I have severe pancolitis. Is it safe to use Infliximab?

Question

Hello doctor,

I am 35, and my ulcerative colitis has been an absolute nightmare since I started menopause early at age 33. Before that, my UC was pretty well controlled with Mesalamine, but now I am having bloody diarrhea 12 to 15 times per day and cannot keep any food down.

My last colonoscopy showed severe pancolitis extending all the way to the cecum, which is much worse than before. My gastroenterologist wants to start Infliximab, but I am scared because my aunt died from an infection while on immunosuppressants.

My hemoglobin dropped to 7.8 due to all the bleeding, and I had to get an iron infusion last month. The worst part is that I am trying to do IVF because early menopause made my egg quality poor, and time is running out.

My fertility doctor says the ulcerative colitis inflammation might be affecting implantation success. Already had two failed transfers and cannot afford many more cycles. Can the UC medications interfere with fertility treatments?

My CRP is constantly elevated at 67, and calprotectin is over 1200. Also, joint pain in the knees and ankles started at the same time as the UC flare got worse.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am so very sorry to hear about the immense challenges you are facing. You are dealing with a perfect storm of multiple complex medical issues like severe ulcerative colitis, premature menopause, and the emotional rollercoaster of IVF (in vitro fertilization), and it is completely understandable that you feel overwhelmed and scared.

Please know that we will work through this together.

First and foremost, let us address your most immediate and dangerous concern: your current UC flare. The symptoms you describe, bloody diarrhea 12 to 15 times a day, an inability to keep food down, a hemoglobin level of 7.8, and markedly elevated inflammatory markers (CRP (C-reactive protein) 67, calprotectin >1200) are signs of a severe, uncontrolled disease.

This is a medical emergency that requires aggressive treatment. The inflammation is not just in your colon; it is affecting your entire body, as evidenced by your joint pain.

Your gastroenterologist's recommendation for Infliximab is precisely the right course of action. This class of medication is designed to rapidly control the severe inflammation that Mesalamine can no longer manage. I know you are terrified because of your aunt's tragic experience.

This fear is valid, but it is crucial to understand the context.

The risk of a serious infection is real, but it is actually highest when the disease is out of control, as it is now. Uncontrolled colitis itself is a significant immunosuppressant.

I understand your fear about immunosuppressants, but uncontrolled inflammation is far more dangerous to you and your IVF chances than modern, carefully monitored treatment.

Your fertility doctor is right. Severe inflammation creates a hostile environment for an embryo and is very likely the reason for your failed transfers. Infliximab is safe to use during IVF and pregnancy. Treating your UC aggressively is not a barrier to fertility treatment; it is an essential part of it.

Your best chance for a healthy pregnancy is to get your colitis into remission first. Please trust your gastroenterologist's advice to start treatment immediately.

I hope this helps.

Thank you and take care.

Regards.