The Potential Effects of IBD on Female Fertility

Fertility is broadly thought of, for women, as the ability to become pregnant. For women having regular intercourse, not becoming pregnant in about 12 month's time is an indication of possible infertility.

There is more to the story, however, especially in women who have a chronic illness such as inflammatory bowel disease (IBD). In order to get pregnant without assistance, one has to have sex that results in making a baby. IBD can throw some barriers in the way, including how often couples have sex and how likely a pregnancy is based on whether a woman is feeling well, is in a flare-up, or has had surgery for IBD.

Understanding how IBD affects fertility is often reassuring because some aspects of IBD that have been shown to decrease fertility can be managed. This article will explore how factors related to IBD, including mental health, medications, and surgery, affect fertility in women.

IBD and Fertility in Women

How having Crohn's disease or ulcerative colitis affects overall fertility in women is not completely understood. For women with Crohn's disease, research shows that fertility is "normal or near-normal," and for women with ulcerative colitis who haven't had surgery, fertility is "normal."

Women with IBD don't have reduced fertility across the board. In other words, women with IBD tend to get pregnant as often as women who don't have IBD. However, IBD affects everyone differently, and there are other reasons why IBD could affect fertility. For example, for those who have severe disease or those who have certain types of surgery, fertility might be lowered.

Women with IBD who are concerned about fertility should discuss it with their physicians. Fears about being able to get pregnant or have a healthy pregnancy can often be managed. In addition, preconception counseling is vital because having IBD and any complications under control is going to offer the best chance of preserving fertility and having a healthy pregnancy.

IBD-Related Aspects That May Affect Fertility

While IBD by itself doesn't seem to cause a decrease in fertility in most cases, there are some reasons that fertility in women with IBD can be reduced.

Many women may think that it is important to stop taking IBD medications in order to get pregnant but that's not always the case, and it's actually typically the reverse. Having active disease can sometimes reduce fertility, but not always.

However, it's important to know that being in remission gives the best odds of a healthy pregnancy.

Disease State

For women with Crohn's disease, having IBD inflammation could potentially lower fertility, but it's uncertain by how much. Having an IBD flare-up could lower fertility because it might lower sex drive and sex might also be uncomfortable for women. It is vital that women with IBD plan a pregnancy when the disease is not active.

Medications

For women, most medications that are routinely used to treat IBD have not been shown to cause a decrease in fertility.

However, it is worth noting that women who are taking methotrexate or ozanimod should not get pregnant, as Methotrexate has been shown to cause birth defects in fetuses, and there if insufficient data about ozanimod use in pregnancy. It is also recommended to avoid the use of tofacitinib or use it with caution in pregnancy.

Gastroenterologists may also recommend stopping the use of steroids (such as prednisone) before becoming pregnant, which is another reason to plan a pregnancy and discuss the use of medications with a healthcare team.

Women with IBD who are taking other medications will want to discuss the effect of those medications on fertility and pregnancy with a gastroenterologist and an obstetrician/gynecologist. While many medications are considered safe during conception and pregnancy, every woman's IBD is different and changes in treatment could be needed.

Even if a woman finds herself pregnant unexpectedly, IBD medications should not be stopped without first discussing the situation with a gastroenterologist. Keeping the IBD inflammation down is key to a healthy pregnancy.

J-Pouch Surgery

For women with ulcerative colitis who have ileal pouch-anal anastomosis (IPAA) surgery (commonly called j-pouch surgery), fertility might be reduced. Surgeons can't predict future fertility in any one woman, but studies show that reduced fertility in women after j-pouch surgery could be as high as 50%, which is obviously concerning.

This is usually because scar tissue may partially or completely block one or both of the fallopian tubes, which prevents an egg from traveling from the ovary to the uterus. This effect of the surgery is known, and women undergoing this procedure who want to preserve their fertility should discuss the potential for reduced fertility with their gastroenterologist and colorectal surgeon.

The surgery does not appear to have an effect on the ability to conceive or to have a healthy, full-term baby. What this means is that fertility treatments, typically in vitro fertilization (IVF), can help if the fallopian tubes are blocked. One study showed that IVF has the same level of success in women who have IBD as it does in women who do not have IBD.

