Will Crohn’s disease affect fertility in women?

Question

Hello doctor,

I am 27 and just got diagnosed with Crohn’s disease after months of stomach pain, diarrhea, and weight loss. My colonoscopy showed terminal ileum inflammation, and biopsy confirmed it. I have started Azathioprine and was offered a biologic too. How do we decide when to go for that? Also, I have a few more questions-

My CRP was 18, and my hemoglobin dropped to 9.8. Is that typical in active Crohn’s? I am anxious because I have heard it can affect fertility.
How are they connected? Should I freeze eggs now or wait?
How closely should a gastroenterologist monitor me early on? What symptoms should prompt urgent attention?
Can lifestyle changes slow disease progression realistically?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is entirely valid to feel overwhelmed right now, especially after a new Crohn’s diagnosis at 27. The inflammation in your terminal ileum, along with your symptoms, CRP (C-reactive protein) of 18 mg/dl (milligram per deciliter), and a hemoglobin of 9.8 g/dl (gram per deciliter) (which may reflect iron deficiency or chronic inflammation), are all typical in moderate to active Crohn’s disease.

Here are my suggestions for your concerns-

Azathioprine is used for long-term immune suppression, but since it can take weeks to months to fully work, biologics (like Infliximab or Adalimumab) are often considered early, especially if there is significant weight loss, anemia, or deep tissue inflammation, as in your case.
Many doctors now use a “top-down” approach where biologics are started early to prevent long-term complications like strictures or fistulas.
Fertility is usually not impaired in remission, but during active flares or surgery involving the pelvic area, it can be affected. So egg freezing may be a good conversation to have with a fertility specialist now, especially before you start immunosuppressive or potentially gonadotoxic medications.
Your gastroenterologist should monitor you quite closely at first, typically every few weeks, checking symptoms, blood tests (like CRP, hemoglobin, liver function, Azathioprine levels), and stool markers like calprotectin.
Urgent symptoms to watch for include persistent or worsening abdominal pain, fever, vomiting, signs of bowel obstruction, or significant bleeding.
As for lifestyle, while medications are the cornerstone of treatment, nutrition, stress management, sleep, and smoking cessation (if applicable) all matter. An anti-inflammatory diet (like a modified Mediterranean or low-FODMAP diet under dietitian guidance) may help.

I hope this helps.

Thank you and take care.

Regards.