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Women with IBD equally successful with in vitro fertilization as general population
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A recent study found that in vitro fertilization is as successful in women with inflammatory bowel disease when compared with the general infertile population.
“We undertook this research project because inflammatory bowel disease often affects women of child-bearing age and there are concerns about its effects on fertility,” Adam S. Cheifetz, MD, director of the Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, and associate professor of medicine at Harvard Medical School, and Sonia Friedman, MD, from Brigham and Women’s Hospital, told Healio Gastroenterology. “It is known that patients with ulcerative colitis who have undergone total proctocolectomy are at a significant risk of infertility. In this population, and in 15% of the general population, in-vitro fertilization (IVF) may be necessary.”
Aiming to compare the live birth rate in women with and without IBD after in vitro fertilization (IVF), Cheifetz, Friedman, and colleagues, performed a matched retrospective cohort study involving 121 women with IBD (Crohn’s disease, n = 49; ulcerative colitis, n = 71; unclassified IBD, n = 1) and 470 women without IBD who underwent IVF from 1998 through 2011 at Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, or affiliated infertility centers. The primary outcome was cumulative live birth rate after no more than six IVF cycles.
Adam S. Cheifetz
Sonia Friedman
The investigators observed comparable live birth rates among women with and without IBD; the rate was 69% (95% CI, 58%-79%) in patients with UC, 57% (95% CI, 44%-71%) in patients with CD and 53% (95% CI, 48%-57%) in patients without IBD.
After the first IVF cycle, pregnancy occurred in 49.3% of patients with UC, 42.9% of patients with CD and 40.9% of patients without IBD. Furthermore, live birth after the first IVF cycle occurred in 33.8% of patients with UC, 30.6% of patients with CD and 30.2% of patients without IBD.
“It was unknown whether IBD influenced the success rate of IVF. Combining the data from two large tertiary referral centers and using a matched retrospective cohort study design, we were able to show that patients with Crohn’s disease and ulcerative colitis undergoing IVF had similar rates of live birth when compared to controls (non-IBD IVF population),” Cheifetz and Friedman said. “We feel that this data is important in clinical practice when discussing fertility in patients with IBD, particularly patients considering surgery.”
“The information provided in this study is potentially reassuring and provides further hope for infertile couples with IBD,” Millie D. Long, MD, MPH, from the division of gastroenterology and hepatology at University of North Carolina, Chapel Hill, wrote in an accompanying editorial. “However, we also must recognize the limitations of these data from selection bias and the potential lack of generalizability based on the medication use patterns of the cohort. Most importantly, there may be a lack of knowledge, among both the provider and patient populations, on the importance of continuing medical therapies in women with IBD during conception and pregnancy to maintain remission. My hope is that we can improve educational efforts, correct misconceptions, and encourage women with IBD that assisted reproductive techniques such as IVF can be effective.” – by Adam Leitenberger
Disclosures: Cheifetz reports he has performed consulting and/or research for Janssen, AbbVie, Takeda and Pfizer. Friedman reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures. Long reports she has consulted for AbbVie and Salix.
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