How IBD Affects Fertility in Men

Illustration of male sperm cells fertilizing a female egg
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For the purposes of many research papers, infertility is defined as being unable to conceive a child for a year (12 months) while having regular unprotected intercourse. For women that means that a pregnancy does not occur and for men that their partner does not achieve a pregnancy while trying for a year.

IBD and Reduction of Fertility

In general, the effect of inflammatory bowel disease (IBD) on fertility is unclear.

Some studies have shown that men and women with IBD don't have fertility rates that are much different from people who don't have IBD. Other studies have shown that men with IBD may have some reduction in fertility, and this might particularly be the case for men with Crohn's disease.

One aspect of IBD that is thought to be at the center of the reduction in fertility is not actually a physical problem but is instead from a voluntary decision not to have children. People with IBD are often concerned that the disease may be passed on to children, which could cause them to choose not to have children at all.

However, there are many physical aspects of IBD that can affect fertility too, including some medications, having surgery, poor nutrition, psychological issues, as well as general overall health. This article will cover how those factors can affect fertility in men. Men (and women) with IBD who have concerns about their current or future fertility should ask their gastroenterologist for a referral to a fertility specialist if needed.

How IBD Affects Male Fertility

Research on how IBD affects male fertility is lacking in scope and depth; there is not much research to draw on, which makes it is difficult to know exactly how much fertility is affected in men with IBD.  There are, however, a few situations where it's known that fertility in men with IBD could be affected.

Disease state. As might be expected, disease activity does have an effect on a man's ability to father a child. Men who are in a moderate to severe IBD flare-up have higher rates of erectile dysfunction, and so getting a flare-up under control is going to be important before starting a family.

Medications. Most medications used to treat IBD have not been shown to affect fertility significantly in men, with one exception. Azulfidine (sulfasalazine), which is used to treat ulcerative colitis, can affect male fertility. A temporary form of infertility is caused by the sulfa component of this drug in up to approximately 60 percent of men who take it. About two months after stopping Azulfidine, fertility goes back to what it was before the drug was started.

Surgery. Surgical procedures that are done to treat IBD could affect male fertility, even though the surgery does not involve the male genital organs. The type of surgery that seems to have the most potential for causing problems with fertility is those that involve incisions near the rectum. This includes proctocolectomy with ileal pouch-anal anastomosis (IPAA), which is more commonly called j-pouch surgery and colostomy surgery and ileostomy surgery.

One small study showed that 2 patients out of 18 had problems with ejaculation after IPAA surgery. Having surgery done at a specialty center by surgeons and other healthcare practitioners who specialize in IBD and have completed many surgeries of this type may bring the risks even lower.

It is a rare occurrence, but infertility can happen after these types of IBD surgery. The important thing to remember about this is that there are effective treatments available for men who experience a reduction in fertility. One drug treatment, in particular, has been shown to help in as many as 79 percent of cases.

For this reason, however, sperm banking is worth considering for men who want to have a family and are going to undergo surgery for their IBD that might affect their fertility.

IBD Medications and Their Impacts

The medications to treat IBD may have an effect on the ability to father a child. In some cases, it may be better to switch medications or to discontinue a medication before starting a family. This will be different for every patient and their family, so it's important to discuss IBD medications with a gastroenterologist before deciding to have a baby.

6-MP. A few studies on 6-mercaptopurine (6-MP) in men who fathered children showed that there could be an increased risk of pregnancy complications or abnormalities. Other studies showed no risk of problems with the pregnancies where them fathers were taking 6-MP. Because of this, it's recommended that healthcare providers have a conversation with men taking 6-MP who want to be a father and discuss the potential for problems when fathering a child.

Azulfidine. There has been at least one study that showed that there could be a small risk of birth defects in children born when the father was taking Azulfidine. Therefore, it might be recommended that men with IBD who want to father a child switch to another medication.

Methotrexate. For women who want to become pregnant, the methotrexate must be stopped (it is a Pregnancy Category X drug). For men, it's also recommended that the methotrexate be stopped about 3 or 4 months before starting a family, as the drug can stay in the body for a few months.

Other Aspects of IBD Worth Noting

It's not only medication that can have an effect on fertility and a pregnancy, a flare-up, poor nutritional status, and the day-to-day of living with a chronic illness also pose challenges.

Living with chronic illness. A chronic illness is difficult to cope with, and IBD is one that affects many aspects of people's lives. Having a healthy body image can be a struggle for some people with IBD. IBD may leave a person feeling as though they are unattractive or undesirable to a partner. This could have the effect of lowering the sex drive, which in turn reduces the chances of getting pregnant.

IBD and depression. Another factor to consider is the connection between IBD and depression, which also affects a man's desire to have sex. Having a healthy sexual relationship and having children are difficult when coping with IBD and IBD-related complications. Talking to a gastroenterologist about these issues can help, because they can be related to the IBD. In some cases, getting guidance from a mental health care professional could be recommended. There are treatments that can help significantly in learning to live with a chronic illness, and even having someone to talk to about it may help.

Flare-ups. Active inflammation, which is what happens in the digestive system during an IBD flare-up, can affect many other body systems. The inflammation also has a negative effect on fertility, in particular when inflammation is considered to be severe. Studies have also shown that men with IBD and severe inflammation have higher rates of erectile dysfunction.

Nutrition. There is not a lot of research on how nutritional status can affect men with IBD who want to father children. There is some evidence that a zinc deficiency may lower fertility, and many patients with Crohn's disease have been shown to have low zinc levels. Nutrition is important for any prospective father and may be especially important to men with Crohn's disease who have inflammation in the small intestine that's preventing good absorption of vitamins.

Remaining childless. People with IBD sometimes decide not to have children because of a concern that the IBD could be passed on. IBD does have a genetic part, but it's not a given that a parent with IBD will have a child who develops IBD. The risk of passing IBD on to a child varies depending on the study, but it is thought to be between 10 percent and 20 percent. It's recommended that people with IBD talk with their physicians about these concerns because it might be reassuring to understand how low the risks are.

A Note From Verywell

In many cases, having a diagnosis of IBD is not going to lead to another diagnosis of infertility. But there are particular areas of concern for men with IBD, especially for those who have particular types of surgery or who are in a disease flare-up.

As with many aspects of  IBD, getting the inflammation under control is going to be the biggest factor in offering the best chance of becoming a father. Talking about becoming a father with a gastroenterologist sooner rather than later can help. If necessary, a gastroenterologist could make a referral a fertility specialist who is trained in helping diagnose and treat problems with fertility.

Sources:

Berndtsson I, Oresland T, Hultén L. "Sexuality in patients with ulcerative colitis before and after restorative proctocolectomy: a prospective study.Scand J Gastroenterol. 2004;39:374–379.

El-Tawil AM. "Zinc deficiency in men with Crohn's disease may contribute to poor sperm function and male infertility." Andrologia. 2003 Dec;35:337-341.

Tavernier N, Fumery M, Peyrin-Biroulet L, Colombel JF, Gower-Rousseau C. "Systematic review: fertility in non-surgically treated inflammatory bowel disease." Aliment Pharmacol Ther. 2013;38:847–853.

Timmer A, Bauer A, Dignass A, Rogler G. "Sexual function in persons with inflammatory bowel disease: a survey with matched controls." Clin Gastroenterol Hepatol. 2007 Jan;5:87-94.

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