Copyright ©The Author(s) 2019.
World J Gastroenterol. Sep 28, 2019; 25(36): 5423-5433
Published online Sep 28, 2019. doi: 10.3748/wjg.v25.i36.5423
Table 1 Factors associated with sexual dysfunction and erectile dysfunction in inflammatory bowel disease patients
Factors associatedFactors not associated
AnxietyDisease activity
Impaired overall quality of lifeBiological therapies
Corticosteroids and psychotropic drugs
Table 2 Summary of the major causes of infertility in the general population and a few specific situations related to inflammatory bowel disease
General risk factors:
Age: High fertility rate around 25 yr, then gradually reduce and more quickly after 35 yrGeneral risk factors:
High age
Addiction and lead poisoning
Ovulation disorders: Obesity or thinness/hyperprolactinaemia/polycystic ovary syndrome/hypothalamic amenorrhoea, etcOligoasthenoteratospermia (the most common cause for male infertility)
Azoospermia (hypogonadism induced or blockages)
Diseases with chronic inflammation
Mechanical obstruction:
Tubal obstruction (frequent cause after a salpingitis or endometriosis)
Ileal pouch-anal anastomosis by laparotomy, Crohn’s disease with severe pelvic inflammation with or without prior surgery
Uterine malformation, uterine synechiae or endometriosis
Cervical stenosis
Table 3 What the gastroenterologist should do in the case of infertility for a patient with inflammatory bowel disease
ConsiderCauses/mechanismsWhat the gastroenterologist should do
Voluntary childlessnessApprehension about fertility/potentially adverse pregnancy outcomes/medication safetyInformation and accurate counseling on medications/risk of transmission/pregnancy outcomes
Correcting misconceptions
MisconceptionsProvide preconceptual cares
Risk of IBD in the offspringInformation about genetics
Involuntary childlessnessSexual dysfunctionPsychological support
Refer to sexologist
Sildenafil therapy for post surgery erectile dysfunction
SurgeryInformations before surgery
IPAA laparoscopy access
Disease activityControl disease activity
Psychological factorsCounseling and psychological support
MedicationsStop sulfasalazine and switch to mesalazine
Stop methotrexate
Sperm banking before surgery
Table 4 Pregnancy outcomes in the general population compared with inflammatory bowel disease patients
General populationIBD patients
Infertility (1 yr)10%-20%Idem except after IPAA with laparotomy access
Spontaneous miscarriage of 1st quarter15%Idem
Ectopic pregnancy2%Idem except in case of prior surgery[80]
Risk of developing IBD for the offspring0.5%UC 2%-CD 5% IBD both parents: 30%
Pregnancy with no events75%Idem