Is assisted reproductive technology safe for women with ulcerative colitis, Crohn's Disease?

Assisted reproductive technology (ART) is both safe and effective in women with ulcerative colitis and medically managed Crohn’s disease (CD), with comparable pregnancy and live birth rates to those of the general population, a study has shown.

“However, within the limitations of the available literature, current data suggest that efficacy is reduced in women with CD-related surgery and ileal pouch-anal anastomosis (IPAA) failure,” the authors said.

A systematic review and random-effects meta-analysis were conducted until May 2020. Eleven studies were eligible for the systematic review and four for the meta-analysis. Pregnancy and live birth rates per cycle of ART were the primary outcomes.

Women with CD, with and without previous surgery, showed no difference from the general population in pregnancy rates (odds ratio [OR], 0.69, 95 percent confidence interval [CI], 0.45–1.05) but had reduced live births (OR, 0.67, 95 percent CI, 0.53–0.85) per cycle of ART.

In women with medically managed CD, ART live birth rates were not reduced but 49–71-percent lower following CD-related surgery.

Pregnancy rates (OR, 0.99, 95 percent CI, 0.63–1.55) and live birth rates (OR, 0.88, 95 percent CI, 0.67–1.17) were not different in women with UC, but live birth rates were reduced after IPAA failure (hazard ratio, 0.36, 95 percent CI, 0.14–0.92).

Of note, significant safety signals were not identified in two studies.

“Greater gastroenterologist awareness of ART is needed to facilitate timely fertility therapy referral when indicated, particularly in CD,” the authors said.