Crohn’s Disease and Fertility: Research, Risks, and Treatment

Crohn’s disease is a type of inflammatory bowel disease (IBD). More than half a million people in the United States it has. There is no cure, but treatments can effectively manage it and bring relief.

People with Crohn’s disease may be concerned about how their condition may affect their fertility, or the ability to conceive children. Inflammation, nutritional deficiencies, certain medications and surgery can all affect your fertility and sexual health when you have IBD.

People with Crohn’s have higher levels of mental health conditions, such as depression and anxiety, which can reduce libido. Symptoms of IBD can also make people feel self-conscious about their bodies and intimacy.

Many people who have Crohn’s can get pregnant safely. Research to understand how Crohn’s affects fertility is still ongoing, but let’s look at what we know so far.

Women who have IBD (including Crohn’s and ulcerative colitis) have similar fertility rates as women who do not, according to a 2021 review of medical literature. Women with IBD do have a higher risk of complications, such as premature delivery and caesarean section, although findings is mixed.

Women who have Crohn’s may have slightly lower fertility rates than the general population, according to a 2015 British study en a 2021 Swedish study. The latter study concluded that bowel resection surgery and perianal disease brought down fertility outcomes when Crohn’s were present.

In another 2021 review, women with Crohn’s disease were found to have infertility rates of 3 to 15 percent. This is slightly higher than infertility rates of women without Crohn’s, ranging from 2.4 to 14 percent.

Many researchers currently believe that men who have managed Crohn’s disease well have the same fertility rates as the general population (or people without IBD). The exception to this may be men who use certain types of Crohn’s medication.

The medication sulfasalazine is often used to treat Crohn’s disease. It can temporarily reduced sperm count and the viability of the sperm produced. It can take several months for sperm to return to healthy levels after sulfasalazine treatment.

There is no single component of IBD that harms someone’s fertility. Many people with IBD will have little to no effect on fertility or libido.

However, there are a variety of factors that can become problems separately or together for someone with IBD who is trying to conceive children.

Let’s look at some general concerns and research findings.

Crohn’s and getting pregnant

Women with Crohn’s may have difficulty conceiving after colon resection. This type of surgery can sometimes damage reproductive organs and leaves scar tissue in the area.

There are also concerns that Crohn’s pelvic inflammatory disease, which is not well managed with medication, may reduce your chances of pregnancy.

Crohn’s and getting pregnant

Some studies suggested that people with poorly managed IBD symptoms may have higher miscarriage rates than people who do not have IBD. It is also not yet clear whether IBD can increase the chances of having a child with congenital disorders.

There is a chance that Crohn’s may flare up during pregnancy, even if you were in remission when you became pregnant. This is why it is essential to have active treatment for your IBD during pregnancy and work with your doctor to safely address any symptom flares should they occur.

Crohn’s and sperm count

A 2019 review of 14 studies found that quality studies on how all types of IBD affect male fertility are lacking.

From what we do know, it seems that most people with Crohn’s have no problem with normal levels of healthy, viable sperm. Medications for Crohn’s, especially sulfasalazine, can cause a temporary decrease in sperm quality and sperm count. Switching to another medication for a few months usually solves this problem.

Crohn’s and choose to be child-free

Some people with Crohn’s may consider their condition an obstacle to pregnancy. They can avoid trying to conceive children out of concern for their health.

Medical literature points to widespread misconceptions about Crohn’s and fertility as part of the reason why many people with Crohn’s have no children.

While there are research suggesting that IBD can affect fertility and reproductive health, many people with Crohn’s are able to have healthy, safe pregnancies. Effective management of Crohn’s symptoms is key.

It is important to remember that not everyone wants children. Some people may make the personal decision to be child-free, in part because of their Crohn’s disease, or completely regardless of it.

Your sexual and reproductive health is nobody’s business except your own. Although everyone deserves access to the information and care around fertility they need, no one should be judged for the decisions they make about their own sexual and reproductive health.

If you are planning to start or expand your family and you have Crohn’s disease, there are steps you can take to get the best possible outcome.

Reach remission

Getting your Crohn’s in remission (with no major symptoms) through effective treatment is the primary goal. Crohn’s that is well managed and in remission leads to the best pregnancy outcomes.

One 2021 review found that women who had active IBD when they became pregnant twice the risk of persistent symptoms during their pregnancy as people who started their pregnancy during a time of remission.

Postponement of operation

If you want to continue pregnancy, you may want to postpone any surgery for IBD until you are done with children. Of course, this is not always an option due to disease progression, so it is best to leave it to you and your doctor to discuss.

Learn more about the types of surgery used to treat Crohn’s disease and ulcerative colitis.

Change medication

Medications used to manage IBD in women will not usually affect fertility, but certain medications can affect sperm count and quality in men.

Regardless of your parenting goals, always talk to your doctor about long-term medication side effects.

Other reproduction options

Some people with Crohn’s may choose to adopt children rather than pursue pregnancy.

It is also possible to freeze eggs or sperm for later use should you be concerned about your fertility due to Crohn’s symptoms or treatments, such as surgery.

Young men who are Crohn’s often advised to bank sperm before a proctocolectomy (removal of colon and rectum) or other surgery.

Surgery for Crohn’s can in some cases affect sexual performance as well as libido. This can make pregnancy more difficult.

Addressing nutritional deficiencies

Crohn’s and other forms of IBD can have an impact on your body’s ability to successfully absorb the necessary nutrients from the food you eat, causing health problems.

Over time, this can lead to malnutrition, which can prevent your body from performing its functions, including reproductive systems, successfully. Malnutrition symptoms can include weight loss, anemia and fatigue.

Iron, calcium and vitamin B12 are just a few of the common micronutrient deficiencies in people with IBD.

Nutritional adjustments can be a way to improve fertility outcomes for men, even if you do not have IBD. Working with a nutritionist to adjust your diet or add nutritional supplements can help. It is important to always take any vitamins and supplements exactly as indicated.

If you are pregnant or trying to become pregnant, tell your doctor about each medication or supplement you are taking.

Crohn’s disease can affect your sexual health in ways that go beyond fertility. People with Crohn’s disease report often low self-esteem and anxiety around sex due to their condition.

Chronic, intense gastrointestinal symptoms and unpredictable flares can make people with IBD feel self-conscious about their bodies. And recovery from surgery for Crohn’s disease may require you to avoid sex for weeks to months to fully heal.

There is also the mental health component of Crohn’s that can further affect body image, relationships and intimacy. Crohn’s disease and ulcerative colitis have been linked to a increased chance of depression and anxiety. Depression, and some medications used to treat it, may also be responsible for lowering libido.

Having any type of IBD, including Crohn’s, is nothing to be ashamed of. No matter what your symptoms or disease progression with IBD are, you deserve a partner who fully supports and accepts you.

It may be necessary to seek mental health care and treatment with your Crohn’s management.

A 2021 study found sexual dysfunction in people with IBD is not solved by treating Crohn’s alone. Researchers have advised to include approaches to mental and sexual health care in addition to managing IBD symptoms.

Research suggests that people who effectively manage their Crohn’s disease have similar fertility rates to those without any type of IBD.

Complications of Crohn’s or another form of IBD can lead to nutritional deficiencies and inflammation, which can affect fertility. Medication and surgery can also alter your body’s reproductive processes.

More research is needed to better understand Crohn’s effects on fertility and reproductive health. If you are considering getting pregnant and have Crohn’s disease, talk to your gastroenterologist about risk factors and how to best prepare for parenting.

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