Inflammatory bowel disease (IBD) is a group of chronic intestinal inflammations with unknown causes, primarily including ulcerative colitis (UC) and Crohn's disease (CD). Both conditions predominantly affect young adults, with patients typically being of childbearing age. The impact of IBD on fertility and the effects of pregnancy on IBD are concerns for many patients.Dr. Chen Baili, Director of Gastroenterology at the First Affiliated Hospital of Sun Yat-sen University, stated during an IBD health lecture that inflammatory bowel disease has minimal impact on fertility. Survey data indicates that the overall fertility rate among women of childbearing age with IBD shows no significant difference compared to the general female population.
Director Chen Baili, Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University
Two Common Forms of Inflammatory Bowel Disease Present Differently Clinically
Inflammatory bowel disease encompasses ulcerative colitis (UC) and Crohn's disease (CD).The key distinction is that ulcerative colitis is a chronic, nonspecific inflammatory disease affecting the rectum and colon, with involvement confined to the large intestine. In contrast, Crohn's disease is a chronic, transmural inflammation that occurs in segmental patterns and can affect any part of the digestive tract, most commonly involving the terminal ileum, colon, and anus.Director Chen Baili stated that the clinical manifestations and outcomes of ulcerative colitis and Crohn's disease differ.Ulcerative colitis (UC) is a chronic, nonspecific inflammatory disease of the rectum and colon that can be cured by surgical resection of the entire rectum and colon. In contrast, Crohn's disease (CD) can affect any part of the digestive tract. After surgical resection of the affected intestinal segment, recurrence is highly likely, necessitating maintenance therapy with medication.Director Chen Baili pointed out that most ulcerative colitis patients in China have mild to moderate disease, responding very well to medication. Except for a small number requiring surgery due to uncontrolled symptoms, most can live normal lives. Crohn's disease, however, is a chronic, lifelong condition.Most Crohn's disease patients experience chronic relapses, while some exhibit persistent activity. Medication control is often suboptimal, with one-third of patients becoming steroid-dependent. Approximately one-third of those treated with steroids eventually require surgery. Half of patients undergo surgery within 10 years of diagnosis, and recurrence rates reach 44%-55% within 10 years post-surgery. Most patients require surgery within 20 years of onset.
Does Inflammatory Bowel Disease Affect Fertility? 90% of Female Patients Can Conceive Normally
Does inflammatory bowel disease impact fertility? This is a common concern. Director Chen Baili states it has minimal effect. Survey data indicates that overall fertility rates among women of childbearing age with inflammatory bowel disease show no significant difference compared to the general female population.
"Among women with ulcerative colitis, 85%-90% can achieve normal pregnancies. In contrast, fertility rates are somewhat lower among young women with Crohn's disease," Director Chen Baili explains. This disparity stems from multiple factors: 1) The disease itself may cause malnutrition, infections, surgical complications, and reduced female endocrine function;2) Major abdominal surgeries such as partial or total colectomy (removal of the colon), ileorectal anastomosis, or ileostomy may impact pregnancy and childbirth;3) Many women with inflammatory bowel disease often avoid pregnancy for subjective reasons. They fear pregnancy and are frequently misled into believing it will cause disease recurrence, exacerbation, or harm the fetus. Therefore, the decline in fertility rates observed in female patients may primarily relate to some patients actively avoiding pregnancy.
Surgical factors significantly impact fertility in ulcerative colitis patients. Those who undergo total colectomy with ileal pouch-anal anastomosis (IPAA) have a 2.42-fold higher infertility rate compared to non-surgical patients. Two primary reasons for reduced fertility post-IPAA are pelvic adhesions following surgery and damage to the reproductive system. Does this also affect male patients?Director Chen Baili states that it can also be affected. Male patients using sulfasalazine (SASP) exhibit a significantly elevated infertility rate, reaching up to 60%. This is due to SASP causing reversible sperm abnormalities, reduced sperm count, decreased motility, and morphological abnormalities. However, this effect is dose-dependent and can be corrected by folic acid supplementation. Sperm quality typically recovers within two months after discontinuing the medication.
When is the optimal time for IBD patients to conceive? Disease remission phase
Conception during remission carries a relapse risk comparable to non-pregnant individuals. However, conception during active disease phase results in persistent activity in two-thirds of patients, with two-thirds of those experiencing worsening symptoms. Additionally, discontinuing maintenance medications often triggers disease flare-ups, particularly during the first trimester.
The adverse effects of IBD on pregnancy primarily depend on disease activity. Active disease increases the risk of difficult labor. Pregnancies occurring during active disease require heightened vigilance for potential miscarriage, premature birth, and difficult delivery. Disease remission or mild inflammatory activity has minimal impact on pregnancy and fetal development. Therefore, the risk of congenital anomalies in newborns does not increase with IBD during pregnancy.Director Chen Baili recommends that couples plan pregnancy during periods of disease remission or mild inflammatory activity.
Does IBD adversely affect the pregnancy process or fetal health? Director Chen Baili states the impact is relatively minor. "Generally, most pregnant women with Crohn's disease or ulcerative colitis experience normal pregnancies, with a congenital malformation rate of only 1%.This rate is no different from that of healthy pregnant women."
Regarding whether IBD medications affect the baby, Professor Chen Baili emphasized that during pregnancy, disease activity—not medications—poses the greatest risk to both mother and fetus. She advises avoiding unnecessary medication use during pregnancy and even before conception.Consultation with a physician is essential for medication decisions during pregnancy, with treatment guided by medical advice. Prescriptions should be tailored to individual circumstances, sometimes requiring specialist consultation to ensure optimal safety for both the condition and the fetus. Finally, Director Chen Baoli emphasized that medication approaches vary across pregnancy stages. Treatment for inflammatory bowel disease during pregnancy must adhere to the principles of prioritizing individualized therapeutic characteristics and selecting only absolutely essential medications.
Expert Profile: Chen Baili has over 10 years of clinical experience in gastroenterology. She possesses extensive expertise in diagnosing and treating digestive system disorders, particularly inflammatory bowel diseases (including ulcerative colitis and Crohn's disease). She specializes in performing double/single-balloon enteroscopy and capsule endoscopy procedures.
Research Focus: ◆Chemoprevention of gastric cancer and its pathogenesis ◆Inflammatory bowel disease (ulcerative colitis, Crohn's disease)
Research Funding: Principal investigator and collaborator on 6 research projects including the National Natural Science Foundation of China, Guangdong Provincial Natural Science Foundation, and Guangdong Medical Research Fund. Published over 30 papers in domestic and international medical journals and contributed to 2 academic publications.
Professional Affiliations: ◆ Member, Physician Working Committee, Digestive Endoscopy Branch, Guangdong Medical Association