Assisted Reproductive Technology in Crohn's Disease and UlcerativeColitis: ASystematic Review andMeta-Analysis

INTRODUCTION: Infertility may occur in women with Crohn's disease (CD) and ulcerative colitis (UC), especially after surgery such as ileal pouch-anal anastomosis (IPAA). Assisted reproductive technology (ART) may be an option, but the safety and efficacy in this setting has been based on small cohorts to date. We performed a systematic review and meta-analysis to address this data gap. METHODS: A systematic review and random-effects meta-analysis was performed until May 2020. The primary outcomes were pregnancy and live birth rates per cycle of ART. RESULTS: Eleven studiesmet inclusion criteria for the systematic review and 4 for themeta-analysis. Compared with the general population, womenwith CD(with andwithout previous surgery) had no difference in pregnancy rates (odds ratio [OR] = 0.69,95% confidence interval [CI]: 0.45-1.05) but hadreduced live births (OR = 0.67, 95% CI: 0.53-0.85) per cycle of ART. ART live birth rates are not reduced in women withmedically managed CD; however, they are 49%-71% lower after CD-related surgery. Women with UC had no difference in both pregnancy rates (OR=0.99, 95% CI: 0.63-1.55) and live birth rates (OR=0.88, 95% CI: 0.67-1.17); however, live birth rates were reduced after IPAA failure (hazard ratio = 0.36, 95% CI: 0.14-0.92). Two studies did not identify any significant safety signals. DISCUSSION: ART is safe and effective in patients with UC and medically managed CD, with pregnancy and live birth rates similar to that of the general population. However, within the limitations of the available literature, current data suggest that efficacy is reduced inwomen with CD-related surgery and IPAA failure. Greater gastroenterologist awareness of ART is needed to facilitate timely fertility therapy referral when indicated, particularly in CD.

Automated summary

Infertility in women with Crohn's disease and ulcerative colitis may be addressed through assisted reproductive technology (ART), with pregnancy and live birth rates similar to the general population. However, efficacy of ART may be reduced in patients with CD-related surgery and IPAA failure.