It should be emphasized that female patients with inflammatory bowel disease are as fertile at rest as the general population. In vitro fertilization in women with inflammatory bowel disease is as successful as it is in the general infertility population.
If a patient with IBD wishes to become pregnant (naturally or through in vitro fertilization), she should always discuss this with their MDL physician beforehand. One of the most important aspects is to ensure that the patient is in (steroid-free) remission. Remission is defined by stool frequency ≤3/day, absence of rectal bleeding and normal mucosa at endoscopy. The absence of histologically acute inflammatory infiltrate predicts a calm course of the disease.
Active UC is associated not only with a reduced fertility rate, but also with adverse effects during pregnancy (risk of preterm birth and low birth weight). Conception during active disease increases the risk of continued disease activity during pregnancy.
It should be discussed with the patient whether treatment of IBD can and/or should be continued during pregnancy. While most agents used to treat IBD during pregnancy are permitted, teratogenic agents (e.g., methotrexate and newer JAK inhibitors) may need to be discontinued. Treatment with methotrexate should be stopped in both women and men at least 3-6 months before becoming pregnant. 5-aminosalicylates (5-ASA) can also be ordered and used during pregnancy. In the same way, biological agents can also be used during pregnancy and lactation – based on data from the PIANO registry.
Finally, the mode of delivery is subject to a multidisciplinary approach, most women with IBD can deliver vaginally, and cesarean delivery is recommended only for active perianal disease or women with a history of the ileo-anal pouch.
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