Crohn’s Disease and Fertility: What You Need to Know

Introduction

Crohn's disease is a chronic inflammatory bowel disease (IBD) that affects various aspects of health, including reproductive health. Many people with Crohn's disease may wonder how the condition—and the medications used to manage it—can impact fertility. In both men and women, the disease itself and certain treatments may influence the ability to conceive, making it crucial to understand these factors when planning a family.

This article will explore the relationship between Crohn's disease and fertility, addressing concerns for both men and women, and providing tips for those looking to start or grow their families.

Crohn’s Disease and Fertility in Women

Impact of Crohn's Disease on Female Fertility For most women with Crohn's disease, fertility is generally unaffected during periods of remission. However, active disease, particularly if it involves the pelvic region, can affect fertility. Inflammation in the bowel can cause scarring or blockages in the reproductive organs, which may reduce the chances of conceiving.

Additionally, women with severe symptoms may experience irregular menstrual cycles or amenorrhea (absence of menstruation), which can further complicate fertility.

Effects of Surgery on Fertility Surgical treatments for Crohn's, such as bowel resection or surgery around the pelvic region, may also affect fertility. In particular, surgeries that involve the removal of part of the intestines near the reproductive organs can cause scarring or adhesions that might make conception more difficult. For women who have had ileal pouch-anal anastomosis (IPAA) surgery, studies show a reduction in fertility due to pelvic adhesions.

Impact of Medication on Fertility Certain medications used to treat Crohn's disease can also influence fertility:

• Corticosteroids: Commonly used to manage flare-ups, corticosteroids are not generally linked to reduced fertility. However, long-term use may lead to side effects like weight gain and mood changes that could indirectly affect reproductive health.

• Immunosuppressants (e.g., methotrexate): Methotrexate is known to cause birth defects and must be avoided if pregnancy is planned. Women are advised to discontinue methotrexate at least three months before attempting to conceive.

• Biologics (e.g., infliximab, adalimumab): Research suggests that biologics do not significantly impact fertility. However, it is important to work closely with a healthcare provider when planning a pregnancy while using these medications.

Crohn’s Disease and Fertility in Men

Impact of Crohn's Disease on Male Fertility While Crohn's disease itself generally does not affect male fertility, certain factors related to the condition may influence reproductive health. Active inflammation, weight loss, and malnutrition can reduce sperm quality and testosterone levels, potentially affecting fertility.

Effects of Medication on Male Fertility

• Sulfasalazine: This medication, commonly used to treat Crohn’s disease, has been linked to reversible male infertility by reducing sperm count and motility. Fortunately, discontinuing sulfasalazine often restores normal sperm function within a few months.

• Immunosuppressants (e.g., azathioprine): Studies suggest that immunosuppressants do not significantly affect sperm quality. However, men on immunosuppressants should consult with a healthcare provider to evaluate their reproductive health.

• Biologics: Like in women, biologics used to treat Crohn's do not appear to negatively affect male fertility. However, more research is needed to fully understand their long-term effects on reproductive health.

Tips for Planning a Family with Crohn’s Disease

1. Achieve Disease Remission Before Conception:

   • Women with Crohn's disease are more likely to have a healthy pregnancy if they conceive during a period of remission. Active disease during conception increases the risk of complications, such as miscarriage, preterm birth, and low birth weight.

2. Work Closely with Healthcare Providers:

   • Both men and women with Crohn’s disease should consult with their gastroenterologist and obstetrician/gynecologist (OB-GYN) before attempting to conceive. This helps ensure that medications are managed appropriately, and any potential complications are addressed in advance.

3. Consider Surgical and Medication Histories:

   • If surgery has been a part of Crohn’s treatment, women should discuss with their doctor how it may impact fertility and pregnancy. Medication history should also be reviewed to ensure safe planning for pregnancy.

4. Maintain a Healthy Lifestyle:

   • Eating a balanced diet, staying hydrated, and maintaining a healthy weight can improve fertility in both men and women. Patients with Crohn’s disease should also ensure they are getting sufficient nutrients like folic acid, which is essential for reproductive health.

5. Be Patient and Seek Fertility Support if Needed:

   • It’s important to recognize that conceiving with Crohn’s disease can sometimes take longer, especially for women who have undergone surgery or have been dealing with active disease. Couples may need to seek fertility treatments such as in vitro fertilization (IVF) or consult a fertility specialist for further guidance.

Conclusion

Crohn’s disease can affect fertility in both men and women, but with careful planning and management, many people with the condition can successfully conceive and have healthy pregnancies. By achieving remission, working closely with healthcare providers, and monitoring medication and surgical history, individuals with Crohn’s can make informed decisions when planning their families.

References:

1. Ronchetti, C., Cirillo, F., & Di Segni, N. (2022). Inflammatory Bowel Disease and Reproductive Health: From Fertility to Pregnancy—A Narrative Review. Nutrients. Link to study

2. Mahadevan, U., & McConnell, R. A. (2016). Reproductive Health in Men with Inflammatory Bowel Disease. American Journal of Gastroenterology. Link to study

3. Smith, M. A., et al. (2018). The Impact of Crohn's Disease Treatment on Reproductive Health: A Review. Inflammatory Bowel Disease Journal.

This article is for informational purposes only. Always consult with a healthcare professional for personalized medical advice and treatment options.