Assisted Reproductive Therapy Safe in Women With IBD, but Efficacy Mixed

NEW YORK (Reuters Health) – Assisted reproductive therapy (ART) is safe in women with inflammatory bowel disease (IBD), with outcomes likely similar in women with ulcerative colitis (UC) and medically managed Crohn’s disease (CD) compared with the general population, suggest results of a systematic review and meta-analysis.

However, ART success rates are lower following CD-related surgery and after failed ileal pouch-anal anastomosis (IPAA).

“Referral for fertility therapy should therefore be initiated promptly in women with previous CD-related surgery failing to conceive naturally, and if possible, delay of elective IPAA formation until completion of childbearing should be considered,” the researchers advise in a paper in the American Journal of Gastroenterology.

It’s known that fertility may be reduced in women with active IBD or IPAA but the efficacy of ART in IBD is poorly documented, note Dr. Robyn Laube, with Macquarie University in Sydney, Australia, and co-authors.

To investigate, they reviewed 11 studies with a total of more than 30,000 women with IBD and 156,000 controls; four of these studies consisting of 250 women with CD, 522 with UC, and 53,073 controls were included in the meta-analysis.

Compared with the general population, women with CD (with and without prior surgery) had no significant difference in pregnancy rates (odds ratio, 0.69; 95% confidence interval, 0.45 to 1.05) but had fewer live births per ART cycle (OR, 0.67; 95% CI, 0.53 to 0.85).

ART live birth rates were not reduced in women with medically managed CD, but they were 49% to 71% lower after CD-related surgery.

Women with UC had no significant difference in either pregnancy rates (OR, 0.99; 95% CI, 0.63 to 1.55) or live-birth rates (OR, 0.88; 95% CI, 0.67 to 1.17), but live-birth rates were reduced after IPAA failure (hazard ratio, 0.36; 95% CI, 0.14 to 0.92).

The researchers caution that this analysis is “limited by the relative paucity of published work, with some studies including overlapping data,” and in most comparisons, the meta-analysis was driven by data from Danish studies.

“All studies included in this review were retrospective cohort designs, unable to adjust for important confounders, including disease activity, smoking status, and IBD medications, the latter of which may be beneficial for ART through reduced inflammatory burden. There is also significant heterogeneity among the studies in terms of method of ART and outcomes reported,” they say.

“In addition, the Danish studies note Danish patients with IBD are only referred for ART (which is publicly funded) if their disease is quiescent, which may limit the generalizability of their findings,” the authors add.

The study had no funding and the authors have no relevant disclosures.

SOURCE: The American Journal of Gastroenterology, online October 25, 2021.

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