IVF in IBD: Initial Validation For Success?

Abstract

The primary clinical manifestation of inflammatory bowel disease (IBD) is idiopathic inflammation of the gastrointestinal-colonic mucosa. Given that IBD strikes most frequently in the teens to thirties [1], corresponding to the prime childbearing years for women, fertility is understandably a topic germane to this population. Whereas fertility rates for women medically managed for ulcerative colitis (UC) do not differ from those without UC, a threefold increase in infertility (average of 15-48 %) has been reported in a meta-analysis of studies of women who have undergone total proctocolectomy with ileal pouchanal anastomosis (IPAA), believed to be secondary to postoperative adnexal adhesions [2]. Elevated post-operative infertility rates may be normalized following laparoscopically performed IPAA [3]. In Crohn's disease (CD), data are more equivocal regarding higher rates of infertility: voluntary childlessness (for a wide variety of reasons) may account for reported higher rates of infertility in past studies [4], although decreased ovarian reserve as measured by anti-Müllerian hormone occurs in CD, particularly at age [30 and with colonic location of disease [5,6]. Regardless of whether a woman with IBD has difficulty becoming pregnant related to surgery, disease or for other reasons, knowledge of what influences the success of in vitro fertilization (IVF) in this population as it compares to women without IBD is certainly welcome.In this issue of Digestive Diseases and Sciences, Oza et al. [7] report their findings of a matched retrospective cohort study regarding specific factors associated with the success of IVF in women with IBD, a subanalysis of data derived from a larger retrospective study comparing IVF success in women with IBD relative to the general population [8]. Since this same group previously published a subanalysis examining IVF in women with UC who had undergone IPAA [9], this subanalysis is actually the third in a series that compared women with IBD undergoing IVF to the general infertility population. The first study identified 121 female patients with IBD (UC: n = 71; CD: n = 49; unclassified: n = 1) from two tertiary IBD centers in Boston and 470 matched controls without IBD, all of whom underwent IVF between 1998 and 2011 at two affiliated centers for infertility. The study reported no differences in the cumulative rate of live births or incidence of pregnancy/live birth after the first cycle of IVF for IBD patients of either subtype compared to controls [8]. The second study described comparable rates of IVF birth rates in women with UC who underwent IPAA (n = 22) versus those with UC who had not undergone IPAA (n = 49) versus matched controls from the general infertility population [9].In the current study, the same group digs more deeply into their data to determine what specific factors may influence success of IVF in the IBD population [7]. In the general population of women undergoing IVF, advanced maternal age, higher body mass index (BMI), and elevated serum concentrations of fol...