In some cases, healthcare providers may suggest having children before completing the j-pouch surgery, in order to preserve fertility. This might mean conceiving and delivering a baby after having colectomy surgery and while there is an ileostomy in place. These are individual decisions and every woman will want to talk it over with not only healthcare providers but also family members, in order to explore all the options available to them for starting or completing their family.

Other Surgeries for IBD

There is little research available on how other types of IBD surgery affect fertility in women. One study suggests that for women with Crohn's disease, surgery may have a small effect on decreasing fertility. However, other studies note that when surgery helps keep IBD in remission, fertility can be improved. As with other aspects of fertility and IBD, it reinforces the idea that keeping inflammation down is going to be the key in improving the chances of becoming pregnant.

Other Aspects of IBD and How They Impact Female Fertility

Body Image Issues

Some women with IBD experience difficulties with body image. This could be from dealing with the various aspects of IBD (pain, diarrhea, surgical scars) or side effects from medications.

Body image issues are important to discuss with a gastroenterologist, and in some cases, a referral to a mental health professional may be the best course of action. Coping with body image issues could mean attending therapy sessions or doing other work to address negative thoughts, but in many cases, it can be helpful and lead to an improvement in the quality of life.

Interest in Sex

Several studies report that women with IBD may have a lowered interest in sex, which would lower their fertility. The reasons for not feeling quite so "in the mood" include having a flare-up, having feelings of depression, or sex being painful (such as from having complications in the perianal area).

Working to address these issues can take time and require help from not only healthcare providers but also from an understanding partner. In some cases, the libido will pick up when the physical problems are managed, but in others, a referral to a mental health professional could also be helpful in discussing these difficulties and offering solutions.

Depression

One study of 181 women with IBD suggested that it is not the concerns of the disease itself that pose the biggest problem with sexual function. In this research, which was done via a survey given to people with and without IBD, women answered that depression was an important problem that affected their sexual function. Another study that polled 336 women with IBD had similar results and found that a depressed mood lowered interest in having intercourse.

Painful Intercourse

The medical term for pain during sex is dyspareunia. Pain during sex can happen for a variety of reasons, but as it relates to IBD, it could be an aftereffect of surgery or due to complications in the perianal area (such as a fistula). Having pain could reduce the ability and desire to have sex and would, therefore, lead to lowered fertility.

Women who have pain during sex will want to talk to their gastroenterologist and their gynecologist to find out what is causing the pain and how to get it treated. Some ideas that may help include using lubrication to help with any vaginal dryness or using a different position during sex. However, pain that is severe and persistent should always be checked out by a doctor, even though it might be embarrassing to discuss it.

Voluntary Childlessness

There is a predisposition among people with IBD to avoid having children at all, in most cases because of worries over passing the disease on to a child. In other cases, there could be worries that because of having IBD, a woman is not capable of becoming pregnant and having a healthy pregnancy and baby.

It's true that years ago, physicians might counsel some women with ulcerative colitis or Crohn's disease to avoid becoming pregnant, but that is no longer the case. Treatments have improved vastly and in many cases, medications will not need to be stopped during pregnancy. Additionally, the ​risk of passing IBD to a child is low. We now know that IBD does have a genetic part, but it is also thought to have an environmental trigger.​

One study showed that women who were not given as much education about IBD were more likely to avoid having children, often unnecessarily. Talking with a gastroenterologist and other healthcare providers about the risks of pregnancy, birth, and passing IBD on to children is vital in making decisions about having a family. In many cases, fears about pregnancy and the risk of IBD will probably be lessened significantly.

A Word From Verywell

In many cases, fertility is not decreased for women with IBD. There are some situations that can impact the ability to get pregnant, including having depression and certain types of surgery.

Unfortunately, it's been shown that women with IBD lack the information they need to make decisions about pregnancy. This may be the biggest impact on them having children because the myth that pregnancy and birth should be avoided persists.

Talking with a gastroenterologist and other healthcare professionals about fertility can lead to better outcomes because the chances of becoming pregnant and having a healthy baby may be better than you think. Help for many of the issues that decrease fertility is also available—it's just a matter of knowing about them and deciding which is right for you.