Assisted Reproductive Technology Effective in Women With IBD

Nearly three-quarters of women with inflammatory bowel disease (IBD) who underwent assisted reproductive technology (ART) were able to achieve pregnancy, according to prospective data from a cohort study.

Among 52 women who underwent fertility treatment with either intrauterine insemination (IUI) and/or embryo transfer, 73% became pregnant, reported Eugenia Shmidt, MD, of the University of Minnesota in Minneapolis.

However, “modality selection is paramount,” Shmidt said during a session at the American College of Gastroenterology annual meeting in Nashville, Tennessee.

Across 97 fertility treatment attempts, 41% resulted in pregnancy, but just 10% of IUI attempts succeeded compared with 73% of embryo transfer attempts (OR 24.0, 95% CI 8.0-70.0, P<0.0001).

“It’s well established that some women with IBD have reduced fertility, particularly during periods of active disease or following pelvic surgery requiring rectal dissection, presumably due to fallopian tube adhesions and scarring,” Shmidt noted.

“While overall ART effectiveness appears comparable between women with and without IBD, and in vitro fertilization can bypass mechanical barriers from pelvic adhesions, significant knowledge gaps remain,” she pointed out. “Specifically, we lack prospective data on how fertility treatments are utilized in real-world clinical practice, and what key clinical factors, such as surgical history, predict pregnancy success.”

The findings from this study “suggest that clinicians should consider early referral to IVF and embryo transfer, rather than prolonged IUI trials in women with IBD, and particularly in those with prior pelvic surgery,” Shmidt concluded.

The observational Women with Inflammatory Bowel Disease and Motherhood (WIsDoM) study involved 30 centers in the U.S. and Canada that enrolled women ages 18-45 years with IBD who were planning pregnancy within 15 months. Monthly surveys captured conception attempts and pregnancy outcomes.

Of the 421 women in the study who were attempting pregnancy, 67 underwent at least one fertility treatment, which included 13 women who underwent IUI only, 39 who underwent embryo transfer with or without IUI, and 15 who underwent egg retrieval only.

While egg retrieval “is an essential step in the IVF pathway,” Shmidt explained that pregnancy attempts were defined specifically as IUI cycles or embryo transfers in this study.

Women undergoing fertility treatment were older than those not undergoing this treatment (median age 34 vs 32), and had attempted to get pregnant for longer (median 11 vs 2 months), were more likely to have had prior fertility treatment (31.3% vs 8.8%) and prior pelvic IBD surgery (16.4% vs 5.4%), and have active disease (56.7% vs 43.5%).

Repeat fertility treatment attempts were common, with 42% of women requiring multiple attempts (averaging 2.45 IUI cycles and 1.23 embryo transfers). Of the 39 women who underwent embryo transfer, 32 proceeded directly to the procedure without undergoing IUI, while seven progressed from IUI to embryo transfer (undergoing an average of three IUI attempts before advancing).

After adjustment for potential confounders, the odds of pregnancy with embryo transfer versus IUI nearly doubled (aOR 44.0, 95% CI 8.9-221.0, P<0.0001). Other variables in the adjusted model — including prior history of ART use, disease activity, IBD-related surgery versus no IBD surgery, and disease duration — were not significantly associated with attempt failure once modality was controlled for, “suggesting that embryo transfer effectively overcomes disease- and surgery-related factors,” Shmidt said.

While the numbers were low, Shmidt noted that of nine women with prior IBD-related pelvic surgery, the seven who underwent embryo transfer were all able to conceive, while neither of the two women who underwent IUI alone became pregnant — a difference Shmidt called “striking.”

When asked how the pregnancy success rates in this analysis compared with those of the general population, Shmidt said that while success rates with IUI were comparable, embryo transfer rates range from 45% to 50% in the general population — much lower than the rate observed in this study — suggesting that “women with IBD are … particularly positioned to benefit from embryo transfer.”