Let’s talk about fertility
MythWomen with Crohn’s have a harder time getting pregnant.
Nope! Women who are in remission and have not undergone surgery for Crohn’s have the same ability to become pregnant as those without Crohn’s.
Can you get pregnant with Crohn’s?
Despite what many may think, women living with Crohn’s may be capable of getting pregnant. In fact, women who are in remission and have not undergone specific types of surgery may get pregnant as often as women who don’t have Crohn’s. And research suggests that there are several Crohn’s treatments that shouldn’t affect the ability to get pregnant. Your doctor will be able to give you more specific details about your treatment and its potential effect on your fertility.
We’ve also mentioned that certain surgeries can impact your ability to get pregnant; those include ileal pouch-anal anastomosis (also known as IPAA or J-Pouch), proctectomy, and permanent ostomies. These surgeries can cause inflammation, scarring, and blockages of the fallopian tubes, which may affect the ability to get pregnant.
If you are potentially undergoing IPAA surgery, some studies have shown that performing the procedure laparoscopically can help improve fertility rates. That might be something worth discussing with your doctor.Read Less
Your Crohn’s treatment won’t prevent you from freezing your eggs or utilizing assisted reproductive technology in order to conceive!
When should you see a fertility specialist?
If you’re younger than 35, the American Society for Reproductive Medicine recommends consulting with a fertility specialist after trying for one year. If you’re older than 35, they recommend seeing a specialist after 6 months.
Guidelines published in 2019 by the American Gastroenterological Association and IBD Parenthood Project Working Group notes that women with IBD, especially those who have had pelvic surgery, can see a specialist after 6 months of trying.
Talk to your doctor about what timeline makes sense for you based on your personal medical history.
Let’s talk about inheritability
MythI’ll definitely pass my Crohn’s disease along to my child.
While there is a possibility, it’s much less than you might think! Only 3-9% of children born to mothers who have Crohn’s develop Crohn’s themselves.
Genetic factors
While genetics play a role, certain environmental factors may also impact the chances of developing Crohn’s. Unfortunately, we still don’t know exactly which environmental triggers are the culprits. There have been a handful of studies that have found the following connections:
- Smoking is a recognized risk factor for developing Crohn’s
- Individuals with Crohn’s typically have a diet low in raw fruits and vegetables
- The impact of breastfeeding isn’t completely clear, but some studies have found that it has a protective effect for the baby, which may be related to the duration of breastfeeding Read Less
Let's talk about birth control
MythI don’t need birth control;
I can’t get pregnant.
Actually, birth control plays a really important part in your Crohn’s pregnancy plan! Birth control will help you plan a pregnancy on your schedule.
Timing is everything
Conception during a flare can be risky for the baby—and for you.
If you conceive during a flare, you’re more likely to experience the same level of symptoms or higher throughout the pregnancy.
That’s why it’s key to be in remission for 3–6 months before conceiving—it greatly increases your chances of staying in remission while pregnant.
In a study of 145 women with Crohn’s, nearly 9 out of 10 women who got pregnant while in remission STAYED in remission throughout their pregnancy!
One small study looked at women with IBD (either Crohn’s or ulcerative colitis) and found that nearly ¼ of them used no contraception. The researchers noted that one reason may be because they believed they were unable to get pregnant.
We know that women who are in remission and have not undergone specific types of surgery may get pregnant as often as women who don’t have Crohn’s.
Not using any type of contraception increases your risk for an unplanned pregnancy or pregnancy at a time when your Crohn’s isn't under control.
Talk to your OB/GYN about what type of birth control works best for your situation and medical history so you can plan for pregnancy when you’re at your healthiest.
Is birth control ok for you to use? What are your options?
For most women with Crohn’s, many forms of birth control can be an option! Certain types of birth control may have risks for certain people. Plus, there are a lot of factors that go into choosing the right birth control (not just your Crohn’s), so talk to your OB/GYN about what makes sense for your body.
- Intrauterine Devices (IUDs) are the most effective (about 99%!). They can be implanted right in your OB/GYN’s office and can be safely removed at any time.
