Sunday, December 6, 2015

{Crohn's Awareness} :: IBD and Infertility

I get a lot of questions about this, because I have Crohn's, and because we have struggled with infertility. Because these are both aspects of our story, I felt I should address the topic. 

Whether or not I could have a healthy pregnancy was my number 1 concern when I was diagnosed, because Mike and I had already decided we were ready to start our family. Even before I knew fully what the disease was and how it could be treated, I wanted to know if we could still have children. It was such a scary time, not only because I was diagnosed with an incurable, chronic disease, but because I didn't know what it all meant for our family. Could I still get pregnant? Am I at an increased risk of complications?

The concern comes from the fact that IBD is usually diagnosed during a woman's prime childbearing years. The good news is that women with IBD have fertility rates that are similar to the general population. Low birth rates among women with IBD usually are related to choice, not IBD-related infertility. My doctor assured me that if I could achieve remission, I could have healthy, successful pregnancies. {And as I mentioned yesterday, being on Humira would be safe for me and a baby during pregnancy}. It should be noted that some IBD medications can decrease fertility in men.

While Crohn's is not {necessarily} the cause of our infertility, there are certain complications that have to be considered. Disease activity, surgeries {because of scarring}, and certain medications can affect fertility. If your disease is active, inflammation can cause problems in your fallopian tubes and ovaries. That's even what they thought when I went in for my laparoscopy: that I had scarring on my fallopian tube due to inflammation related to Crohn's. That ended up not being the case, but they did find endometriosis. And there is some research that suggests that women with endometriosis are 80% more likely to also be diagnosed with IBD. So Crohn's probably didn't cause my endometriosis, but my endometriosis might have been the cause of my Crohn's {fun, huh?}. 

There does seem to be a higher instance of disease activity during pregnancy in UC patients, rather than Crohn's patients. But whether you have Crohn's or UC, it's never a good time to have a flare; it is definitely not good to have one while you are pregnant. It is why achieving remission is so critical if you also want to conceive. Active IBD itself is associated with poor pregnancy outcomes. So women who are flaring during the time of conception are more likely to flare during pregnancy, and active disease during pregnancy can be unsafe for both mother and baby. 

Is Humira safe during pregnancy? I touched on this briefly yesterday, but wanted to reiterate that {for me}, the risks associated with discontinuing my medication are higher than the known risks of the medication itself. And we have had multiple tests to ensure that our miscarriage was not associated with Crohn's, Humira, or any other underlying autoimmune issues.

So what does all of that mean for us? It means:
  • I needed to achieve and maintain remission {something I have been able to do for 3 years...the best possible situation for someone trying to conceive with Crohn's Disease}
  • Because I am currently in remission, I will likely stay in remission during pregnancy
  • The risk of me going off Humira to try to get pregnant was too high and not worth it; it was better and safer {for both me and potential baby} to stay on Humira
  • Regardless of my disease activity, I will automatically be considered a high-risk pregnancy because I have Crohn's. I knew that going in to the process, and it's part of why I chose the doctors I did.
  • All of my decisions have been made with extensive prayer, research, and consultation with a team of doctors
My Crohn's Disease and our infertility are not related {thankfully}. But there are extra considerations we have to make in our journey to build our family. So while it stinks that we have had to face both life-altering issues, we know that both are just part of the story that the Lord is writing for us.

*Research/information taken from NCBI, Up to Date, and CCFA

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