Fertility
- Patients with IBD and well controlled IBD have the same fertility rates as the general population.
Factors which may reduce fertility
- Involvement of the fallopian tubes
- Methotrexate and sulfasalazine can cause a reversible oligospermia
- Pelvic surgery can influence fertility in both woman and men
Things which need to be discussed with patients prior to conception
- Children are at increased risk of IBD – 3-20x likelihood of developing IBD.
- Disease should be in remission prior to conception – this is because patients with active disease at the time of pregnancy are more likely to have difficult with disease control.
- Woman are more likely to have antepartum haemorrhages, and babies with low birth weight.
- Woman are more likely to have issues with nutrition.
- More likely to have low iron and low b12
IBD medication
- Generally should be continued while pregnant – most medications have a good risk profile during pregnancy.
- Methotrexate should be ceased for at least 3 months but ideally 6 months prior to getting pregnant due its risk of skeletal abnormalities.
What to do with patients with flares or complications during pregnancy
- MRI is the preferred modality for working up a patient with IBD
- Complications of IBD still needs to be addressed as per usual – the indications for surgery in a pregnant mother are the same as a non-pregnant patient.
- Surgery is associated with pre-term labour and spontaneous abortion but this is relatively rare.
Mode of delivery
- In general a NVD can be attempted in patients with IBD, even patients with a colostomy or ileostomy
- Some people with advocate for a C-section in patients with a J pouch
- Patients with active perineal disease should also have a C-section.