- Next up are hormonal contraceptives, which can come in the form of a shot, patch, pill, or ring. They’re a little less effective than IUDs, and these methods will require you to carry more of the burden in maintaining the contraceptive regimen (whether it’s getting a shot at your doctor’s office every few months or taking a pill every day), so keep that in mind when considering whether it will work for your lifestyle.
- And there are barrier methods too. Of the three options, these are the least effective at preventing pregnancy, but they’re still (quite literally) better than nothing! These can have up to an 18% failure rate, but even if you’ve chosen another method for contraception, you should still continue to use them as needed to protect against sexually transmitted infections. Read Less
Will birth control affect your Crohn’s treatment?
While there haven’t been many studies focused on this area, there’s no strong evidence to suggest that birth control would impact how well your treatment will work or the likelihood of a relapse. That said, there are a few things to watch out for: Read More- While birth control may be safe for many women, you should avoid any contraceptives that contain estrogen if you’re at a higher risk for blood clots—this includes if you’re currently experiencing a severe flare, undergoing surgery, or have a history of blood clots.
- You should also be aware that your ability to absorb oral methods of birth control may be reduced if you’ve had significant bowel resection surgery. Read Less
Let's talk about treatments
MythI’ll have to stop taking my Crohn’s medication while I’m pregnant or nursing.
Not necessarily true. The goal is to try and keep you flare-free throughout your pregnancy. You and your gastroenterologist will work together to create a plan to get you into remission and help you stay there.
Can you continue treatment during pregnancy?
We wish there were a simple answer to this—but the truth is that it’s a very individual decision.
Researchers are studying how different Crohn’s treatments affect mom and baby throughout pregnancy. And while there are various treatments that may be ok to continue to take, it comes down to what’s best for you and your baby. Your doctor will look at the available research and your medical history, talk to you about the benefits and risks, and you’ll decide together how to move forward.
There is information about treatments that are not safe during pregnancy. Studies have shown clear evidence that methotrexate can have negative effects on a growing fetus. Make sure to use at least one form of birth control to avoid an unplanned pregnancy while you’re taking methotrexate and talk to your doctor about discontinuing methotrexate at least 3–6 months before you plan to get pregnant.
It’s always helpful to know a bit more about the different types of treatments. So we’ve put together a list of the classes of medications that can be used to treat Crohn’s and its symptoms below.
Reminder: this is all general information. We haven’t included research on the potential effects of medications during pregnancy or breastfeeding. You and your doctor should talk about all the details together and figure out if it makes sense for you to continue or stop a medication while you’re pregnant and/or breastfeeding.
Class of Medication:
These are compounds that work to reduce inflammation in your intestine. Unlike many other types of Crohn’s treatments, they are not immunosuppressants.
Aminosalicylates (or 5-ASAs) are typically used to manage mild to moderate disease activity and can be effective in maintaining remission, although they may need to be used with another medication to be most effective.
While not used to treat Crohn’s disease itself, antibiotics can be helpful in treating conditions associated with Crohn’s disease, like abscesses, fistulae, and other infections.
These are bio-engineered treatments made from living organisms that are designed to target specific molecules that can cause inflammation. Biologics are usually recommended for people with moderate to severe Crohn’s disease who didn’t respond sufficiently to previous therapies like corticosteroids.
Corticosteroids affect the body’s ability to trigger and run the immune system. While they’re especially effective for relieving the symptoms of an active flare quickly, corticosteroids are not an ideal long-term treatment because of the risks and side effects, which increase with prolonged use.
These medications change the way your immune system reacts in order to reduce inflammation. They are sometimes prescribed along with a biologic. Immunomodulators can take 3-6 months to begin working effectively.
Janus kinase inhibitors, or JAK inhibitors, are molecular compounds that break down in your gastrointestinal tract, where they are then transported to many different pathways in the body that can be the sources of inflammation. While other classes of medication might take several weeks to work, JAK inhibitors work more quickly to achieve remission.
