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Fertility and pregnancy in the patient with inflammatory bowel disease
  1. U Mahadevan
  1. Correspondence to:
    Dr U Mahadevan
    Department of Medicine, University of California San Francisco, Center for Colitis and CD, 2330 Post Street #610, San Francisco, CA 94115 USA; uma.mahadevan{at}ucsf.edu

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The majority of patients with inflammatory bowel disease (IBD) are affected during their peak reproductive years.1 While initial concerns focus on attaining a durable remission and avoiding the side effects of medications, once in remission the focus often shifts to the effect of disease and the medications used to treat it on fertility and the ability to conceive a healthy child. This paper summarises the existing literature on the effects of ulcerative colitis (UC) and Crohn’s disease (CD) and the medications used to treat it on fertility and pregnancy outcomes.

GENETICS AND INHERITANCE

Patients are naturally concerned about passing their disease on to their offspring. Unfortunately, family history is the strongest predictor for developing IBD. If one parent is affected, the risks of the offspring developing IBD are 2–13 times higher than in the general population.2,3 One study estimated that the risks of IBD in first degree relatives of probands with UC and CD were 1.6% and 5.2%, respectively, values that were even higher in the Jewish population.4 If both parents have IBD, the risk of their offspring developing IBD over their lifetime was estimated to be 36%.5

Several studies suggest that breastfeeding may be protective against the development of IBD in the infant. In a meta-analysis of 17 studies, the eight highest quality studies showed a pooled odds ratio of 0.45 (0.26, 0.79) for CD and 0.56 (0.38, 0.81) for UC.6 However, these were not mothers who had IBD themselves.

FERTILITY

Infertility is defined as the diminished ability or the inability to conceive and have offspring. It is also defined in specific terms as failure to conceive after a year of regular intercourse without contraception. In general, women with CD appear to have similar fertility rates to the general population. Older referral centre studies estimated infertility rates …

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