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Crohn's Disease

Crohn's Disease, Fertility, And Childbearing

Wednesday, March 21, 2012 - 13:31

Contributing Author: Guy Slowik FRCS

There is no evidence to suggest that inactive Crohn's disease has any effect on either female or male fertility, or on a woman's ability to carry a pregnancy to term and have a vaginal delivery.

None of the medications used to treat inflammatory bowel disease have been shown to be teratogenic, which means to cause birth defects, when used by men. However, some of the medications have been shown to decrease sperm count and reduce sperm motility. For this reason, it is suggested that a man being treated for Crohn's disease go off medication when he and his partner are trying to conceive. He should resume his regimen as soon as a pregnancy has been confirmed.

For women, active disease can affect fertility. This is not so much an issue of mechanical malfunction as it is the effects of underlying fever, anemia, and possible infection. Both obstetricians and gastroenterologists suggest that if a woman experiences a flare-up while trying to conceive, she should focus first on getting her Crohn's disease under control and then resume trying to become pregnant.

The questions surrounding pharmaceutical treatment during pregnancy are complex and should be discussed with physicians on a case-by-case basis. A flare-up during pregnancy increases the risk of premature delivery and low birth weight, both of which increase the risk of complications for the newborn.

But drugs are not, as a general rule, tested for safety in pregnant women. Data regarding potential risks to the developing fetus are collected from case studies and are not subjected to the same types of controls found in other safety studies.

Research suggests that some of the immunoregulators used to treat Crohn's disease slightly increase the statistical chance of birth defects when used by pregnant women.

Research also indicates that antibiotics should be avoided during pregnancy, again due to the increased risks of particular birth defects. On the other hand, it is widely accepted that sulfasalazine can be used to treat a flare-up during pregnancy and can be safely continued to maintain remission.

Some doctors would suggest that a woman with inactive Crohn's disease should stop taking her medication(s) during pregnancy, resuming an appropriate regimen only if a flare-up occurs. Others might have different advice. Any woman who has Crohn's disease and wants to become pregnant should discuss the issue of treatment during pregnancy with her health-care providers, where her personal medical history and treatment requirements can be taken into account.

Women with Crohn's disease whose disease is in remission at the time they conceive may experience increased symptoms during their third trimester, if they have symptoms at all. Many women suffer flare-ups immediately after giving birth. Doctors believe this is due to the hormonal changes of the pregnancy and postpartum period.

Crohn's Disease