some of these drugs, such as thalidomide/ methotrexate, are absolutely contraindicated during pregnancy, while others are evaluated on an individual risk/benefit basis. It’s important to discuss future family plans with your physician.
Pregnancy Prognosis
The bottom line is that if you have IBD, you can get pregnant, even if your disease is severe. The goal is to get you as well as possible before you begin trying to conceive. Talk to your gastroenterologist and ob/gyn about the best time to try to get pregnant, especially since this means you’ll likely have to change or go off your medications. While a lot of the medications are Category B (they’re safe to take during pregnancy) others aren’t, and should be avoided by anyone trying to conceive.
When the disease isn’t under control, women may face problems getting pregnant, as well as the potential of early miscarriage. But when the disease is in remission—especially if a woman has been able to get her disease under control with drugs alone and not surgery—she should have a very good chance of getting pregnant. A study conducted in 2003 at the London School of Medicine suggested that women with IBD have an increased risk of having a small or premature baby, but the majority were found to be able to conceive and have a normal pregnancy, provided the disease was in an inactive state.
If your partner has ulcerative colitis or Crohn’s, his sperm count may be impaired, especially if he takes azulfidine (sulfasalazine), one of the drugs prescribed to control the disease. Doctors recommend a semen analysis for men who take this drug. If his sperm counts and sperm motility are low, he should talk to his physician about switching to another drug.
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