Getting Pregnant With Ibd
Most people with IBD receive a diagnosis between the ages of 15 and 30 years old, which coincides with peak years of fertility and pregnancy. So it makes sense that fertility, and getting pregnant, is often a concern for many women who have been diagnosed with Crohn’s disease or ulcerative colitis.
The overall fertility rate for women with Crohn’s and UC has been reported to be similar to women without IBD. However, it’s important to keep in mind that certain surgeries or medical treatments for IBD may impact fertility. So, if you or your partner with IBD plans on becoming pregnant in the future, it’s a good idea to talk with a doctor who understands the special care required during this important time in your life.
Each Person’s Uc Is Different
The studies that are currently available on fertility and UC are extremely small. Not only does UC vary from person to person, but the health and body chemistry of two people need to be considered when you are considering pregnancy. Learn the facts related to UC and fertility now to better prepare yourself knowing your own body and staying in close contact with your medical provider during this exciting time is paramount.
Ibd And Medication During Pregnancy
Key points
- Active disease is the main cause of pregnancy complications so it is important to try and stay in remission during pregnancy.
- Most IBD medications are safe for your baby but there are some that must be avoided before and during pregnancy.
- Have a talk with your gastroenterologist 3-6 months before youre planning to have a child so that you can feel confident in the medications you are using during your pregnancy.
The single most important thing you can do to have a healthy pregnancy and delivering a healthy baby is to have your IBD under control, ideally before you attempt to become pregnant and also throughout the pregnancy. Thats why it is important to be on top of the medication you are using and talk with your doctor about your plans to have a child 3-6 months ahead of time.
Women with IBD are at higher risk for spontaneous abortions and other pregnancy complications compared to those without IBD. So its best to have close follow-up with your doctor and specialists during this time. Before making any changes to your IBD medications, make sure that you, your obstetrician and your doctor are all on the same page about what treatment plan is best for you.
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Untreated Depression Is More Common Among Men With Crohns
Crohns disease may increase a mans risk of depression. A meta-analysis of 13 studies, published in March 2016 in the journal Inflammatory Bowel Diseases, found that people who have IBD, including Crohns disease, are significantly more likely to experience anxiety and depression, especially during flare-ups. IBD patients are at higher risk of depression, anxiety, and PTSD, says Qazi. These mood disorders are also linked to a worsening course of disease.
Its not surprising that a chronic illness especially one that can interfere with peoples daily lifestyles contributes to depression, says Salem. Drugs used to treat Crohns disease, including steroids, have also been linked to mental health conditions, including acute psychosis, mania, hypomania, and depression.
Whats more, men are far less likely to seek treatment for depression than women, possibly because men have a harder time expressing their emotions and may hide symptoms by overworking or engaging in risky behaviors, according to the American Psychological Association. Multiple studies clearly show that masculine norms and attitudes often directly lead men to refuse help, particularly for mental health issues, says Salem. This could be due to the stigma that is perceived by men with this diagnosis.
Monitoring And Management Of Ibd During Pregnancy
Key points
- Staying in regular contact with your IBD team before, during and after pregnancy will keep you on top of any unexpected developments.
- Surgery is always risky for the wellbeing of mother and child and should be avoided if possible, during pregnancy.
- Some testing procedures are not safe for your foetus like CT scans and full colonoscopies.
You should check in with your IBD treating team at least once per trimester during pregnancy and 6 weeks after birth, in addition to your usual obstetric care.
Flares during the pregnancy may further heighten the risk for premature deliveries and low birth weights at a time when testing and treatment options may be more limited. Therefore, its important to remain vigilant about controlling IBD inflammation from conception to birth.
Pregnancy itself does not increase disease activity or cause flares but stress caused by pregnancy can worsen disease symptoms.
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How Ibd Affects Fertility In Men
In general, the effect of inflammatory bowel disease on fertility is unclear. Some studies have shown that men and women with IBD don’t have fertility rates that are much different from people who don’t have IBD. Other studies have shown that men with IBD may have some reduction in fertility, and this might particularly be the case for men with Crohn’s disease.
Surgery Related To Ibd Complications May Impact Fertility
Pelvic surgery, especially the ileoanal J pouch surgery or a permanent ostomy with removal of the rectum, can decrease fertility. This is due to scarring around the fallopian tubes and ovaries that happens wiith pelvic surgery. Although older studies say that an IPAA can increase the risk of infertility by three times, newer studies show that fertility rates are much improved with laparoscopic surgery.
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Can I Do Anything To Reduce The Risk Of My Child Developing Ibd
The causes of developing IBD are still being researched and the reasons why IBD runs in families are not fully understood. Genetics are only one factor involved in the likelihood of a child developing the disease. Environment and the microbiome also have a part to play which is still being explored by researchers.
Since the cause of IBD is unknown, there are no sure ways to decrease the likelihood of passing on the risk of developing the disease to your child. What you can do is become as knowledgeable about the disease as you can so you can be a strong pillar of support if your child is diagnosed with IBD.
