Sexual health and fertility for individuals with inflammatory bowel disease

Table 1 Factors associated with sexual dysfunction and erectile dysfunction in inflammatory bowel disease patients

Factors associated	Factors not associated
Anxiety	Disease activity
Depression	Immunosuppressants
Impaired overall quality of life	Biological therapies
Fatigue
Corticosteroids and psychotropic drugs

Table 2 Summary of the major causes of infertility in the general population and a few specific situations related to inflammatory bowel disease

Women	Men
General risk factors:
Age: High fertility rate around 25 yr, then gradually reduce and more quickly after 35 yr	General risk factors:
	High age
	Tobacco
	Addiction and lead poisoning
Tobacco
Ovulation disorders: Obesity or thinness/hyperprolactinaemia/polycystic ovary syndrome/hypothalamic amenorrhoea, etc	Oligoasthenoteratospermia (the most common cause for male infertility)
	Sulfasalazine
	Azoospermia (hypogonadism induced or blockages)
Diseases with chronic inflammation
	Sulfasalazine
Mechanical obstruction:
Tubal obstruction (frequent cause after a salpingitis or endometriosis)
Ileal pouch-anal anastomosis by laparotomy, Crohn’s disease with severe pelvic inflammation with or without prior surgery
Uterine malformation, uterine synechiae or endometriosis
Cervical stenosis

Table 3 What the gastroenterologist should do in the case of infertility for a patient with inflammatory bowel disease

Consider	Causes/mechanisms	What the gastroenterologist should do
Voluntary childlessness	Apprehension about fertility/potentially adverse pregnancy outcomes/medication safety	Information and accurate counseling on medications/risk of transmission/pregnancy outcomes
		Correcting misconceptions
	Misconceptions	Provide preconceptual cares
	Risk of IBD in the offspring	Information about genetics
Involuntary childlessness	Sexual dysfunction	Psychological support
		Refer to sexologist
		Sildenafil therapy for post surgery erectile dysfunction
	Surgery	Informations before surgery
		IPAA laparoscopy access
	Disease activity	Control disease activity
	Psychological factors	Counseling and psychological support
	Medications	Stop sulfasalazine and switch to mesalazine
		Stop methotrexate
		Sperm banking before surgery

IPAA: Ileal pouch-anal anastomosis; IBD: Inflammatory bowel disease.

Table 4 Pregnancy outcomes in the general population compared with inflammatory bowel disease patients

	General population	IBD patients
Infertility (1 yr)	10%-20%	Idem except after IPAA with laparotomy access
Spontaneous miscarriage of 1st quarter	15%	Idem
Ectopic pregnancy	2%	Idem except in case of prior surgery[80]
Stillbirth	0.1%	Idem
Prematurity	7%	10%
Malformations	2.7%	Idem
Risk of developing IBD for the offspring	0.5%	UC 2%-CD 5% IBD both parents: 30%
Pregnancy with no events	75%	Idem

UC: Ulcerative colitis; CD: Crohn’s disease; IBD: Inflammatory bowel disease.