Fertility & Sexual Health in IBD

Quiescent disease or mildly active = same fertility and birth outcomes as a normal pregnancy/those without IBD  

 

Body image and sexual intimacy are major concerns for those with IBD, yet rarely discusses 

https://pubmed.ncbi.nlm.nih.gov/11419835/ 

With almost 40% of patients reporting their disease negatively impacting their decision to pursue intimate relationships 

https://pubmed.ncbi.nlm.nih.gov/21172179/ 

Sexual health is multidimensional, encompassing physical, emotional, social, mental, and spiritual aspects, allowing depression and anxiety to be the main driver of sexual dysfunction in IBD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767981/#:~:text=Impact%20of%20the%20disease%20and%20frequency%20of%20sexual%20dysfunction&text=Indeed%2C%20sexual%20dysfunction%20rates%20are,the%20general%20population%5B16%5D  

 

“In IBD patients, more than 50% of women suffer from sexual dysfunction and 45% of men from erectile dysfunction. Psychological comorbidities, body image, and disease perception are strongly associated with poor sexual health in IBD patients”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767981/#:~:text=Impact%20of%20the%20disease%20and%20frequency%20of%20sexual%20dysfunction&text=Indeed%2C%20sexual%20dysfunction%20rates%20are,the%20general%20population%5B16%5D 

 

Can IBD affect my fertility? 

 

• Malnutrition
• Nutrient deficiencies – B12, anemia
• Decreased appetite, nausea, weight loss
• Poor absorption of nutrients and/or increased losses in the stool 
• Women: Damage to reproductive organs in surgery 
  • https://pubmed.ncbi.nlm.nih.gov/21766164/
  • https://pubmed.ncbi.nlm.nih.gov/23360923/ – laparoscopy > open surgery 
• Non-surgical: Perianal disease and fallopian tube inflammation 
  • https://pubmed.ncbi.nlm.nih.gov/24004045/ 
• Men: Active inflammation, poor nutrition, alcohol use, smoking, medications, and surgery may cause infertility in men with IBD
  • https://pubmed.ncbi.nlm.nih.gov/27602237/ 
• Most medications do not affect fertility 
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865770/ 
• Equally likely to respond to IVF as their normal counterparts 
• Every effort should be made to achieve disease remission prior to conception, as medications are unlikely to affect this process
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865770/ 
• IBD itself does not itself lead to reduced fertility among male and female patients, although many voluntarily choose childlessness thinking it will 
  • https://pubmed.ncbi.nlm.nih.gov/24004045/ 

 

Can IBD affect my pregnancy?

• Preterm birth
• Low birth weight 

 

Family Planning Methods: 

• Slightly increased risk for development of IBD with OCP use 
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865770/
  • https://pubmed.ncbi.nlm.nih.gov/8030630/ 
• No sufficient data for a contraceptive as a cause for relapse 
• Avoid contraceptives with an estrogen component if at risk for VTE
• Avoid DMPA injections if at risk for or with osteopenia 
• IUDs and etonogestrel implants are safe and highly effective forms of contraception that can be recommended as a first-line intervention in patients with IBD

 

All patients with IBD should have access to: 

• Counseling on appropriate protection from STIs and safe behaviors 
• Screening for early identification of depression and anxiety 
• Discussion of fertility and sexual issues with healthcare providers