Colon to Rectum
Gastroenterology. 2024;166(5):802–14.e18
Histologic remission in inflammatory bowel disease and female fertility: A nationwide study
Background and aims: Inflammatory bowel disease (IBD) is linked to reduced female fertility, but it is unclear how fertility rates vary by histologic disease activity.
Methods: Nationwide IBD cohort of Swedish women aged 15 to 44 years. The authors examined fertility rates during periods with versus without histologic inflammation (n = 21,046; follow-up, 1990–2016) and during periods with versus without clinical activity (IBD-related hospitalization, surgery, or treatment escalation) (n = 24,995; follow-up, 2006–2020). Accounting for sociodemographics and comorbidities, they used Poisson regression to estimate adjusted fertility rate ratios (aFRRs) for live births conceived during 12-month periods of histologic inflammation (vs. histologic remission) and 3-month periods of clinically active IBD (vs. quiescent IBD).
Results: During periods with versus without histologic inflammation, there were 6.35 (95% confidence interval [CI]: 5.98–6.73) and 7.09 (95% CI: 6.48–7.70) live births conceived per 100 person-years of follow-up, respectively, or 1 fewer child per 14 women with 10 years of histologic inflammation (aFRR = 0.90; 95% CI: 0.81–1.00). In women with histologic inflammation, fertility was similarly reduced in ulcerative colitis (aFRR = 0.89; 95% CI: 0.78–1.02) and Crohn’s disease (aFRR = 0.86; 95% CI: 0.72–1.04). Clinical IBD activity was associated with an aFRR of 0.76 (95% CI: 0.72–0.79) or 1 fewer child per 6 women with 10 years of clinical activity. Fertility was reduced in clinically active ulcerative colitis (aFRR = 0.75; 95% CI: 0.70–0.81) and Crohn’s disease (aFRR = 0.76; 95% CI: 0.70–0.82). Finally, among women with clinically quiescent IBD, histologic inflammation (vs. histologic remission) was associated with reduced fertility (aFRR = 0.85; 95% CI: 0.73–0.98).
Conclusions: An association between histologic and clinical activity and reduced female fertility in Crohn’s disease and ulcerative colitis was found. Notably, histologic inflammation was also linked to reduced fertility in women with clinically quiescent inflammatory bowel disease.