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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2016; 7(3): 361-369
Published online Aug 6, 2016. doi: 10.4292/wjgpt.v7.i3.361
Infertility in men with inflammatory bowel disease
Takeshi Shin, Hiroshi Okada
Takeshi Shin, Hiroshi Okada, Department of Urology, Dokkyo Medical University Koshigaya Hospital, Saitama 343-8555, Japan
Author contributions: Shin T designed the study, performed the literature review, and wrote the manuscript; Okada H collected data and analyzed them and performed critical revision of the manuscript for important intellectual content; all authors gave final approval of the version of the manuscript to be published.
Conflict-of-interest statement: The authors declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takeshi Shin, MD, Assistant Professor, Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya City, Saitama 343-8555, Japan. shintakeshi@nifty.com
Telephone: +81-48-9651111 Fax: +81-46-9651111
Received: April 5, 2016
Peer-review started: April 5, 2016
First decision: June 6, 2016
Revised: June 19, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: August 6, 2016
Processing time: 118 Days and 10 Hours
Abstract

Inflammatory bowel disease (IBD) predominantly affects young adults. Fertility-related issues are therefore important in the management of patients with IBD. However, relatively modest attention has been paid to reproductive issues faced by men with IBD. To investigate the effects of IBD and its treatment on male fertility, we reviewed the current literature using a systematic search for published studies. A PubMed search were performed using the main search terms “IBD AND male infertility”, “Crohn’s disease AND male infertility”, “ulcerative colitis AND male infertility”. References in review articles were used if relevant. We noted that active inflammation, poor nutrition, alcohol use, smoking, medications, and surgery may cause infertility in men with IBD. In surgery such as proctocolectomy with ileal pouch-anal anastomosis, rectal incision seems to be associated with sexual dysfunction. Of the medications used for IBD, sulfasalazine reversibly reduces male fertility. No other medications appear to affect male fertility significantly, although small studies suggested some adverse effects. There are limited data on the effects of drugs for IBD on male fertility and pregnancy outcomes; however, patients should be informed of the possible effects of paternal drug exposure. This review provides information on fertility-related issues in men with IBD and discusses treatment options.

Keywords: Crohn’s disease; Infertility; Inflammatory bowel disease; Male; Ulcerative colitis

Core tip: In men with inflammatory bowel disease (IBD), factors such as surgery, medications, disease activity, and poor nutritional status are thought to contribute to infertility. Surgery with rectal incision is associated with sexual dysfunction (e.g., erectile dysfunction, anejaculation, and retrograde ejaculation). Among medications, sulfasalazine causes reversible qualitative and quantitative semen abnormalities. No other medications seem to affect male fertility significantly. There are limited data on the effects of paternal exposure to IBD medications on pregnancy outcomes, but no significant increase in fetal risk has been noted except for thiopurines. Patients should be appropriately informed of possible effects of paternal drug exposure.