IBD Drugs and Fertility

What Is IBD?

Inflammatory bowel disease (IBD) is the umbrella label given to a chronic disorder that affects people, particularly in their reproductive years. These diseases under the label of IBD are Crohn's Disease and Ulcerative Colitis. Although they are both IBDs and they share many of the same symptoms, they are treated differently both medically and surgically. Often the only way a final diagnosis is possible is after an event during the course of the disease or the treatment established makes the difference apparent.

The difference lies in the location of the inflammation. In Crohn's Disease, the inflammation can occur anywhere along the digestive tract from the mouth all the way to anus. In Ulcerative Colitis, the inflammation is primarily in the large intestine. However, some people who have UC in the ileum, the last part of the small intestine, can show inflammation as well.

It May Not Be IBD Causing Infertility

IBD may not necessarily reduce the chances of conception, pregnancy and birth, but some of the drugs associated with the management of this disease can affect fertility. It is important to remember that fertility problems may not be associated with IBD at all. One in seven couples experience fertility issues and require help to conceive. While human nature looks for a reason, it may not be the IBD. On the other hand, it may be the drugs associated with IBD that are causing the problem.

Overall, the drugs taken for IBD are fine to take when trying to conceive. However, there are some that may affect the health of the baby. It is important not to change or stop medication when trying to conceive without consulting the doctor. Stopping or changing medication can cause a flare up which reduces fertility.

Avoid Immunosuppressive Drugs

IBD can be controlled effectively with the use of specific drugs. A specialist in the area of IBD will prescribe drugs to control either CD or UC - the protocols are different and a specialist is the best person to help. Couples trying to conceive should not take the immunosuppressive drugs, methotrexate and mycophenolate mofetil because there is a risk of birth defects with these drugs. A couple should avoid pregnancy if the drugs have been taken within the last three to twelve months. The doctor can make the decision as to how much time should elapse before trying to conceive after having taken these drugs.

Using Contraception to Avoid Problems

Two relatively new drugs, Infliximab and Adalimumab, affect the immune process and are recommended when other drugs used to treat Crohn's Disease have not worked. If a couple is planning to become pregnant, then treatment with these drugs should be avoided. Contraception, for both men and women, should be used for at least six months after having used these drugs. While the pregnancy outcomes for women who became pregnant accidentally while on these drugs showed the same outcomes as women who were not taking the drugs, there is limited evidence about the safety of infliximab during pregnancy. It is far better to be safe than sorry.

Affect of Some Drugs on Male Fertility

Men may be safer to avoid the use of azathioprine and 6-mercaptopurine, mainstream immunosuppressive drugs given for IBD, if they are trying to conceive. Although fertility does not seem to be affected, there has been a small study that showed conceiving with a man who is on these drugs leads to higher incidences of birth defects and miscarriage - especially if the man has been taking the drugs three months prior to conception. There are no further studies to confirm the risks.

One medication commonly used to treat IBD does reduce male fertility. Sulphasalazine infertility can be reversed within two or three months of stopping the medication. The infertility from this drug tends to be temporary, but there has been a study that shows there is an increased risk for birth defects if the father has been taking this drug. There are better alternatives that have the same effect on the colon but do not affect fertility. Mesalazine, olsalazine or balsalazide are all good alternatives.