Crohns And Choosing To Be Child
Some people with Crohns may view their condition as an obstacle to pregnancy. They may avoid trying to conceive children out of concern for their health.
points to widespread misconceptions about Crohns and fertility as part of the reason many people with Crohns forego having children.
While theres research suggesting IBD can affect fertility and reproductive health, many people with Crohns are able to have healthy, safe pregnancies. Managing Crohns symptoms effectively is key.
Its important to remember not everyone wants children. Some people may make the personal decision to be child-free due in part to their Crohns disease, or completely irrespective of it.
Your sexual and reproductive health is no ones business but your own. While everyone deserves access to the information and care surrounding fertility that they need, no one should face judgment for the decisions they make regarding their own sexual and reproductive health.
If youre planning to start or expand your family and you have Crohns disease, there are steps you can take to have the best outcome possible.
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The Connection Between Ulcerative Colitis And Male Sexual Function
Almost 40 percent of men say their sexual desire has decreased because of their Irritable Bowel Disease over 25 percent say IBD prevents them from having sex and about 20 percent of men say its caused problems for them during sex. IBD is a chronic condition that affects 1.6 million people, and men are equally affected as women. Its usually diagnosed between the ages of fifteen and forty. Of course, those are the years when men are the most sexually active. The disease causes numerous side effects and interrupts a mans sex life both mentally and physically. Not to mention, treatments for IBD, like surgery and medications, can cause mental and physical scars too. Lets discuss how IBD negatively affects male sexual dysfunction and what we can do to help improve sexual desire.
What Should I Eat During My Pregnancy
Any supplements you are on should be supporting a nutritional diet that has good sources of protein, iron, calcium and folic acid. Depending on your current diet you may want to make some changes to make sure there is a good intake of these important nutrients.
Protein: Red meat, poultry, fish, tofu, eggs, lentils, quinoa
Iron: Red meat, poultry, fish, spinach, leady greens & beans
Calcium: Milk, yoghurt, cheese, calcium-fortified cereals and juices
Folic acid: Cereal, bread, legumes, leafy greens, citrus fruits
Will my pregnancy be affected if I am underweight? In general, women will need to increase their calorie intake by 200-300 calories a day during the first two trimesters and by 500 calories during the third.
Women who are underweight or have active disease may need to increase this by 10% to 20%. Being underweight during pregnancy has been connected with an increased risk of underweight or preterm babies. Finding help from a dietitian with knowledge of IBD can really help to develop a diet that addresses all your needs for a healthy pregnancy.
Which foods should I avoid during my pregnancy?
Pregnant women can be more easily affected by serious infections like listeria and salmonella which are caused by food. To reduce your chances of getting these infections try to avoid eating:
- Raw or undercooked meat, eggs and seafood
- Unpasteurised milk, by itself or in foods
- Cold meats , smoked seafood and pâtés
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Sex Isnt Necessarily Intimacy
Although a man may be able to be sexually active, theres a difference between having sex and being intimate. When someone has sex, he or she can disconnect emotionally to fulfill a physical need. Intimacy involves emotional closeness. A closeness first to yourself and second to your partner. Many times, the effects of IBD causes depression and anxiety. This makes it difficult for a man to be intimate. Fear can also hold a man back, as in fear of failure to perform and fear of rejection. Too much sex without intimacy can lead to more depression and anxiety, leaving a man discouraged and wondering how he can ever be intimate with his partner. Men with IBD suffer from both physical and emotional ailments. When a man has active IBD, there is a direct link to erectile dysfunction and decreased sexual function. Depression affects men emotionally by impairing sexual function.
Uc Symptoms May Improve During Pregnancy
The risk of a flare-up is no greater during pregnancy than in any other year of a womans life, according to a 2008 article in the World Journal of Gastroenterology. If conception happens when the disease is active, the symptoms will settle in about one-third of women with UC. One-quarter of those with active IBD during pregnancy will experience chronically active disease throughout the pregnancy. It is advised that conception take place when UC is in remission if possible.
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Crohns And Sperm Count
A 2019 review of 14 studies found that quality studies on how all types of IBD affect male fertility are lacking.
From what we do know, it seems most people with Crohns have no issue with having normal levels of healthy, viable sperm. Medications for Crohns, especially sulfasalazine, can cause a temporary reduction in sperm quality and sperm count. Switching to a different medication for several months typically solves this issue.
When It’s Time To See A Fertility Specialist
If you’ve had surgery for IBD and experience irregular menstrual cycles or you’ve been trying to conceive for three months without success, it may be time to be referred to a fertility specialist. Patients who have not had surgery should see a fertility specialist if they have been unsuccessful after one year of trying to conceive.
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Ibd And Reduction Of Fertility
One aspect of IBD that is thought to be at the center of the reduction in fertility is not actually a physical problem but is instead from a voluntary decision not to have children. People with IBD are often concerned that the disease may be passed on to children, which could cause them to choose not to have children at all.
However, there are many physical aspects of IBD that can affect fertility too, including some medications, having surgery, poor nutrition, psychological issues, as well as general overall health. This article will cover how those factors can affect fertility in men. Men with IBD who have concerns about their current or future fertility should ask their gastroenterologist for a referral to a fertility specialist if needed.
