Fertility and IBD Part 1

Crohn’s Disease and Ulcerative Colitis (the two main forms of Inflammatory Bowel Disease – IBD) are often first diagnosed in people in their 20s and 30s. This is also the age at which many couples are thinking of having children. If you or your partner have IBD and are thinking of starting a family, you may be concerned about how IBD might affect your fertility. This article looks at the main ways in which UC or Crohn’s, or the treatments for these conditions, may sometimes have an effect on fertility. We also have an information sheet Pregnancy and IBD, which covers concerns you may have about IBD once you have conceived. 


How might having IBD affect my fertility?

If you are a woman...
In general, women who have inactive IBD - either Crohn’s or UC - should have no more difficulty in becoming pregnant than women without IBD. However, some women with active IBD, especially Crohn’s Disease, may have problems, particularly if they are underweight and eating poorly. Also, severe inflammation in the small intestine can sometimes affect the normal functioning of the ovaries or cause adhesions (bands of scar tissue) that affect the fallopian tubes.


Complications such as abscesses and fistulas in the pelvic and anal area may make you less interested in sex and so less likely to conceive. Some of the other general difficulties associated with living with IBD, such as fatigue, abdominal pain, diarrhoea and a poor body image can have a similar effect. 

For all these reasons doctors generally recommend getting your IBD under control before you try to become pregnant. Studies have also shown that if your disease is very active when you conceive, your symptoms may remain troublesome through your pregnancy. The likelihood of miscarriage is also higher. That said,  numerous women have had uneventful and successful pregnancies even when they have conceived during active phases of IBD.

If you are a man... 
In general, male fertility is not affected by IBD. A few studies have suggested that sperm quality may be affected by Crohn’s disease, but it is not clear whether this is more likely to be the effect of poor  nourishment. Treatment of the disease should restore fertility to its usual level. 

However, for men as well as women, problems such as fatigue and a poor body image can affect sexual relationships and make it more difficult to conceive a child. Abscesses and fistulas in the pelvis and anal regions may also cause some difficulties with erection and ejaculation. 

What about surgery: can this affect my fertility?

Surgery for women
Research has shown that Ileo pouch–anal anastomosis surgery (also known as IPAA or pouch surgery), often carried out for UC, can reduce fertility in women. This appears to be much less likely with a colectomy and the formation of an ileostomy - the usual alternative to pouch surgery. (For more details on these and other types of surgery for IBD see our information sheets Surgery for Ulcerative Colitis and Surgery for Crohn’s Disease.)


However, any pelvic surgery, including surgery for Crohn’s, may carry a small risk of infertility in women as this may also lead to adhesions or scarring on the fallopian tubes. So if you are considering surgery for IBD and want to get pregnant, do discuss this possibility with your IBD team - and if necessary with a fertility specialist. 

If you have recently had IBD surgery of any kind, you may find that you are advised to wait a year after surgery before trying to become pregnant, in order to give your body time to recover fully. Again, this should be discussed with your doctor.

Surgery for men
Very rarely, men with IBD who have had an IPAA or pouch operation, or have had both their colon and their rectum removed by surgery, may have difficulty having an erection. However, this problem is usually temporary or can be successfully treated with medication.