Can Crohn’s disease affect my fertility at the age of 28?

Question

Hello doctor,

I am a 28-year-old woman who has just been told that I likely have Crohn’s disease after experiencing repeated diarrhea, weight loss, and abdominal cramps. I am very scared about the possibility of needing surgery in the future. Is that common? I have a few more concerns, like:

Can Crohn’s disease affect fertility or pregnancy outcomes?
I have also heard about strict diets such as the low-FODMAP diet or the specific carbohydrate diet. Are these truly helpful?
I am worried about the long-term side effects of medications such as steroids and biologics. How do doctors decide when to escalate treatment?
Since I am young, will this disease shorten my lifespan or affect my quality of life?
Are there support groups or counseling options for women dealing with Crohn’s disease?

Please help.

Thank you in advance.

Answer 1

Hello,

Welcome to iclinq.com.

I can understand this is very annoying for you, but yes, we will deal with it.

Surgery is a reality for many people with Crohn's disease (a chronic inflammatory bowel disease where the immune system attacks the digestive tract), but it is far from inevitable for everyone. Current statistics suggest that about 50 to 70% of people with Crohn's will require surgery at some point in their lives. However, the goal of modern treatment is to prevent the need for surgery by using medications to control inflammation and achieve deep remission (a state where symptoms and inflammation are minimal or absent). Surgery is typically reserved for complications that do not respond to medication, such as:

Strictures (narrowing of the intestine due to scar tissue).
Fistulas (abnormal tunnels or connections between the intestine and other organs or skin).
Severe bleeding (bleeding that cannot be controlled with medicines).

Think of surgery as a tool to manage complications, not as a failure of treatment.

Women with Crohn's disease can have healthy pregnancies and healthy babies. The most crucial factor is to have your disease under good control before you conceive. Active inflammation (ongoing irritation and damage in the intestine) can reduce fertility and increase the risk of complications such as preterm birth (baby born too early) or low birth weight (baby born smaller than normal). When the disease is in remission, fertility rates are similar to those without Crohn's, and pregnancy outcomes are excellent.

It is essential to have a preconception discussion (planning conversation before trying to get pregnant) with your gastroenterologist (digestive system specialist) and obstetrician (pregnancy and childbirth specialist). Many medications for Crohn's, including biologics (advanced medicines that target specific parts of the immune system) and most immunomodulators (medicines that regulate the immune system), are considered safe to continue during pregnancy. The risk of a disease flare (sudden worsening of symptoms) is far greater than the risk of continuing the medication.

Diet plays a significant role in managing symptoms, but it is not a cure for the underlying inflammation. The low-FODMAP diet (a diet that limits certain fermentable carbohydrates that can cause gas and bloating) is often very helpful for managing irritable bowel syndrome (IBS)-like symptoms such as gas, bloating, and diarrhea. It is best undertaken with the guidance of a registered dietitian.

The specific carbohydrate diet (SCD) is a very restrictive diet that some patients anecdotally (based on personal experience rather than scientific proof) report as helpful. However, strong scientific evidence for its effectiveness is limited.

The most important dietary advice is to ensure you are getting adequate nutrition, especially during a flare. I strongly recommend working with a dietitian who specializes in inflammatory bowel disease (IBD) to create a personalized plan that avoids your individual trigger foods while ensuring you do not become malnourished.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.