Fertility, Pregnancy and Sexual Function Program for Women with Inflammatory Bowel Disease
How Does Inflammatory Bowel Disease Affect Women?
Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, can affect a woman’s sexual and reproductive health in several ways.
If you have IBD, your menstrual periods may be especially uncomfortable. You may also have a harder time getting pregnant or having a healthy pregnancy if you still get frequent flare-ups. And like many other women with IBD, you may find that your disease has a negative effect on your sex life.
Specialized Treatment for Women with IBD
At the Preconception and Pregnancy (PPIBD) Program at the University of Chicago Medicine, our specialists have extensive experience helping women with IBD. Our team include experts with additional training and research interest in pre-conception and pregnancy in women with IBD, as well as maternal-fetal medicine specialists and a team of genetic counselors.
We have the expertise and resources to help you plan for a healthy pregnancy. We also understand the special concerns that you may have around your sexual health. If you are a woman with IBD, we’re here to help you at every stage of your life.
Inflammatory Bowel Disease and Fertility in Women
If you’re like many women with Crohn's disease or ulcerative colitis, you may be concerned about how your disease affects your ability to conceive. At UChicago Medicine, we can assist you with your family planning and help you get as healthy as possible before you get pregnant.
As soon as you are thinking about becoming pregnant, give us a call at 773-702-6140. We will arrange any tests you may need to ensure your IBD is in remission. We can also refer you to a maternal-fetal medicine specialist to help you plan for a healthy pregnancy. For the best outcomes, you should aim to be in stable remission (without flare-ups) for three to six months before getting pregnant.
If your IBD is in stable remission and you have not had surgery, you are just as likely to get pregnant as a woman without IBD. However, active inflammation from uncontrolled IBD may affect your ability to conceive. Having scar tissue from a prior surgery to create a J-pouch or an ostomy also can decrease your fertility.
If you have IBD and have not been able to conceive after six months, you should see an infertility specialist. This is true for all women of childbearing age with IBD.
No, IBD medications do not affect infertility treatment. However, infertility treatment may be less effective in IBD patients, although researchers aren’t sure why that is the case.
Inflammatory Bowel Disease and Pregnancy
If you have Crohn's disease or ulcerative colitis, you can have a healthy pregnancy. Planning ahead and keeping your IBD in stable remission improves your chances of delivering a healthy baby.
At UChicago Medicine, our IBD specialists are available for pre-conception counseling to help you manage your medications so that you and your baby are as healthy as possible. During your pregnancy, we may refer you to a maternal-fetal medicine specialist, who is trained to manage pregnant patients with chronic conditions. We also can coordinate care with your primary obstetrician-gynecologist (OB/GYN) and develop a plan to monitor you during your pregnancy so that you and your baby have the best possible outcomes.
Whenever possible, it’s best to have a conversation with your IBD team before you become pregnant. We can order tests to make sure that you do not have any active inflammation, which could reduce your chances of a healthy pregnancy. We can also adjust medications that are part of your IBD treatment plan, if necessary.
For example, if you take methotrexate, it’s important to stop taking the immune-suppressing drug at least three months before conception. You also should gradually taper off any steroids like prednisone used to control inflammation before becoming pregnant. You also may need to add supplements like folic acid if you are on the anti-inflammatory drug sulfasalazine, which can affect your folate levels.
With a few specific exceptions like methotrexate and prednisone, most IBD medications are safe to take during pregnancy and while breastfeeding. Drugs considered safe during pregnancy include newer biologic medications like Remicade® (infliximab), Humira® (adalimumab), Stelara® (ustekinumab) and Entyvio® (vedolizumab).
Research studies have found that continuing these medications during pregnancy is not only safe for the baby but also helps maintain your health during pregnancy and beyond.
Do not stop taking your medication without talking to your gastroenterologist first.
If you are pregnant, we can help you come up with a plan that will keep your inflammation under control while protecting your baby.
If you have active inflammation during your pregnancy, you have a higher risk for delivering a premature or low birthweight baby. That is why it is important to stay on whatever IBD medications are recommended by your doctor so you can maintain remission.
