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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Ulcerative Colitis
Also see entry for Crohn’s Disease
What It Is
A condition in which sores and inflammation develop along the lining of the colon or large intestine. The disease is marked by chronic inflammation and ulceration of the colon mucosa, or innermost lining. Tiny open sores, or ulcers, form on the surface of the lining, where they bleed and produce pus and mucus.
On average, people are diagnosed with ulcerative colitis in their mid-30s, although the disease can occur at any age. Men are more likely than women to be diagnosed with ulcerative colitis in their 50s and 60s. There is a greater incidence of ulcerative colitis among whites than non-whites, and a higher incidence in Jewish people.
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
Severe diarrhea, rectal bleeding, crampy abdominal pain, loss of appetite and subsequent weight loss, fatigue. In cases of severe bleeding, anemia may also occur. In addition, there may be skin lesions, joint pain, eye inflammation, and liver disorders. Children with ulcerative colitis may fail to develop or grow properly.
How It's Diagnosed/Detected
Generally a blood test is performed first to rule out infection and parasites, since both can cause symptoms similar to ulcerative colitis. A blood test may show anemia and an elevated white blood cell count. To confirm the diagnosis, a doctor must be able to examine the colon by inserting a flexible tube through the rectum (a sigmoidoscopy or colonoscopy). A biopsy (small tissue sample) can be taken during this procedure to determine the severity of the disease.
How It Affects Fertility (And Pregnancy)
It’s the treatment for ulcerative colitis more than the condition itself which can cause fertility problems. See below for how drug and surgical treatments can affect fertility.
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, such as thalidomide/methotrexate, are absolutely contraindicated during pregnancy, while others are viewed on an individual risk/benefit basis. It’s important to discuss plans to conceive with your physician.
Severe cases may require surgery, which carries a higher risk for infertility. Researchers estimate that women who undergo a procedure called ileal pouch anal anastomosis (in which the lower large intestine is removed and replaced with a small, artificial pouch built from the small intestine) may have as much as a 50 percent chance of infertility afterwards, versus a 15 percent risk of fertility problems after drug treatment alone.
Pregnancy Prognosis
The bottom line is that if 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.
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 disesase, 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.Reader Faves
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