Female Fertility and IBD
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) encompasses two different illnesses that have many of the same symptoms, but are treated very differently. Crohn's Disease is inflammation of the digestive tract from the mouth to the anus, and Ulcerative Colitis is mainly inflammation of the colon and sometimes of the bottom of the small intestine, the ileum. Generally speaking, women with IBD are capable of conception, pregnancy and delivery. See our article on the effect of some of the drugs upon fertility and reproduction.
Complications That Lead to Infertility
If a woman has IBD that is well controlled with medications or is not active she should not have a problem becoming pregnant. If she does, then it is possible there is another cause for the problem. One in seven couples has difficulty conceiving and need some type of fertility treatment to conceive. However, a woman with active Crohn's Disease could encounter problems, especially if she is underweight or malnourished. Either of these conditions leads to problems with fertility. Should there be a severe inflammation in the small intestine the ovaries' normal function can be affected. There are some unpleasant and painful complications that come along with IBD. Fistulas and abscesses in the vaginal area are not uncommon and the discomfort they cause could put sex on the back burner for some time.
The Risk Associated with Pouch Surgery
There is also a risk of fertility issues if a woman with ulcerative colitis has pouch surgery. This type of surgery reconstructs the colon to eliminate the need for an external pouch for body waste when the colon malfunctions. A recent study in the medical journal Gut states that 48% of women who have j-pouch (ileal pouch-anal anastomosis) surgery suffer with infertility. The cause is presumed to be the result of scarring in the fallopian tubes that may happen after extensive surgery such as this. The difficulty with this result is that most of the women who suffer with IBD are young and in their reproductive years. Before having surgery, a woman should discuss the possible outcomes with her doctor and be certain she is willing to take the risk before she goes under the knife.
Ways to Improve Fertility with IBD
There are ways to improve fertility for women with IBD, especially if the disease has been under control for at least three months prior to conceiving. Getting pregnant while IBD is active can lead to a very problematic time throughout pregnancy and there is a significant increase in the risk of miscarriage. Some women have had uneventful pregnancies when they've conceived during an active phase of IBD, but the risk is still there.
Fertility may be lowered in a woman with IBD, either as a result of the IBD or issues unrelated to it. Regardless, there are things to do to help ensure the body is ready for conception including eating a healthy diet that is well balanced. The doctor may be able to suggest some supplements to enhance the diet if it is difficult for the woman to eat well. Additionally, nutrients that are particularly important during pregnancy should be taken - such as zinc and vitamin B6, both of which are important to fertility.
The Importance of Supplementation
Folic acid supplements are important to include in the diet, particularly just before conception and for the first trimester (12 weeks) of pregnancy. It is during this period of time that the risk is highest for neural tube defects and birth defects in the baby. For women with Crohn's in the small intestine, absorbing folic acid may be difficult. If she is taking sulphasalazine or if part of the small intestine has been surgically removed, then an increase in the amount of folic acid is necessary to 2mg per day. The doctor will advise what is necessary.