By Dr. Elisa Pérez (Gynaecologist – Reg. No. 203311163).
Crohn’s disease is an inflammatory bowel disease that, by itself, does not necessarily affect the fertility of those who have it. In other words, simply having this condition does not reduce the chances of achieving pregnancy. However, there are factors related to disease activity, such as treatments or certain surgeries, that are important to be aware of.
It is a chronic inflammatory condition that most commonly affects the small intestine and the colon, although it can involve any part of the digestive tract. The disease is characterized by alternating flare-ups and periods of remission.
During these flare-ups, the most common symptoms are abdominal pain, persistent diarrhea, weight loss, fatigue, and anemia. In some cases, this can lead to complications such as fistulas, strictures, or the need for intestinal surgery. Beyond digestive symptoms, the disease can also cause a systemic inflammatory state and nutritional deficiencies that may influence hormonal balance and reproductive function.
The diagnosis is usually made in young people, many of them during their reproductive years, which is why concerns often arise about its possible impact on fertility.
The origin of Crohn’s disease is complex and is usually due to multiple factors, such as genetic predisposition, immune system alterations, changes in the intestinal microbiota, and environmental factors such as diet, smoking, or certain infections.
If the disease is in remission, a woman’s fertility is comparable to that of the general population — in other words, it does not affect it in any way. However, during active phases, temporary difficulties in conceiving may arise.
Fertility may be affected by:
On the other hand, some surgical procedures, particularly those involving the colon and rectum, may increase the risk of adhesions, which could make natural conception more difficult. Even so, many women achieve pregnancy after appropriate medical management.
In men, Crohn’s disease can also have an impact, although in most cases it is reversible and mainly depends on the clinical condition. In fact, permanent infertility caused by this disease is very uncommon. That said, chronic inflammation, significant weight loss, or certain nutritional deficiencies may affect semen quality.
In addition, some medications used to treat the disease, such as sulfasalazine, may temporarily alter sperm count or motility. However, these effects usually improve once the medication is adjusted under medical supervision.
One of the most common concerns is whether medication can harm fertility or the development of pregnancy. In general, keeping the disease under control is essential, both for overall health and to prevent possible effects on fertility, especially when trying to conceive.
The key to success lies in planning pregnancy when the disease has been well controlled (in remission) for at least six months. This “window of remission” is the ideal scenario to ensure that the body is nutritionally prepared and to reduce the risk of relapse during pregnancy.
Inflammatory activity poses a greater risk to fertility and pregnancy than many of the available treatments. Therefore, pregnancy planning should be carried out in coordination between the digestive disease specialist and the assisted reproduction or gynecology team.
Most of the medications used to treat this disease allow for a safe attempt at pregnancy, although each case should be evaluated individually.
European Crohn's and Colitis Organisation (ECCO).
European Crohn's and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation.
European Crohn's and Colitis Organisation (ECCO).
2023;
Journal of Crohn's and Colitis. 17(1):1-27
Guía clínica europea (texto completo):
https://academic.oup.com/ecco-jcc/article/17/1/1/6675338
European Crohn's and Colitis Organisation (ECCO).
The Second European Evidenced-Based Consensus on Reproduction and Pregnancy in Inflammatory Bowel Disease.
European Crohn's and Colitis Organisation (ECCO).
2015;
Journal of Crohn's and Colitis. 9(2):107-124
Consenso europeo (texto completo):
https://academic.oup.com/ecco-jcc/article/9/2/107/439011
Kim MA, Kim YH, Chun J, Lee HS, Park SJ, Cheon JH.
The Influence of Disease Activity on Pregnancy Outcomes in Women With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.
European Crohn's and Colitis Organisation (ECCO).
2021;
Journal of Crohn's and Colitis. 15(5):719-732
Artículo científico (PubMed):
https://pubmed.ncbi.nlm.nih.gov/33175122/
Laube R, Paramsothy S, Leong RW.
Review of pregnancy in Crohn's disease and ulcerative colitis.
SAGE Publications.
2026;
Therapeutic Advances in Gastroenterology. 14:17562848211016242
Revisión científica (texto completo):
https://pmc.ncbi.nlm.nih.gov/articles/PMC8135214/
Akiyama S, Steinberg JM, Kobayashi M, Suzuki H, Tsuchiya K.
Pregnancy and medications for inflammatory bowel disease: An updated narrative review.
World Journal of Clinical Cases (Baishideng Publishing Group).
2023;
World Journal of Clinical Cases. 11(8):1730-1740
Revisión narrativa (texto completo):
https://pmc.ncbi.nlm.nih.gov/articles/PMC10037280/
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