Crohn’s disease (CD) is a type of Inflammatory Bowel Disease (IBD) that causes chronic inflammation anywhere along the digestive tract. Since CD often begins in young adulthood, people frequently wonder how it might affect their ability to conceive. The disease introduces complexities to the reproductive process through inflammation, nutritional deficiencies, and surgical history. However, fertility rates are comparable to the general population when the disease is well-controlled and in sustained remission.
Female Fertility and Disease Activity
Active Crohn’s disease can negatively impact a woman’s fertility through systemic inflammation. Inflammation interferes with the hormonal cycle, which is necessary for timely ovulation and successful implantation. Studies suggest that active CD may also reduce ovarian reserve, indicated by lower levels of Anti-Müllerian hormone (AMH) in women experiencing flares.
Fertility is preserved and similar to that of women without IBD when the disease is in remission. Conversely, a significant reduction in the ability to conceive is observed during periods of active disease or flare-ups. Gastroenterologists strongly recommend achieving and maintaining remission for at least three to six months before attempting conception.
A history of pelvic surgery for Crohn’s disease is another factor that can physically impact female fertility. Procedures like proctocolectomy, which involves deep dissection in the pelvis, may lead to the formation of scar tissue or adhesions. These adhesions can mechanically obstruct or distort the fallopian tubes or ovaries, preventing the egg and sperm from meeting.
The risk of infertility is higher following open surgical procedures, such as restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Newer techniques, such as laparoscopic surgery, are associated with a lower incidence of adhesion formation. Women who have had pelvic surgery for IBD should discuss the potential for mechanical subfertility with their care team, although the overall impact of surgery is debated.
Fertility Considerations for Males with Crohn’s Disease
Active inflammation in Crohn’s disease can temporarily affect male reproductive function by reducing overall sperm quality. Severe inflammation and nutritional deficiencies can lead to a decrease in sperm count and motility. This decline in sperm parameters is reversible once the disease is brought under control and the man achieves remission.
A specific concern for males is the effect of certain medications used to treat CD. The drug sulfasalazine, an aminosalicylate, is known to cause reversible reductions in sperm count (oligospermia) and motility, and an increased proportion of abnormally formed sperm. This effect is caused by the sulfapyridine component, which interferes with the later stages of sperm maturation.
The negative impact of sulfasalazine on sperm is not permanent. Discontinuing the medication usually leads to a complete reversal of these effects, with sperm parameters typically returning to normal within two to three months. Changing to a different therapy can restore fertility for men who rely on this drug for disease management.
Medication Management and Preconception Planning
Preconception planning is a necessary step for all individuals with Crohn’s disease considering starting a family. This process requires counseling with both a gastroenterologist and an obstetrician to optimize disease control and review current medications. The goal is to ensure the disease is in deep remission, as active inflammation poses a greater risk to pregnancy outcomes than most maintenance medications.
Physicians evaluate the risk-benefit profile of each drug, emphasizing that maintaining remission with safe medication is paramount. Many modern therapies, including most biologics and thiopurines, are considered safe to continue throughout conception and pregnancy. These medications prevent flares, which increase the chance of adverse maternal and fetal outcomes.
Certain medications must be discontinued before attempting conception due to safety concerns. Methotrexate is known to cause birth defects and must be stopped completely, typically for at least three months, before conception. Sulfasalazine use should be discussed with the care team, and a high dose of folic acid (2 mg daily) is often recommended if the drug is continued.
Preconception counseling also addresses non-medication factors, such as screening for common vitamin deficiencies in CD, including vitamin D and B12. Ensuring adequate folic acid supplementation is also addressed. This multidisciplinary approach provides the safest and most effective management strategy for a healthy pregnancy.