Ulcerative Colitis (UC) is a chronic inflammatory bowel disease (IBD) that primarily causes inflammation and ulcers in the lining of the large intestine (colon). Since UC often affects individuals during their peak reproductive years, concerns about conception are common. UC itself does not necessarily cause infertility, provided the disease is well-controlled and in remission. However, factors connected to the management and severity of UC, such as active inflammation, specific surgical procedures, and some medications, can influence the ability to conceive successfully.
Understanding Ulcerative Colitis and Female Fertility
When Ulcerative Colitis is active, systemic inflammation can temporarily impair a woman’s ability to become pregnant. The release of inflammatory molecules can disrupt the hormonal balance that regulates the menstrual cycle. This disruption can lead to menstrual irregularities, such as amenorrhea (absence of menstruation) or anovulation (lack of ovulation), making conception more difficult.
Active flare-ups also involve secondary factors that indirectly reduce conception rates. These include chronic diarrhea and intestinal bleeding, which can result in malnutrition, anemia, and fatigue. A woman dealing with these symptoms is less likely to have the general well-being required for frequent intercourse. Fertility rates return to levels similar to the general population when the disease is maintained in remission.
Surgical Considerations and Mechanical Effects
For women with severe UC, a total proctocolectomy (removing the entire colon and rectum) may be necessary. A common restorative option is the creation of an ileal pouch-anal anastomosis, often called a J-pouch. This major abdominal surgery is associated with a mechanical reduction in female fertility.
The primary mechanism for reduced fertility is the formation of pelvic adhesions (scar tissue) that develops after surgery. These adhesions can wrap around the fallopian tubes, causing them to become kinked or obstructed. Blocked fallopian tubes prevent the egg from meeting the sperm, leading to tubal factor infertility. Women who undergo J-pouch surgery may have an infertility risk approximately three times higher than women managed medically.
The increased infertility rates are specific to the extensive pelvic dissection required for the J-pouch. Newer surgical techniques, such as laparoscopic approaches, may help reduce the risk of adhesion formation. For women who experience infertility after this procedure, in vitro fertilization (IVF) is often a successful option because it bypasses the need for the fallopian tubes entirely.
Medication Effects on Conception
Some medications used to treat UC have specific and reversible effects on fertility that must be addressed before trying to conceive. The most well-known example is Sulfasalazine, which has a direct impact on male fertility. In men, Sulfasalazine causes a reversible reduction in sperm quality, decreasing sperm count and impairing sperm motility.
This negative effect is not permanent and typically resolves completely within two to three months after the medication is discontinued or switched. Other common treatments for UC, such as modern biologics and thiopurines, are generally considered safe for use during conception and pregnancy. For women, the risk from these medications is low compared to the risk posed by having active, uncontrolled UC during pregnancy.
Ulcerative Colitis and Male Fertility
Male fertility is generally not permanently impaired by Ulcerative Colitis, but it can be temporarily affected by active disease. Men experiencing a flare-up have systemic inflammation that can negatively affect sperm quality, leading to reduced sperm motility and count. This is often attributed to the overall stress and poor nutritional status associated with active disease.
The semen abnormalities linked to active disease are typically temporary and resolve once the inflammation is brought under control. A rare concern following extensive pelvic surgery is the potential for nerve damage leading to sexual dysfunction, such as retrograde ejaculation. However, the risk of permanent male infertility following surgery is significantly lower than the reversible issues caused by certain medications.
Optimizing Conception When Living with UC
The most significant factor in optimizing conception for both men and women with UC is achieving and maintaining disease remission. When UC is in a quiescent state, fertility rates are comparable to those of the general population. Pre-conception counseling with a gastroenterologist and a fertility specialist is recommended to review medications and ensure a stable treatment plan. If a male patient is taking Sulfasalazine, switching to an alternative drug several months before attempting conception is recommended to reverse sperm abnormalities. For women who have undergone J-pouch surgery, a specialist can evaluate for tubal obstruction and discuss fertility treatment options like IVF.