Assisted reproduction in IBD

January 4, 2022

Issue 01

Clinical Question

How effective is assisted reproductive therapy in women with IBD?

Editor’s Bottom Line

Assisted reproductive technology is less likely to lead to a live birth among patients with Crohn’s disease who have required surgery and those with ulcerative colitis who have failed ileal pouch-anal anastomosis. These patients may benefit from early referral to a fertility specialist.

Reference

Laube R, Tran Y, Paramsothy S, et al. Assisted Reproductive Technology in Crohn’s Disease and Ulcerative Colitis: A Systematic Review and Meta-Analysis. Gastroenterol. 2021;116(12):2334–44; https://journals.lww.com/ajg/Fulltext/2021.aspx

Synopsis

Infertility rates among women with active IBD and those who have had ileal pouch-anal anastomosis (IPAA) have been reported to be as high as 63%. To shed light on the role of assisted reproductive technology (ART) in addressing infertility in IBD patients, Australian researchers systematically reviewed 11 randomized controlled trials or cohort studies on the topic, including data from 30,130 patients with IBD and 156,353 non-IBD controls. They performed a meta-analysis of four of these studies, all of which documented live birth and pregnancy rates in IBD patients and non-IBD patients, including data from 250 women with Crohn’s disease (CD), 522 with ulcerative colitis (UC), and 53,073 controls. Most studies examined the efficacy and safety of in vitro fertilization (IVF).

The meta-analysis revealed that, compared to women without IBD, there were no differences in pregnancy rates per cycle of assisted reproductive technology among women with IBD. However, the chance of a live birth per cycle of reproductive treatment was significantly lower among those with CD (Odds Ratio [OR]: 0.67; 95% Confidence Interval [CI], 0.53–0.85). Additionally, women who had undergone CD-related surgery were less likely than women with medically managed CD who had not undergone surgery to have a live birth (OR per embryo transfer: 0.58; 95% CI, 0.37–0.90).

Among women with UC, failed IPAA was significantly associated with a lower rate of live birth with ART (Hazard Ratio: 0.36; 95% CI, 0.14–0.92).

There were no significant differences in rates of preterm birth, low birth weight or congenital abnormalities among women with or without IBD who underwent ART.

Details

Study Design: Systematic review and meta-analysis

Funding: None

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2a