IBD & Sexual/Reproductive Health -FSRH Oct 2016 |

Question 1

IBD and Fertility

Answer 1

• Possible effects of some IBD medication on
  sperm quality and quantity and the potential impact on male fertility.
• risk of subfertility following reconstructive surgery should be discussed with & their partners.

Question 2

IBD and Pregnancy planning

Answer 2

• Advise: plan to conceive when disease well controlled.
• Referral for pre-pregnancy counselling for men &
  women in order to optimise.
• Guided in their decision by obstetric and GI specialists. in charge of their care.

Question 3

IBD and Pregnancy

Mode of delivery

Answer 3

• Controversy regarding the most appropriate mode of delivery (CS or vaginal) following ileal pouch-anal anastomosis surgery.

Question 4

IBD and Pregnancy

drugs

Answer 4

• If either partner is taking methotrexate, effective
  contraception during and for at least 3 months after treatment.
• If either partner is taking mycophenolate mofetil, effective contraception during and for at least 6 weeks (women) or 3 months (men) after treatment has ended.
• women treated with tumour necrosis factor alpha (TNF-α) inhibitors (e.g. infliximab, adalimumab) effective contraception during & 6 months after treatment ended.
  Consideration for use during pregnancy requires specialist advice.

Question 5

IBD and Pregnancy

Answer 5

For each medication (trying to conceive, pregnant or breastfeeding) Check current
– NICE,
– British Society for Gastroenterology, and
– European Crohn’s and Colitis Organisation guidelines
– Summary of Product Characteristics .
Decision to discontinue any treatment requires
– expert clinical judgement,
– balancing the risks of stopping the drug against the risks associated with continuing.

Question 6

IBD and Pregnancy

abdominal pain and gastrointestinal symptoms in sexually active women

Answer 6

• consider ectopic pregnancy in their differential diagnosis.

Question 7

IBD and Contraceptive Choice

COC

Answer 7

• causal association between COC use and onset or exacerbation of IBD has not been established.
• efficacy of oral contraception is unlikely to be reduced
  by large bowel disease but may be reduced in women with Crohn’s disease who have small bowel disease and malabsorption.
• Health professionals should consider the impact of IBD-associated conditions (e.g. VTE, primary sclerosing cholangitis and osteoporosis) as well as other medical conditions when prescribing contraception to women with IBD.

Question 8

IBD and Contraceptive Choice

Condoms

Answer 8

• Health professionals should check whether any prescribed medications for rectal or genital administration contain constituents that could reduce the efficacy of condoms.

Question 9

IBD and Contraceptive Choice

laparoscopic sterilisation.

Answer 9

• Previous pelvic/abdominal surgery could affect safety & success of laparoscopic sterilisation.
• Women considering sterilisation – and their partners – should be counselled about alternative methods of contraception including LARC and vasectomy.

Question 10

IBD and Contraceptive COC

major elective surgery

Answer 10

• should stop COC at least 4 weeks before major elective surgery and
• alternative contraception should be provided.
• Advice regarding recommencing COC should be given individually.

Question 11

IBD and sexuality, body image and mental well-being,

Answer 11

• Health professionals should provide an opportunity for individuals & partners to discuss issues relating.
• know where to refer locally when appropriate.

Question 12

IBD & sexual and reproductive health (SRH)

Answer 12

• Presents reproductive years,
• consider SRH issues in management of affected.
• integrated working between different service providers