Can ulcerative colitis affect my fertility or pregnancy?

Question

Hello doctor,

I am a 31-year-old woman diagnosed with ulcerative colitis (UC) two years ago. I am currently on Mesalamine and occasionally take steroids during flare-ups. Recently, I have been having more frequent loose stools with mucus and a small amount of blood. My latest colonoscopy showed moderate inflammation up to the sigmoid colon.

I am planning to conceive soon, and I am worried about whether ulcerative colitis could affect my fertility or pregnancy. If I have a flare during pregnancy, could it harm the baby?
Should I continue Mesalamine while trying to conceive, or are there safer alternatives?
My recent tests also showed low vitamin D (18 ng/mL), and my gynecologist mentioned that this might impact fertility. Is that true?
Additionally, I have heard that birth control pills can sometimes worsen ulcerative colitis (UC) symptoms. Is it safe to use them?
Lastly, are there specific dietary or lifestyle changes that could help control bloating, loose stools, and anxiety during this time?
Could my gut symptoms be linked to hormonal changes or inflammation itself?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query, and I can completely understand your concern.

Managing ulcerative colitis (UC) while planning for pregnancy can be stressful, but with the right approach and stable disease control, most women go on to have healthy pregnancies and babies. Let me explain this step by step.

When UC is under control, your fertility is usually similar to that of women without UC.

Impact of active inflammation: Active UC can temporarily affect fertility because of inflammation, nutritional deficiencies, stress, and hormonal changes.

It is best to plan pregnancy after your disease has been in remission for at least three to six months to give yourself the best chance for a healthy outcome.

As for UC and pregnancy outcomes-

Pregnancy during a flare, conceiving while UC is active, may slightly increase the risk of miscarriage, preterm delivery, or worsening UC symptoms.
Pregnancy in remission, if UC is well-controlled before conception, most women have healthy pregnancies and babies. Maintaining remission before and during pregnancy is key.

Use of Mesalamine during your pregnancy-

Mesalamine (5-ASA) is considered safe during conception, pregnancy, and breastfeeding.
Continuing your medication helps prevent flares. Stopping suddenly can make inflammation worse and impact both your health and your baby’s.
Stick to the brand or formulation that works for you, as switching may sometimes cause mild intolerance.

Now the connection between Vitamin D and fertility-

Your vitamin D level is low (18 ng/mL). Vitamin D supports immune balance, hormone regulation, and egg quality, so deficiency may slightly affect fertility.
Your doctor might suggest you take 2,000 to 4,000 IU daily. And 50,000 IU weekly for six to eight weeks, then a maintenance dose.

Make sure you get enough calcium to support bone and reproductive health.

Now, about birth control pills and UC-

Oral contraceptives usually do not trigger UC flares.
Pills may slightly increase the risk of blood clots, especially if you are on steroids or less mobile.
If you have active UC or a history of clotting, talk with your gynecologist and gastroenterologist about safer options like a copper IUD (intrauterine device) or progestin-only pill.

Methods to maintain diet, gut health, and deal with bloating-

During flare-ups, eat low-residue foods like well-cooked vegetables, white rice or soft grains, and lean proteins. And avoid raw vegetables, salads, high-fiber grains, spicy/fatty foods, caffeine, and dairy if it worsens symptoms.

During remission, gradually reintroduce fiber and maintain a balanced diet.
Bloating and anxiety can come from both hormones and inflammation. Managing stress through relaxation techniques, regular sleep, and moderate exercise can help.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.