For patients with Crohn’s Disease, two common surgeries are the ileal (small bowel only) resection and the ileocolic (small bowel and part of large bowel) resection. During these surgeries the portion of the bowel that is strictured or diseased is removed and the healthy ends are attached. These surgeries usually do not interfere with the reproductive organs and are unlikely to affect fertility. However, adhesions (scar tissue) can form from any surgery, and adhesions that block the fallopian tubes can lead to infertility.
For more information on IBD surgeries and fertility, please go to our IBD surgery and fertility resource page.
For patients with ulcerative colitis unresponsive to medical therapy, colectomy is often needed. The small intestine is brought up to an opening in the abdominal skin and formed into an ostomy (Image B). An ostomy bag sits outside to collect the waste. The ostomy can be a permanent end-ileostomy, or a temporary ostomy, depending on the situation.
In some cases, the ileum (small bowel) is brought down into the pelvis, shaped into a pelvic pouch, and connected to the anus – ileal pouch-anal anastomosis (IPAA, or J-pouch) surgery.
Since the surgery occurs deep in the pelvis, injury can occur to the fallopian tubes (a reproductive organ through which an egg travels from the ovary to the uterus); scarring and adhesions that form after the surgery can block the fallopian tubes.
For women who need a colectomy but also wish to have children, it is suggested that they have the colectomy with a temporary ileostomy until they have finished having children. Then they can undergo the IPAA procedure to create a J pouch.
For more information on IBD surgeries and fertility, please go to our IBD surgery and fertility resources page.
If you have an ostomy, either ileostomy or colostomy, here are some handy tips on sex, intimacy, and fertility.
There are several classes of biologics used to treat IBD. Anti-TNF, anti-IL-12/23, anti-integrins. These are all monoclonal antibodies that cross the placenta in the 2nd half of pregnancy. Previously, before the safety of these medications was understood physicians would administer the last dose of biologics before the third trimester, to minimize fetal exposure to the medication. However, women with IBD who require a biologic during pregnancy may continue the medications if the risks of having uncontrolled IBD outweigh the risks of fetal exposure
For more information regarding biologics in pregnancy, please go to our IBD Medications and Pregnancy Resources page.