Fertility and Disease Activity

Most studies support normal fertility rates in females with UC. However, Swedish physicians (Olsen et al, 2002) report a markedly reduced potential of reproductive capacity of women after restorative proctocolectomy. It has been noted that women with IBD have fewer children than unaffected individuals. This may reflect decreased libido, dyspareu-nia, abdominal pain, diarrhea, or a conscious decision not to procreate.

Active CD does impair fertility (Khosla et al, 1984). Ileal inflammation can involve the ovaries and fallopian tubes resulting in scarring and obstruction. In addition, recto-vaginal and perianal fistulizing disease may contribute to fear of intimacy, and dyspareunia, and vaginal candidiasis may follow medical therapy. In general, patients with UC and CD should have a quiescent disease interval of at least 3 months prior to conception. The course of IBD during pregnancy usually correlates with disease activity at time of conception. Patients with active disease may continue with symptoms one-third of the time and may actually have worsening of disease. Women with disease quiescence typically remain in remission during the pregnancy. Additionally, the gastroenterologist should be vigilant for possible disease recurrence in the puerperium.

Studies suggest that smoking supports active CD, affecting fertility and reducing fetal growth. Most patients are aware of tobacco's ill effects and consider cessation prior to conception. Alternatively, the UC patient risks disease flare with smoking cessation. The physician should prescribe adequate medical maintenance therapy to avoid reactivation of symptoms and disease during tobacco withdrawal, pregnancy, and postpartum.

In male patients with IBD, impotence from procto-colectomy may be an unspoken issue regarding fertility. Compassionate inquiry may be helpful; some patients respond to Viagra therapy. It is known that sulfasalazine may cause reversible oligospermia and impair sperm morphology and motility (Narendranathan et al, 1989).

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