Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn's disease receiving assisted reproduction: a 20-year nationwide cohort study

Abstract

Objective To examine the chance of live births and adverse birth outcomes in women with ulcerative colitis (UC) and Crohn's disease (CD) compared with women without inflammatory bowel disease (IBD) who have undergone assisted reproductive technology (ART) treatments. Methods This was a nationwide cohort study based on Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 2013. The cohorts comprised 1360 ART treatments in 432 women with UC, 554 ART treatments in 182 women with CD and 148 540 treatments in 52 489 women without IBD. Our primary outcome was live births per ART treatment cycle. We controlled for multiple covariates in the analyses. Our secondary outcomes were adverse birth outcomes. Results The chance of a live birth for each embryo transfer was significantly reduced in ART treatments in women with UC (OR=0.73, 95% CI 0.58 to 0.92), but not significantly reduced in the full model of ART treatments in women with CD (OR=0.77, 95% CI 0.52 to 1.14). Surgery for CD before ART treatment significantly reduced the chance of live birth for each embryo transfer (OR=0.51, 95% CI 0.29 to 0.91). In children conceived through ART treatment by women with UC, the OR of preterm birth was 5.29 (95% CI 2.41 to 11.63) in analyses including singletons and multiple births; restricted to singletons the OR was 1.80, 95% CI 0.49 to 6.62. Conclusions Our results suggest that women with UC and CD receiving ART treatments cannot expect the same success for each embryo transfer as other infertile women. Women with CD may seek to initiate ART treatment before needing CD surgery. Increased prenatal observation in UC pregnancies after ART should be considered.

The reduced chance of a live birth in women with IBD receiving assisted reproduction is due to a failure to achieve a clinical pregnancy

“…In women with Crohn's disease (CD), the chance of a live birth after each embryo transfer cycle also decreased but was not significant in the fully adjusted regression model 1. In our study, we chose the outcome live birth because it was the most important clinical outcome for patients with UC and CD undergoing ART.…”

“…and/or (2) a reduced chance of maintaining a fetus throughout the entire pregnancy and delivering a live born child? Using the dataset described in our previous paper,1 we chose a similar approach with cohorts of treatment cycles in women with UC, CD and an unexposed cohort of all other treatment cycles in women receiving ART treatments in Denmark from 1 January 1994 through 2013. The number of ART treatments in the cohorts is slightly different in these new analyses as a few ART cycles had missing or incomplete values according to relevant variables on measurements of human chorionic gonadotropin (hCG).…”

“…The results were adjusted for the confounders described in our previous paper 1. Both women with UC and CD had a reduced chance of becoming pregnant for each ART treatment cycle (see online supplementary table S1).…”

The SLC2A14 gene, encoding the novel glucose/dehydroascorbate transporter GLUT14, is associated with inflammatory bowel disease

“…Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn disease (CD), are chronic, relapsing, immunemediated intestinal inflammatory diseases of complex etiology (1)(2)(3)(4), found predominantly in white people (1,3) and incurring substantial socioeconomic costs; in excess of $1.7 billion/y in Canada (5). The exact contributions of environmental factors (6), immune dysregulations (7), and genetics (8) are unknown, which impairs therapeutic success.…”

IVF in IBD: Initial Validation For Success?

“…Patients included in this study received IBD care at a tertiary center, which may further affect the ability to generalize these results to patients cared for in the community. Of note, earlier this year, a large population-based Danish cohort study of IVF success in IBD (614 IBD patients vs. 52,489 women without IBD) related overall lower rates of live births for the IBD group, a more robust result in UC patients [10]. Interestingly, while no differences in the rate of live births for UC patients who had surgery were observed, a decreased rate of live births was reported in CD patients who had undergone surgery.…”