With the right planning and coordination with your IBD team, you can have a healthy pregnancy and delivery.
Yes, in most cases, you can have a vaginal delivery. However, you may need a Caesarean section if you have a fistula, abscess or other sign of active perianal disease.
The risk of passing on ulcerative colitis or Crohn’s disease to your baby are fairly small—less than 3 percent if you have Crohn’s, and less than 2 percent if you have ulcerative colitis. That risk becomes much higher — 30 percent — if both you and your partner have IBD.
Inflammatory Bowel Disease and Sexual Health in Women
If you are like many women with IBD, you may find that your symptoms, medications or other issues related to your disease interfere with your sex life. But working with our team can help you enjoy this important part of your life again.
Surveys show that as many as 90 percent of IBD patients experience sexual dysfunction at some point.
If you’re a woman with IBD, many factors can contribute to your sexual problems. IBD symptoms like abdominal pain, fatigue and diarrhea are often to blame. Medications like steroids also can add to the problem. IBD also can cause your pelvic floor muscles to become very tight, making intercourse uncomfortable. IBD treatments like surgery and ostomies also can lead to anxiety, depression and a negative body image. All of these factors can affect your sex life and quality of life.
We understand that you may be reluctant to bring up your sexual health concerns with your gastroenterologist. But we’re here to help, just as we have helped many other women coping with IBD-related sexual issues.
At UChicago Medicine, we are sensitive to your concerns and can help you find relief from symptoms like pain and diarrhea that affect your sexual health. Our IBD specialists also can refer you to a gynecologist, GI psychologist or pelvic floor physical therapist for specific therapies designed to improve your sex life.
We offer a variety of specialized treatments to improve sexual health in women with IBD. These include:
- Biologics and non-biologic small molecule drugs, which can help you stay in remission
- Pelvic floor physical therapy, which can help you learn to relax or strengthen your core and pelvic floor muscles that could be affected by your IBD
- Cognitive-behavioral therapy, which is led by a GI psychologist who understands the mind-gut connection and has special training in helping women with IBD address mood-related issues and body image concerns
We believe that every woman experiences IBD differently. That is why we work with you to develop an individualized treatment approach so you can live the fullest life possible.
Intestinal Ultrasound in Pregnancy
Intestinal Ultrasound (IUS) is a safe, non-invasive, and radiation-free tool for assessing bowel inflammation, suitable for all stages of pregnancy. Visualization may be more difficult in the 2nd and 3rd trimesters depending on disease location. It provides real-time assessment of bowel inflammation and is increasingly valuable in managing IBD, particularly in women planning pregnancy or already pregnant.
UChicago Medicine is among the few centers nationwide with dedicated IUS experts, offering this advanced imaging in our Preconception and Pregnancy IBD Clinic.
- Safe for fetus and mother (no ionizing radiation or contrast agents).
- Can be performed at bedside or outpatient setting.
- Provides immediate results, and is useful for clinical decision-making.
- May reduce need for MRI or endoscopy during pregnancy.
- Safe Monitoring Tool: No radiation exposure and well tolerated by pregnant women, making it ideal for repeated use throughout pregnancy.
- Evaluation of Disease Flares: Enables prompt assessment of new or worsening symptoms without delaying care or resorting to more invasive tests.
- Monitoring Response to Therapy: Tracks treatment effectiveness and helps avoid unnecessary escalation or premature delivery.
- Differentiating Causes of Symptoms: Helps distinguish IBD flares from other pregnancy-related gastrointestinal symptoms (e.g., constipation, bloating).
PPIBD Research Initiatives
A distinct feature of the PPIBD program is the opportunity for patients to participate in international, multicenter research initiatives. The University of Chicago Medicine IBD Center is a major site for the Pregnancy in IBD and Neonatal Outcomes (PIANO) registry, which evaluates the safety of IBD medications in pregnancy and short- and long-term outcomes of the children.
The IBD Center participates in the Women with Inflammatory Bowel Disease and Motherhood (WIsDoM) Study, which is a research initiative seeking to follow women with IBD who are planning pregnancy within six months to better understand the impact of IBD on fertility.
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