For the purposes of many research papers, infertility is defined as being unable to conceive a child for a year while having regular unprotected intercourse. For women that means that a pregnancy does not occur and for men that their partner does not achieve a pregnancy while trying for a year.
Ibd Medications And Their Impacts
The medications to treat IBD may have an effect on the ability to father a child. In some cases, it may be better to switch medications or to discontinue a medication before starting a family. This will be different for every patient and their family, so it’s important to discuss IBD medications with a gastroenterologist before deciding to have a baby.
6-MP: A few studies on 6-mercaptopurine in men who fathered children showed that there could be an increased risk of pregnancy complications or abnormalities. Other studies showed no risk of problems with the pregnancies where fathers were taking 6-MP. Because of this inconsistency in the evidence, it’s recommended that healthcare providers have a conversation with men taking 6-MP who want to be a father and discuss the potential for problems when fathering a child.
Azulfidine : There has been at least one study that showed that there could be a small risk of birth defects in children born when the father was taking Azulfidine. Therefore, it might be recommended that men with IBD who want to father a child switch to another medication.
Methotrexate: For women who want to become pregnant, methotrexate must be stopped, as it is contraindicated for use during pregnancy. For men, it’s also recommended that the methotrexate be stopped about 3 or 4 months before starting a family, as the drug can stay in the body for a few months after it’s discontinued.
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Bone Loss And Osteoporosis
As women get closer to menopause, estrogen levels begin to drop. This can lead to osteoporosis. Women who have IBD are at risk for osteoporosis even before menopause, especially if they have experienced loss of nutrients or have taken steroids to manage flares. Steps can be taken early in life to try to minimize early bone loss and prevent complications later.
Should My Baby Get Vaccinated
Vaccinations are one of the easiest and most effective ways to protect your newborn child from illness. They help promote immunity to certain fatal diseases and protect your child from infections in the future. To ensure your baby gets the best possible protection from vaccines, its important he or she start receiving them, typically starting at two months, during the first year of life. Before vaccinating your child, your pediatrician should know of any medications youthe motherare taking.
The hepatitis B, DTaP, Hib, pneumococcal and polio vaccines are inactivated vaccines. That means they are made up of cells of the illness grown and killed in a lab, which the human body can learn to identify and defend against without becoming infected. These types of vaccinations are safe to administer on schedule to babies born to mothers who are currently on any IBD medication.
However, Rotavirus vaccines, RotaTeq or Rotarix , are both live vaccines taken by mouth. If youre taking biologic medications such as infliximab, adalimumab, vedolizumab or ustekinumab, your babys pediatrician should not administer the Rotavirus vaccine to your newborn. However, if youre only taking the other types of immunosuppressive medications, such as steroids, mercaptopurine or azathioprine, then the rotavirus vaccines can typically be started on schedule.
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What Is Inflammatory Bowel Disease
IBD is a collective term that refers to the conditions Ulcerative Colitis and Crohns Disease. Both are inflammatory conditions that occur mainly within the bowel, more specifically the large intestine, however, Crohns disease can impact anywhere along the digestive tract from the mouth to the rectum
Symptoms of IBD can include:
- Unintentional weight loss
- Very frequent bowel motions often very loose
- Blood in stools
- Nutritional deficiencies such as iron, B12 and vitamin D deficiency
- Poor energy levels and fatigue
If you have any of these symptoms, please see your doctor to discuss a formal diagnosis.
The Good News!
Lets start off with some good news first: If your IBD is managed and under control and theres no history of pelvic surgery , fertility rates are found to be the same as the general population . Experts recommend couples who havent yet completed their families, work with their doctor around the optimal timing of any surgery to avoid increasing the risk of infertility.
Nutrient Absorption And Losses
Lastly, we know that our diet impacts on our fertility and ability to conceive, but what nutrients should we pay special attention to when diagnosed with IBD
Depending on where your ulcerative colitis or Crohns disease is in your intestine can affect different nutrient needs, which is why working with a dietitian one-on-one whilst managing IBD is so important alongside monitoring your blood tests with your doctor.
Iron
Iron is a critical mineral responsible for helping to oxygenate our tissues via red blood cells. Iron deficiency is one of the worlds most common nutritional deficiencies and affects more women than men. IBD is associated with an increased risk of iron deficiency, if the disease is in a spot in your intestine where iron is absorbed.
Not getting enough iron not only leaves you feeling more fatigued, but can really mean youre behind the eight-ball when it comes to pregnancy where iron demands really ramp up!
Correcting iron deficiency before conceiving is ideal by working on your diet and an appropriate supplementation regime based on your blood results and dietitians guidance.
Vitamin D
Want to know why vitamin D is so important for fertility, read more here.
Folate
Lets just say, if theres one nutrient you should place a strong focus on throughout your journey to conceive, its hard to look past folate!
Therefore, it is essential to work with your fertility dietitian to ensure your folate intake is up to scratch!
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