Women with IBD at Risk for Reduced Fertility: Daily Dose

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Last week, we reported on findings from a study published in the journal Gastroenterology that aimed to compare the female fertility rate during periods with vs without histologic inflammation and clinical inflammatory bowel disease (IBD) activity.

The study

Researchers tapped data from the Swedish National Patient Register and the Swedish Prescribed Drug Register to identify women diagnosed with IBD between 1969 and 2017 and then compared fertility outcomes for individuals with and without histologic remission.

The study included a pair of non-mutually exclusive groups of women aged 15 to 44 years with IBD. The first group included 21 046 women diagnosed in 1990-2016 with longitudinal data on colorectal biopsies. The second comprised 24 995 women with IBD diagnosed in 2006-2020 with data on clinical IBD activity.

Researchers analyzed 2 measures of IBD activity, the primary exposure being periods of histologic inflammation and the secondary exposure, clinically active IBD. The study’s primary outcomes were fertility rate (live births per 100 person-years [PY] of follow-up) and fertility rate ratio (FRR; an estimate of <1.00 indicates reduced fertility).

The findings

Fertility rates among women with IBD during periods of histologic inflammation were decreased by 10% compared to periods of histologic remission. Further, the association between active inflammation and reduced fertility remained when the investigators restricted analyses to women whose IBD was clinically quiescent.

Investigators also reported lower fertility rates during clinically active IBD than when IBD was in clinical remission. Fertility rates were similarly reduced in both ulcerative colitis (UC) and Crohn disease (CD) during histologic inflammation and clinical IBD activity.

Authors' comment

"This nationwide study presents novel epidemiologic evidence of a reduced female fertility during periods of histologic inflammation vs periods of histologic remission in IBD. Our findings should motivate research toward a deeper understanding of the role of histologic inflammation of IBD in female fertility."

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