Fertility and pregnancy in Crohn's

Written by: 
Lisa Sewards

This page covers:

A pregnancy planned when your IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. is in remission has the greatest chance of a positive result

Fertility

Women with Crohn's disease that is in remission should have no more difficulty becoming pregnant than those without an inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. (IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.).

However, women with active Crohn's disease may have problems getting pregnant if they are underweight and eating poorly, as this can affect fertility.

Severe inflammationThe body’s response to injury. in the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. can also affect the normal functioning of the ovaries and so impair fertility.

The chances of conceiving are highest when Crohn's disease has been under control for at least three months before conceptionThe fertilisation of an ovum by a sperm cell: the start of pregnancy..

In addition, women who become pregnant when their Crohn's disease is very active may find the symptoms more problematic throughout the pregnancy. The likelihood of miscarriageThe spontaneous loss of pregnancy. is also higher.

However, numerous women have had uneventful and successful pregnancies even when they have conceived during active phases of IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis..

Medications

Most drugs used to treat Crohn's disease do not affect fertility, but it is sensible to talk to your doctor to make sure. It has been known for many years that sulfasalazine, a drug used to treat Crohn's disease, can cause temporary infertility in about 60 per cent of men. The sulfa component of the drug can alter sperm, but this effect is reversed within two months of stopping its use.

See the page on medications used in the treatment of Crohn's disease.

Diet

Eating a healthy and balanced diet will also give you the best chance of conceptionThe fertilisation of an ovum by a sperm cell: the start of pregnancy.. You may also like to talk to your doctor about whether you may need supplements to get all the nutrients you need.

See the Nutrition in IBD practical help page.

As with any woman, it is advisable to take folic acid supplements while trying to conceive and during the first three months of pregnancy.

Pregnancy

Women who have a chronicA disease of long duration generally involving slow changes. illness while pregnant may require extra attention from their doctor, but a healthy pregnancy and baby are both possible.

On average, one third of women with Crohn's disease go into remission during their pregnancy, one third worsen and one third experience no change

A pregnancy planned when your IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. is in remission has the greatest chance of a positive result.

The severity of Crohn's disease during pregnancy tends to remain similar to the condition at the time of conceptionThe fertilisation of an ovum by a sperm cell: the start of pregnancy.. So it is important for women who are considering pregnancy to make sure to take their medication as instructed to give themselves the best chance to bring, or to keep, their disease in remission and to help ensure that the pregnancy is as healthy as possible.

On average, one third of women with Crohn's disease go into remission during their pregnancy, one third worsen and one third experience no change.

For women with Crohn's disease in remission, the risks of miscarriageThe spontaneous loss of pregnancy., stillbirth and congenitalAny condition present since birth. abnormality are the same as those for healthy women. A flare-upTerm to describe an episode when the symptoms of a condition worsen. of Crohn's disease at the time of conceptionThe fertilisation of an ovum by a sperm cell: the start of pregnancy. or during the course of a pregnancy is associated with a higher risk of miscarriageThe spontaneous loss of pregnancy. and premature birth.

Managing your condition

Some women experience a flare-upTerm to describe an episode when the symptoms of a condition worsen. of Crohn's disease during the first trimesterA period of three months often used to describe the stage of pregnancy, where there are three - first, second and third trimesters. of pregnancy because they stop taking their medications. But most Crohn's disease medications, including immunomodulators, can be tolerated during pregnancy. Methotrexate, however, has been linked to birth defects and pregnancy loss, so should be avoided.

It is important to check with your doctor or healthcare provider about the safety of your individual medication during pregnancy before attempting to become pregnant.

As long as your disease is controlled, your pregnancy should progress as normal with no special considerations. It is important for your midwife or health care specialist to know you have IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. however as this can affect your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. tests during pregnancy.

Other considerations

Symptoms of Crohn's disease, such as diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid. or constipation, can increase the risk of haemorrhoids, which are in any case a common problem for pregnant women.  Techniques that may help include: pelvicRelating to the pelvis. floor (Kegel) exercises, keeping the anal area clean, avoiding sitting and standing for long periods, avoiding heavy lifting, using petroleum jelly or sitting on an ice pack to cool off the anal area and ease bowel movements, and using suppositories or creams.

Doctors may recommend delivery by Caesarean section for women who have abscesses or fistulae with Crohn's disease .

Most women can breastfeed safely while taking medication to control Crohn's disease, but methotrexate should be avoided and it is important always to check with your doctor or healthcare provider to make sure that your medications are safe during breastfeeding.