Fertility and pregnancy in inflammatory bowel disease

Abstract

Fertility in women is normal in ulcerative colitis but impaired in Crohn's disease. In men fertility can be decreased during treatment with sulphasalazine and after proctectomy. In the case of drug-induced (SASP) infertility, withdrawal of the drug or substitution by one of the new 5-ASA drugs will normalize the fertility. Pregnancy has no adverse effect on the course of UC or CD and there is no place for a therapeutic abortion. Moreover, therapeutic abortion does not influence the activity of the disease. In general, the outcome of pregnancy in women with IBD is good, particularly when the disease is inactive at the time of conception. When at the start of pregnancy the disease is active, the risk of spontaneous abortion or premature delivery is increased and the patient has a considerable chance of having symptoms throughout pregnancy despite medical treatment. Therefore the patient should be advised to plan pregnancy when the disease is in remission. Medical treatment of pregnant patients should be the same as in non-pregnant patients with active disease with the exception of the drugs azathioprine, 6-MP and metronidazole. The majority of the patients will respond to medical treatment and surgical intervention is rarely necessary. However, when there is an indication for surgery, there should be no delay, despite the risk to the fetus.