I have IBD, can I become pregnant?

Background

In a recent study conducted by The University of Alberta IBD clinic, women with IBD were surveyed on what they understood about IBD and pregnancy, and what their concerns were. More than 50% of the surveyed women had a lack of knowledge about IBD and pregnancy¹. More than 50% of surveyed women were childless, and more than 10% said they chose not to become pregnant (“voluntary childlessness”) ¹.

Our survey study and previous studies showed that the concerns women with IBD have are often based on a lack of knowledge and/or incorrect information^1,2.

 Yes, women with IBD can become pregnant

Women with inactive IBD have similar fertility rates as the general population, which varies from 1 in 10 couples to 1 in 6 couples³.

Women with active IBD or history of pouch surgery may find it harder to become pregnant

Active IBD is associated with decreased fertility^3,4 so it is important that women who are trying to become pregnant speak to their physician to ensure their IBD is controlled and inactive.

Women with colitis who have had the ileal pouch-anal anastomosis (IPAA) surgery can have decreased fertility^5,6.  The second stage of the surgery is the creation of the pouch – this stage occurs deep in the pelvis and is associated with risk of damage and scarring of the fallopian tubes (the tubes that connect the ovaries to the uterus allowing the eggs to reach the uterus to be fertilized).

Women who need to have this surgery and who plan to become pregnant afterwards should speak to their surgeon. It is often recommended to have a staged procedure where the surgeon will create a temporary ileostomy after removing the colon and create the pouch after the woman has completed her pregnancies.

However, there are factors other than IBD that can affect fertility

• Fertility decreases with age . . .
  • Women’s fertility peaks in their late teens and early 20s⁷. After the age of 35 years, fertility declines sharply and by 45 years, pregnancy is uncommon7,8. Older women also have increased odds of abnormal embryos⁷.
  • Male fertility significantly decreases after the age of 35 years⁸. The viability of sperm in the female reproductive tract decreases with age.
• Preconception health can affect fertility . . .
  • Body weight: Extremes of body weight can decrease fertility. Obesity has been associated with an increased risk of infertility because of decreased sperm concentration in men and higher incidences of miscarriages in women^9-11.
  • Nutritional Status: It is essential that people who are trying to conceive are getting enough vitamins and nutrients^9-11. This is especially true for IBD patients as their diets may be limited. The Health Canada Food Guide suggests that women take daily multivitamins with iron and folic acid¹⁰.
  • Habits (smoking, drinking): Smoking and alcohol consumption should be stopped prior to attempting to become pregnant as they can affect the eggs and sperm, and decrease fertility¹¹.
• Family and personal history before pregnancy can affect fertility . . .
  • Family history of fertility issues: A family history of fertility issues may suggest a genetic disorder^12,13.
  • Personal history of fertility issues and other medical conditions: An individual’s medical history can suggest reasons for decreased fertility. For example, polycystic ovarian syndrome14 and uncontrolled diabetes9 are associated with infertility.

References

1. Huang V et al. Does the level of reproductive knowledge specific to inflammatory bowel disease predict childlessness among women with inflammatory bowel disease. Can J Gastroenterol Hepatol 2015;29(2):95-103.
2. Selinger CP et al. IBD and pregnancy: Lack of knowledge is associated with negative views. JCC. 2012 Sep;7:206-213.
3. Habal F M & Huang V W. Review Article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient. Aliment Pharmacol Ther. 2012 January;35:501-515.
4. Ng S W & Mahadevan U. My Treatment Approach to Management of the Pregnant Patient With Inflammatory Bowel Disease. Mayo Clin Proc. 2014 March;89(3):355-360.
5. Walijess A et al. Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in Ulcerative Colitis. Gut. 2006;55(11):1575-1580.
6. Tulchinsky A et al. Restorative proctocolectomy impairs fertility and pregnancy outcomes in women with Ulcerative Colitis. Colorectal Dis. 2013;15:842-847.
7. Craig B M et al. A Generation of Childless Women: Lessons from the United States. Women Health Iss. 2014;24-1:e21-e27.
8. Dunson D B, Colombo B, & Baird D D. Changes with age in the level and duration of fertility in the menstrual cycle. Human Reproduction. 2002;17(5):1399- 1403
9. Healthy Pregnancy webpage, Health Canada. http://www.hc-sc.gc.ca/hl-vs/preg-gros/index-eng.php. Accessed March 2015.
10. Farhari N & Zolotor A. Recommendations for preconception counseling and care. Am Fam Physician. 2013. Oct 15; 88(8): 499-506
11. Sharma R et al. Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrin. 2013;11:66.
12. Shah K et al. The genetic basis of infertility. Reproduction. 2003;126:13-25.
13. Shapira S K & Dolan S. Genetic Risks to the Mother and the Infant: Assessment, Counseling, and Management. Matern Child Health J. 2006;10:S143–S146.
14. Setji T L & Brown A J. Polycystic ovary syndrome: update on diagnosis and treatment. AMJ 2014.