Does IBD affect my pregnancy or fertility?
HOW MIGHT MY IBD AFFECT MY FERTILITY?
If you have inactive IBD, whether UC or Crohn’s Disease, your chances of conceiving are unlikely to be affected by the disease.
If you have active IBD, especially Crohn’s, you may have a slightly lower chance of conceiving. Severe inflammation in the small intestine can affect the fallopian tubes and make it more difficult to get pregnant. There is also some evidence linking Crohn’s with a lower ‘ovarian reserve’ (eggs capable of being fertilized) in women over 30.
Surgery for IBD, especially ‘pouch surgery’ (an IPAA or ileo pouch-anal anastomosis operation), can affect fertility, so if you are planning a pregnancy you may wish to discuss this with your specialist or surgical team.
Most of the drugs prescribed for IBD do not affect fertility, but there are a few exceptions, such as sulphasalazine, a 5-ASA medication. This is known to reduce fertility in men. This effect is usually temporary and there are good alternatives that can be taken instead. Sulphasalazine does not affect fertility in women.
Methotrexate, an immunosuppressant, should not be taken by either partner when trying to conceive or by women while pregnant. This is because it can cause birth defects or miscarriages, and may also affect the formation of sperm.
HOW MIGHT IBD AFFECT MY PREGNANCY?
A large number of studies have looked at the effect of IBD on pregnancy, and not all the findings have been consistent. However, there is some evidence linking IBD with problems such as preterm (early) birth, babies with a low birth weight and, more rarely, miscarriages.
That said, many experts believe that disease activity can be an important factor. Several studies have shown that most women with IBD who are in remission or have only mild active disease at the time they conceive, are very likely to have a normal uncomplicated pregnancy.
In addition, for those who remain in remission, the risk of problems such as miscarriage is about the same for a woman without IBD. (Sadly, about one in five of all pregnancies is estimated to end in a miscarriage.)
You are also more likely to remain well in yourself if your symptoms are under control when you conceive.
This is why, if you are thinking of getting pregnant, most doctors will advise you to try to get your IBD under control first.
As mentioned above, research has also suggested that active disease at conception or flare-ups while pregnant may make you more likely to give birth early or have a low birth weight baby. Severe active Crohn’s Disease or a very severe flare-up of UC may put you and the baby at greater risk. It is important to bear in mind that this does not always happen - many women who conceived when their disease was active or had a relapse while pregnant have gone on to have normal pregnancies and healthy babies. But, it is definitely better for you and your baby if you can keep in remission while you are pregnant. So, if your IBD symptoms do begin to get worse, consult your doctor or our IBD team as soon as possible.
