Preconception When You Have IBD

Understanding the disease

One of the first things to do when considering starting a family is to understand your IBD and its complications. It is important to see your doctor to determine the activity of your IBD. Your health care provider may order investigations (tests) or procedures to check for inflammation in your gastrointestinal tract.
In addition to intestinal inflammation, some complications of IBD could affect your childbirth delivery method:

  • Perianal disease: complications of the rectum or anus

  • Abscesses: pockets of pus along the intestine caused by infection

  • Fistula: a deep sore in the intestinal tract that may tunnel into other parts of the intestine or surrounding tissues of the bladder, vagina, or skin

You may also have had surgery or a procedure called a J-pouch done, which could affect your fertility or whether you can give birth vaginally. A J-pouch is a short name for ileal pouch-anal anastomosis surgery. This type of surgery is sometimes performed when a person has their entire colon removed (colectomy).

In this video, a patient and volunteer with Crohn's and Colitis Canada talks about being diagnosed with Crohn's disease, her fears about what the disease could mean for her fertility, and how important finding effective medication is for helping her stay healthy as a mother-to-be:


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Medications

Many women with IBD who are considering pregnancy think their medications will harm the baby, and – with few exceptions – this is NOT the case. Your disease is more likely to cause problems if it is not controlled. To control your IBD, you generally need to continue your medications.

Other medications

There may be other drugs you are taking and wondering if they will affect your fetus, including:

  • Pain medications: Acetaminophen (‘Tylenol’), anticonvulsants (e.g., gabapentin), antispasmodics, anticonvulsants (e.g., gabapentin), opioids
  • Non-steroidal anti-inflammatory drugs: Ibuprofen (‘Advil’), naproxen (‘Aspirin’)
  • Antidepressants or anti-anxiety medication
  • In vitro medications: Generally, if your IBD is under control, any risks from IVF medications are minimized when used under the care of a fertility specialist.
  • Medical cannabis. Cannabis poses risks in pregnancy and should be avoided at that time.

Speak to your doctor about the risks and benefits of using these medications during pregnancy.


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Sexual health and intimacy

IBD can lead to increased bowel frequency, incontinence, and other issues that can decrease confidence and desire. Surgery can lead to body image issues, especially if there is a stoma involved.

Systemic symptoms such as chronic pain, fatigue, or joint pain, and mental health issues such as depression can affect your sex drive and enjoyment.

Women with IBD have a higher risk of vaginal infections and poor lubrication, which can cause vaginal pain during intercourse.

IBD is associated with chronic pelvic pain, and this can lead to sexual dysfunction or problems being sexually active. The most frequent causes of pelvic pain are disorders of the digestive system (about 38%). Causes related to IBD include having an ileal pouch/pouchitis, infections, and certain types of fistulas or abscesses. Pelvic pain can have a major impact on quality of life.

If you are experiencing chronic pelvic pain or other sexual health problems, speak with your gastroenterologist and obstetrician-gynecologist (OBGYN) before becoming pregnant.

For more tips to maintain sexual health and intimacy, visit our section on Relationships and Intimacy.


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What about contraception?

After considering all of your options, you may decide this is not the right time for you to become pregnant after all. Perhaps you still need to get your disease under control. Whatever the reason, you may need to be on contraception.

Women with IBD can use any form of contraception their health care provider recommends. Talk to your specialist about contraception when you have IBD and whether there are considerations regarding the other medications you are taking.

Speak to your health care provider about safely coming off your birth control when the time is right for you to consider becoming pregnant.


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