I’m not a doctor but I am a woman and I feel this is something that goes beyond the doctors office. Before IBD and surgery I didn’t really see children in my life plan. I preferred the idea of sitting on a beach in the south coast of France with a glass of wine, rather than at Disney on ice. I’m only 22 and kids still aren’t at the forefront of my mind, but because of how my surgeries effect my whole body, it’s a topic I’m reconsidering. This is down to the fact my fertility might be compromised, or my options might be taken away altogether; meaning I’m warming to the idea of Disney on ice.
With IBD, possible complications surrounding fertility or pregnancy lie in the medication more so than the disease itself. According to consultant gynaecologist Miss Meg Wilson from www.london-gynaecology.com and ‘labour ward lead’ at The Whittington Hospital, IBD itself won’t effect fertility per se, but the medication or impact of surgery may effect the whole process. Although pregnancy will effect everyone differently, women with IBD who are pregnant are defined as ‘high risk’. Being within the parameters of ‘high risk’, it ensures mother and baby are kept as healthy as possible and can be kept under stronger surveillance from a medical team.
There are more studies being done to confirm the safety of biological drugs such as Infliximab and Adalimumab. However, medication such as methotrexate and steroids can impact a pregnancy; so it’s best to talk to your doctors before family plans are made. Ultimately Miss Wilson states, if you have IBD and are looking to start a family, all it takes is planning. She advises, “being in the best health before falling pregnant and not doing it in a flare up, as well as informing your medical team, will give you the best chance of having a successful pregnancy”.
According to the IA support, many women with stoma’s and internal pouches have successful pregnancies, but there are potential risks to consider. It’s key to remember this effects everyone differently, and the numbers on how bowel surgery effects fertility, or the ability to fall pregnant naturally aren’t exact. That said Miss Wilson notes, the stoma itself won’t impact fertility but the adhesions around the fallopian tubes, and the risk of infection may complicate matters. The surgical scarring can block the fallopian tubes from producing an egg; hence a difficulty in conceiving naturally. Miss Wilson says, this doesn’t mean someone with a blocked fallopian tube is incapable of having children, and there are lots of other options you may want to explore. IVF for example bypasses the fallopian tubes, and this can be a good avenue for those having difficulties after bowel surgery.
Those who’ve had a subtotal colectomy, or permanent bowel surgery aren’t at the same risk as someone with a j-pouch; however this is case dependent. For those with a j-pouch the risk of reduced fertility is higher than permanent bag surgery due to the nature of the procedure. It isn’t impossible to have a child when you have a pouch; there are many success stories; but the conclusion is that doctors can’t predict how stoma or j-pouch surgery will effect fertility in every single case. In spite of this, and evaluating those who’ve had j-pouch surgery in the past, there is said to be a risk of a 30-50% reduction in fertility when someone undergoes pouch surgery (FYI: These numbers aren’t exact but common in my research).
I’ve been advised to go away and have kids before any further surgery. Part of the reason I’ve decided to rethink the South of France vs. Disney on ice debate is an element of control over my body, and my future. Before IBD and surgery, I chose to keep the idea of kids on the back-foot because (to my knowledge) my fertility was intact, and that gave me the choice whether to have them or not. The moment someone else took control of my body and my future, was the moment I decided I wanted that control back in my hands; mostly because the idea of starting a family doesn’t just effect me.
I wish I was given the option to see an OBGYN after my first surgery, or even at the start of my IBD treatment; regardless of possible surgery or not. For me, the scariest part is not having control over my body. This is a decision that’s completely out of my hands. Due to the magnitude of this decision and after a chat with my surgeon, Ive decided I want to see a gynaecologist to explore my options.
At the end of the day, it’s about talking to your medical team to give you the best chance and keep you as safe as possible.