Inflammatory bowel disease may discourage pregnancy

Many women with a bowel disorder that can affect fertility choose not to attempt pregnancy even though treatment may make it possible for them to conceive, a recent study suggests.

Researchers studied more than 1,300 women with inflammatory bowel disease (IBD), which involves chronic or recurring inflammation of the gastrointestinal tract. Ulcerative colitis and Crohn’s disease are the most common forms of IBD. People with Crohn’s have inflammation throughout the entire digestive tract, while in ulcerative colitis, only the large intestine is inflamed.

Almost one in six women were voluntarily childless, often because they were older, had worse IBD symptoms or were unaware of options that might improve their odds of having a baby, the study found.

“Poor knowledge is one of the drivers of voluntary childlessness,” said lead author Dr. Christian Selinger, a gastroenterologist at the University of Leeds in the U.K.

While IBD doesn’t necessarily reduce fertility, medications to treat these conditions can impact the odds of conception and are also linked to certain birth defects. Surgical treatments can also lead to scarring that limits fertility, and many patients with IBD also experience sexual dysfunction.

Despite these challenges, many women can still conceive through in vitro fertilization (IVF) and other reproductive technologies.

For the current study, Selinger and colleagues surveyed female members of the patient support group Crohn’s and Colitis U.K. who were between 18 and 45 years old.

Participants were 33 years old on average. Almost 59 percent were diagnosed with Crohn’s, while 38 percent had ulcerative colitis. While 14 percent of the women had kids before they got an IBD diagnosis, 26 percent had kids afterwards and another 36 percent said they planned to in the future.

The women who said they didn’t want kids tended to have more hospitalizations and were more likely to have had surgeries for IBD than their peers who were mothers or planned to start a family at some point. The voluntarily childless women were also more likely to be single and unemployed.

Some women with no plans to have children also said they were concerned their baby might inherit IBD or that the disease might make pregnancy difficult, and they expressed concerns about raising a child while coping with their disease.

Because the study only included people in a patient support group for IBD, it’s possible the women surveyed were more knowledgeable about their medical issues and fertility options than women in the general population might be, the authors note in the Journal of Crohn’s and Colitis. In addition, the study relied on self-reported health information that wasn’t verified with the women’s doctors or medical records.

The study also doesn’t assess exactly how women who opted not to conceive decided that they didn’t want to have children, Dr. C. Janneke van der Woude, a researcher at Erasmus Medical Center in Rotterdam, The Netherlands, who wasn’t involved in the study said by email. Symptom severity may very well come into play, said Dr. Yvette Leung, a researcher at the University of Calgary in Canada who wasn’t involved in the study.

“The vast majority of treatments for Crohn’s and ulcerative colitis are completely safe for a female to take when she is conceiving and equally safe during pregnancy and breastfeeding,” Leung said by email.

“For patients who are acutely ill, however, from their Crohn’s or ulcerative colitis, there may be multiple good reasons not to have children including depression, malnutrition, amenorrhea (lack of menstruation), and general poor quality of life,” Leung added.

Still, women who get acute symptoms under control and ensure their specific medications are safe during pregnancy shouldn’t necessarily be deterred from trying to conceive, said Dr. Jane Andrews, head of the IBD service and education at Royal Adelaide Hospital in Australia.

“The news is almost all good,” Andrews, who wasn’t involved in the study, said by email. “Very few women should be advised not to go ahead with a family due to IBD.”