A new case study describes a 33-year-old woman with Crohn’s disease who had major bowel surgery at age 28 and then struggled to become pregnant through fertility treatments. After the surgery, she had complications including infections and scarring that made it harder for her body to support pregnancy. The doctors found several problems that may have reduced her chances, including bacterial infections, inflammation in her uterus, and nutritional deficiencies. This case shows that women with Crohn’s disease who want to have children in the future should talk with their doctors before having major surgery, because the surgery itself might make pregnancy more difficult.

The Quick Take

  • What they studied: How major bowel surgery for Crohn’s disease affects a woman’s ability to become pregnant using fertility treatments
  • Who participated: One 33-year-old woman who had Crohn’s disease and underwent complete bowel removal surgery (panproctocolectomy) with creation of an ileostomy at age 28
  • Key finding: The woman was only able to achieve one very early pregnancy (biochemical pregnancy) across five separate fertility treatment cycles after her surgery, despite being in disease remission. This is much lower than expected success rates.
  • What it means for you: If you’re a woman with Crohn’s disease who wants to have children, it’s important to discuss the timing of any major surgery with your doctors before the procedure. Surgery may create complications that make pregnancy harder, so planning ahead is crucial.

The Research Details

This is a case report, which means doctors are describing what happened to one specific patient in detail. The 33-year-old woman had Crohn’s disease affecting her perianal area (around the anus) and vulvovaginal area (external female genitals). At age 28, she underwent panproctocolectomy, which is surgery to remove the entire colon and rectum, and had an ileostomy created (a surgically made opening that allows waste to exit into a pouch worn on the skin). After surgery, she developed complications including an enterovaginal fistula (an abnormal tunnel between her bowel and vagina) and recurrent bacterial vaginosis (vaginal infections). When she tried to become pregnant using assisted reproductive technology (fertility treatments) five years later, she had very limited success. The doctors investigated why and found multiple problems that may have contributed to her difficulty conceiving.

Case reports are important because they describe unusual or important clinical situations that doctors might not see very often. This case is significant because it shows that surgery for Crohn’s disease may have long-term effects on fertility that are different from surgery for ulcerative colitis (a similar bowel disease). Understanding these complications helps doctors counsel women about the potential risks before surgery and plan better treatment strategies.

This is a single case report, which is the lowest level of scientific evidence. It describes one patient’s experience in detail but cannot prove that all women with Crohn’s disease will have the same outcome after surgery. The findings are important for raising awareness and suggesting areas for future research, but they should not be considered definitive proof. The case is well-documented with medical investigations that identified specific problems, which adds credibility to the observations.

What the Results Show

The main finding is that this woman achieved only one biochemical pregnancy (a very early pregnancy detected only by blood tests, not a viable pregnancy) across five complete fertility treatment cycles. This is significantly lower than the expected success rate for fertility treatments in women without complications. Medical tests revealed several problems that likely contributed to her difficulty: group B Streptococcus bacteria colonizing her vagina, chronic inflammation of the uterus lining (chronic endometritis), pelvic scarring and adhesions from surgery, and nutritional deficiencies including low vitamin B12. The woman’s Crohn’s disease was in remission at the time of fertility treatment, meaning her disease was not actively flaring, yet her fertility remained impaired. This suggests that the surgical complications and their aftermath, rather than active disease, were the primary barriers to pregnancy.

The case also highlights that the woman developed an enterovaginal fistula after surgery, which is an abnormal connection between her intestine and vagina. She also experienced recurrent bacterial vaginosis, which are repeated vaginal infections. These complications may have created an environment in her reproductive tract that was hostile to pregnancy. The doctors noted that unlike ulcerative colitis (a related disease where surgery can be curative), Crohn’s disease often returns even after surgery, meaning women may face ongoing disease management issues in addition to surgical complications.

Previous research shows that women with Crohn’s disease who are treated with medications alone (without surgery) have fertility rates similar to women without Crohn’s disease when using fertility treatments. However, this case suggests that women who undergo major surgery for Crohn’s disease may have significantly reduced fertility outcomes. Interestingly, women with ulcerative colitis who have similar surgery do not show the same fertility decline, which suggests that Crohn’s disease itself or the specific complications from Crohn’s surgery may be responsible for the fertility problems.

This is a single case report describing one woman’s experience, so we cannot generalize these findings to all women with Crohn’s disease who have surgery. The woman had particularly severe Crohn’s disease affecting multiple areas, which may not be typical. We don’t know how common these fertility problems are after Crohn’s surgery, or whether other women might have better or worse outcomes. The case does not include a comparison group of women with similar surgery who did become pregnant. Additionally, the woman had multiple complications (fistula, infections, nutritional deficiencies) that may not all occur together in other patients.

The Bottom Line

Women with Crohn’s disease who want to have children should discuss the timing of major surgery with their doctors before the procedure (HIGH IMPORTANCE). If possible, surgery should be delayed until after childbearing years to preserve fertility (MODERATE CONFIDENCE). Before surgery, women should receive fertility counseling to understand potential risks (HIGH IMPORTANCE). After surgery, women may benefit from comprehensive evaluation including screening for infections, nutritional deficiencies, and uterine inflammation before attempting pregnancy (MODERATE CONFIDENCE). A team approach involving gastroenterologists, gynecologists, and fertility specialists is recommended (MODERATE CONFIDENCE).

This information is most relevant to women of reproductive age (roughly ages 18-40) who have Crohn’s disease and are considering surgery or planning to have children. It’s also important for their doctors, including gastroenterologists, gynecologists, and fertility specialists. Women with ulcerative colitis should note that this research suggests their fertility outcomes after surgery may be different. Men with Crohn’s disease should be aware that their partners’ fertility may be affected if they have had surgery. This is less relevant to people with Crohn’s disease who have already completed their childbearing years or who do not plan to have biological children.

The woman in this case waited five years after her surgery before attempting fertility treatments. It’s unclear whether attempting pregnancy sooner or later would have changed outcomes. Women should expect that if complications like infections or inflammation are present, treating these conditions may take several months. Fertility treatments themselves typically take 2-4 weeks per cycle, and multiple cycles may be needed. Realistic expectations should be discussed with fertility specialists, as outcomes may be reduced compared to women without surgical complications.

Want to Apply This Research?

  • Track monthly fertility treatment cycles and outcomes (biochemical pregnancy, clinical pregnancy, live birth), along with any infections or health complications. Also monitor vitamin B12 levels and other nutritional markers every 3-6 months, as deficiencies may impact fertility.
  • If you have had Crohn’s surgery and are planning to become pregnant, use the app to: (1) Schedule and track preconception medical appointments with your gastroenterologist, gynecologist, and fertility specialist; (2) Monitor and log any vaginal infections or unusual symptoms; (3) Track nutritional supplementation, especially vitamin B12; (4) Record fertility treatment cycles and outcomes; (5) Set reminders for recommended screening tests.
  • Establish a long-term tracking system that monitors: monthly menstrual cycle patterns, any signs of infection or inflammation, nutritional supplement adherence (especially B12), fertility treatment progress, and regular check-ins with your medical team. Review this data quarterly with your doctors to adjust treatment plans as needed.

This case report describes one woman’s experience and should not be considered medical advice or proof that all women with Crohn’s disease will have similar outcomes after surgery. Fertility outcomes vary greatly between individuals. If you have Crohn’s disease and are considering surgery or planning to become pregnant, please discuss your specific situation with your healthcare team, including your gastroenterologist and gynecologist. Do not delay necessary medical treatment based on fertility concerns without consulting your doctors. This information is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment.