Factors That Affect Fertility

Women with IBD have the same fertility rates as other women. However, there are a few situations that could potentially affect your fertility: having active IBD, having a J-pouch, or previously having pelvic surgery. Scroll down to learn about these factors, and talk to your physician if you have more questions about their influence on your fertility.

Active disease and inflammation

Active IBD leads to a number of situations that make it hard to become pregnant and sustain a pregnancy. Lack of adequate nutrition due to not eating properly can be a factor. If you are considering pregnancy, it’s best to wait until your IBD is in remission and you are on stable medications that can be continued during pregnancy.

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J-pouch surgery (ileoanal anastomosis)

A J-pouch is a short name for ileal pouch. This type of surgery is sometimes done when a person has their entire colon removed (colectomy).

In J-pouch surgeries, after the surgeon removes the colon (while preserving the sphincter muscle and anus), a pouch shaped like the letter J from the end of the small intestine will be created and attached to the rectum. The J-pouch surgeries are done to avoid needing a permanent stoma in the abdomen to pass stool through. There are other similar types of ileal pouches that can be created, called the S-pouch or W-pouch.

Complications from this type of surgery may include damage to the fallopian tubes or adhesions (bands of scar tissue) that can block the fallopian tubes. These complications may decrease your chances of becoming pregnant.

If you have had this type of surgery, and are having difficulties getting pregnant, one consideration may be in vitro fertilization (IVF). IVF is a medical procedure whereby an egg is fertilized by sperm in a test tube or elsewhere outside the body.

If you have not already had a J-pouch surgery but are thinking about it, speak to your gastroenterologist or surgeon. Options may include a temporary stoma done as a first step, with the J-pouch created a few years later.

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Proctocolectomy surgery

A proctocolectomy is a surgical procedure where part or all of your colon is removed, along with your rectum. Studies have shown infertility rates increase after this type of surgery. This is likely related to adhesions and obstructions that form after surgery in the fallopian tube. Talk to your IBD specialist for more information.

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Pelvic surgery

After pelvic surgery, adhesions can arise and block the fallopian tubes and affect fertility. Surgery for endometriosis or removal of fibroids, ovarian cysts, or ectopic pregnancies are most likely to result in adhesions.

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Certain medications

There do not appear to be any IBD medications that affect a woman’s fertility. However, methotrexate can cause birth defects during pregnancy.

If you are taking methotrexate, consider stopping this medication three months before conceiving. Speak to your health care team about your medication options.

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