Does IBD make it harder to have children?
For most people, no. When your Crohn's or Colitis is in remission, your fertility is usually similar to anyone else's. Fertility tends to drop mainly when the disease is active, which is one good reason to aim for remission before trying for a baby. Some specific situations matter: pelvic surgery such as an ileo-anal pouch can make it harder for women to conceive, and the drug sulfasalazine can lower a man's sperm count, though that reverses a few months after stopping it. None of this means children are off the table; it means it is worth planning with your IBD team a few months ahead.
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This is one of the biggest worries after a diagnosis, especially for younger people. The reassuring headline is that most people with IBD can have children.
In remission, fertility is usually normal
Crohn's & Colitis UK is clear that "many people living with Crohn's or Colitis are as fertile as people who are not living with Crohn's or Colitis" (Crohn's & Colitis UK). The picture changes mainly when the disease is active.
Active disease is the main factor
"Uncontrolled Crohn's or Colitis has been linked to reduced fertility in some studies" (Crohn's & Colitis UK). The European (ECCO) guidelines agree that "active disease is associated with decreased fertility in women with IBD," while "achieving clinical remission may increase the probability of successful conception" (ECCO Guidelines). This is a strong reason to try to settle a flare and reach remission before trying for a baby.
Two specific situations
- Pelvic surgery in women. If you have had an ileo-anal pouch (IPAA), you "may have more difficulty getting pregnant," because pelvic scarring can affect the fallopian tubes and ovaries (Crohn's & Colitis UK). The ECCO guidelines note IPAA can raise the infertility rate several-fold (ECCO Guidelines).
- Sulfasalazine in men. This drug "can lower sperm count and sperm motility," but the effect "is reversible and normally returns to normal two to three months after you stop taking" it (Crohn's & Colitis UK).
What to do
- Plan ahead. Talk to your IBD team a few months before you start trying.
- Aim for remission first, since that helps both fertility and pregnancy.
- If you are on a specific medication or have had pelvic surgery, ask your team how it affects your situation.