W1136 Fear and Fertility in Inflammatory Bowel Disease - A Mismatch of Perception and Reality Affects Patient Behaviour

Abstract

Introduction: Overall fertility in male and female Inflammatory Bowel Disease (IBD) patients is similar to the general population, with the exception of reduced fertility in males on sulphasalzaine. Adverse pregnancy outcomes are slightly increased in women with IBD. Apart from methotrexate, IBD medications are safe in pregnancy. Voluntary childlessness has been described in IBD, thus we wanted to understand the extent to which fear of infertility and poor pregnancy outcomes affected behaviour in IBD patients. Method : 365 patients (146 male [M]; 219 female [F]; 18-50 yrs) from a hospital-based, IBD database were surveyed. Data were obtained by questionnaire on diagnosis, demographics, relationships, body image, sexual function, as well as fertility and pregnancy data. Descriptive data are presented, statistical comparisons made using a chi square test. A p value < 0.05 was considered significant. Results : 183 invitees participated; 109 CD, 69 UC (36 % M, 65% F , mean age 36.3 years; response rate 50% overall). 76% were in a current relationship, 6% had never been partnered. 58.7% of patients with CD and 14.5% with UC reported previous IBD surgery. Overall, 17.9% of patients reported consulting a doctor for fertility problems (22% of CD patients vs 11.6% UC patients,) p=0.078. 48% of CD patients feared a lack of fertility related to IBD vs 26% of UC patients, p=0.004. Respondents had fewer children than desired or planned in 25% of Crohn's and 23% of UC cases (p=0.84). Reasons volunteered for this centred around fear of adverse fertility and pregnancy outcomes. Termination of pregnancy was reported in females with IBD or female partners of male IBD patients in 17.4% of CD respondents, vs 14.4% in UC (p=0.61) The decision to terminate pregnancy was directly attributed to IBD in 20.7% of these patients. Conclusions: Despite no overall fertility reduction and only modest increase in adverse pregnancy outcomes amongst most IBD subgroups, Crohn's patients in particular report sufficient fear of such outcomes to influence their family planning.