inflammatory bowel disease and its impact on fertility and pregnancy

the peak age of onset of inflammatory bowel disease (ibd) is simultaneous with the peak reproductive years. patients have many concerns about the impact of ibd on fertility and pregnancy outcomes. the most important reason for voluntary childlessness is the fear of side effects from medications for ibd. decision making for medical therapy is a complex equation. it is important to summarize available information about the management of ibd during pregnancy and its interactions. among ibd patients, those undergoing surgery are at risk for reductions in fertility. patients with ileal pouches-anal anastomosis (ipaa) experience higher rates of infertility. disease activity at the time of conception is the main determinant of the impact of ibd on adverse pregnancy outcomes. in different nations, disease activity and relapse depend on many factors and may even be slightly lower during pregnancy. the recommended mode of delivery in ibd is still controversial. however, there is an increased rate of cesarean sections in women with ibd. choosing the appropriate method of delivery should be based on the obstetrician's opinion, however active perianal disease and the presence of an ileoanal pouch are two major exceptions. if women remain on their maintenance therapy, there would be no increased risk of a flare-up during the postpartum period. in most patients, maintaining remission with medication outweighs the risks of their adverse effects. however, the pros and cons must be discussed with the patient and decisions should be made on an individual basis. among all drugs used in ibd treatment, only methotrexate (mtx) and thalidomide are contraindicated in pregnancy.