1. Conception and Fertility in Women With IBD

2. Effects of IBD on Fertility Women Women –UC: normal fertility rate overall (92.2%) 1,2 IPAA reduces fertilityIPAA reduces fertility –CD: normal fertility, but pelvic inflammation may block fallopian tubes 3 –Voluntary childlessness higher for IBD patients 4 Men Men –Reversible sperm abnormalities with sulfasalazine 5 –Azathioprine: Semen analysis normal with immunomodulators 6 –Methotrexate caused temporary low sperm count in animals 7 1 Willoughby CP, Truelove SC. Gut. 1980;21:469-474. 2 Kane SV. In Kirsner JB, Shorter RG, eds. Inflammatory Bowel Disease. 4th ed. 1995. 3 Järnerot G. Scand J Gastroenterol. 1982;17:1-4. 4 Baird DD, et al. Gastroenterology. 1990;99:987-994. 5 Kornbluth A, Sachar DB. Am J Gastroenterol. 1997;92:204-211. 6 Rajapakse RO, et al. Am J Gastroenterol. 2000;95:684-688. 7 Johnson FE, et al. J Surg Oncol. 1994;55:175-178.

3. Effects of CD on Female Fertility: Conflicting Findings In 5 studies, inability of patients to conceive because of CD ranged from 12% to 67% 1-5 In 5 studies, inability of patients to conceive because of CD ranged from 12% to 67% 1-5 Risk of inability to conceive was higher in patients with large-bowel disease than in those with small-bowel disease 1-4 Risk of inability to conceive was higher in patients with large-bowel disease than in those with small-bowel disease 1-4 –Difference sometimes significant 1 –No difference 5 Chances of conceiving increased after surgery for CD 2 Chances of conceiving increased after surgery for CD 2 1 Fielding JF, Cooke WT. Br Med J. 1970;2:76-77. 2 De Dombal FT, et al. Br Med J. 1972;3:550-553. 3 Homan WP, Thorbjarnarson B. Arch Surg. 1976;111:545-547. 4 Khosla R, et al. Gut. 1984;25:52-56. 5 Mayberry JF, Weterman IT. Gut. 1986;27:821-825.

4. Female Fertility After IPAA Fecundability Ratio Number of Menstrual Periods Observed (time to pregnancy) P Value Reference population 1914 Patients before diagnosis 1.4698.002 Patients before colectomy 1.0184.92 Patients after IPAA 0.20149<.0001 Adapted from Gastroenterology, Vol 122, Olsen KØ, Juul S, Berndtsson I, Öresland T, Laurberg S, Ulcerative Colitis: Female Fecundity Before Diagnosis, During Disease, and After Surgery Compared with a Population Sample, pages 15-19, Copyright 2002 with permission from Elsevier. (n=343)

5. Cumulative Incidence of Pregnancy Within 5 Years Adapted from Gastroenterology, Vol 122, Olsen KØ, Juul S, Berndtsson I, Öresland T, Laurberg S, Ulcerative Colitis: Female Fecundity Before Diagnosis, During Disease, and After Surgery Compared with a Population Sample, pages 15-19, Copyright 2002 with permission from Elsevier. Time to Pregnancy (months) 60 0.0 1.0 0.8 0.6 0.4 0.2 Cumulative Incidence of Pregnancy 048362412 After surgery Before diagnosis Reference Before surgery

6. Surgical Approaches to Minimize Infertility Possibly delay pelvic surgery Possibly delay pelvic surgery Minimize septic complications Minimize septic complications Decrease adhesion formation Decrease adhesion formation –Ferric hyaluronate adhesion-prevention gel –Pexing ovaries Laparoscopic procedures Laparoscopic procedures

7. IBD and Conception: Summary Close to normal fertility with UC, decreased after IPAA Close to normal fertility with UC, decreased after IPAA Conflicting findings regarding influence of CD on ability to conceive Conflicting findings regarding influence of CD on ability to conceive Conflicting findings regarding influence of surgery for CD on ability to conceive Conflicting findings regarding influence of surgery for CD on ability to conceive Some IBD treatments may cause sperm abnormalities in men Some IBD treatments may cause sperm abnormalities in men