IVF in IBD: Initial Validation For Success?

Excerpt

The primary clinical manifestation of inflammatory bowel disease (IBD) is idiopathic inflammation of the gastrointestinal-colonic mucosa. Given that IBD strikes most frequently in the teens to thirties [1], corresponding to the prime childbearing years for women, fertility is understandably a topic germane to this population. Whereas fertility rates for women medically managed for ulcerative colitis (UC) do not differ from those without UC, a threefold increase in infertility (average of 15–48 %) has been reported in a meta-analysis of studies of women who have undergone total proctocolectomy with ileal pouch-anal anastomosis (IPAA), believed to be secondary to post-operative adnexal adhesions [2]. Elevated post-operative infertility rates may be normalized following laparoscopically performed IPAA [3]. In Crohn’s disease (CD), data are more equivocal regarding higher rates of infertility: voluntary childlessness (for a wide variety of reasons) may account for reported higher rates of infertility in past studies [4], although decreased ovarian reserve as measured by anti-Müllerian hormone occurs in CD, particularly at age >30 and with colonic location of disease [5, 6]. Regardless of whether a woman with IBD has difficulty becoming pregnant related to surgery, disease or for other reasons, knowledge of what influences the success of in vitro fertilization (IVF) in this population as it compares to women without IBD is certainly welcome. …