Inflammatory Bowel Disease and Fertility
If you have Crohn’s disease or ulcerative colitis (sister diseases collectively known as inflammatory bowel disease or IBD), you’ll know it. You likely have severe abdominal pain along with severe chronic diarrhea. You may also have rectal bleeding. What many patients—and even some doctors—don’t know is that if you’re planning to get pregnant now or in the future, the type of treatment you receive can make a difference to your fertility. This is especially important considering that around half of the 1 million Americans affected by IBD are women. 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.
Crohn’s 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. “Because the bowel is so close to so many other structures in the pelvic area, these can become ‘involved’ by this inflammation,” Dr. Yoshida explains. “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, this could lead to infertility.”
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, such as thalidomide/methotrexate, are absolutely contraindicated during pregnancy,” says Dr. Yoshida. “While others are really viewed on an individual risk/benefit basis. It’s important to discuss possible future conception with your physician.”
Ulcerative colitis—a condition in which sores and inflammation develop along the lining of the large intestine, prompting severe diarrhea and rectal bleeding—is sometimes treated via surgery in which the lower large intestine is removed and replaced with a small, artificial pouch built from the small intestine (a procedure called ileal pouch anal anastomosis). Researchers have estimated that women who undergo this surgery may have nearly a 50 percent chance of infertility afterward, in contrast to the 15-percent risk of fertility problems after drug treatment alone.
“Any significant surgery in the pelvic area has an effect on fertility,” says Dr. Chutkan. “Even in the absence of scarring, there’s something about the surgery that affects fertility. It may be the adhesions or the potential for fallopian tube scarring or blockage. So, if you’re hoping to have a child one day and have ulcerative colitis, talk to your doctor about medical options before you consider surgery.”
The bottom line is that if you do 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,” explains Dr. Abreu. 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 go off your medications or change them. While a lot of the medications are Category B, meaning that they’re safe to take while you’re pregnant, others aren’t safe and should be avoided by anyone trying to conceive.
Male Fertility and IBD
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, says Jerald S. Goldstein, MD, a reproductive endocrinologist at the Presbyterian Hospital of Dallas.
“If your husband is taking that drug, he should have a semen analysis done,” he recommends. “If his counts and motility are low, it would make sense to talk to his physician and see if there’s another drug he can take.”