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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.

We recently reported that for women with UC receiving assisted reproductive technology (ART) treatment, the chance of a live birth after each embryo transfer cycle decreased significantly. 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. After demonstrating the negative effects of UC and CD on chances of live birth, we wish to update our readers by exploring where along the process from fertilisation through pregnancy the risk of delivering a live born child decreases. Is the reduced chance of live birth due to (1) a reduced chance of conceiving after an ART cycle? and/or (2) a reduced chance of maintaining a fetus …

With great interest we have read the paper by Rungoe et al 1 describing a possible decrease rate in surgery in patients with IBD. The authors have identified all Danish patients with IBD by their first IBD diagnosis registered in the time period from 1979 to 2011. Data were extracted from the Danish National Patient Register, which contains information about all inpatient hospital contacts including diagnoses and surgical interventions, and outpatient diagnoses were not registered before 1995. Accordingly, Cohorts 1 and 2 represent only patients, who have had conditions requiring first time admissions, whereas Cohorts 3 and 4 represent a mixture of patients having first time diagnoses of IBD as inpatients or as outpatients (probably milder cases). Thus, Cohorts 3 and 4 might represent patients with less severe disease at …

In recent years, 5-aminosalicylic acid (5-ASA) has increasingly replaced sulfasalazine for treating inflammatory bowel disease (IBD), a condition that frequently affects women of childbearing age. Both 5-ASA and its metabolite, N-acetyl-5-ASA, cross the placenta. The single past study that included a control group found an increased risk of preterm birth, but not of major malformations. The present cohort study from Denmark examined pregnancy outcomes in 60 pregnancies in which the mother took 5-ASA within 30 days before pregnancy or during the first trimester and 88 others exposed throughout pregnancy. The control group included 19,418 pregnancies in which the mother received no prescription drugs. The women given 5-aminosalicylic (5-ASA) drugs were older than control women, smoked less, and were more often multiparous. In those prescribed 5-ASA drugs, odds ratios (OR) were 1.9 for malformations, 6.4 for stillbirth, 1.9 for preterm birth (before 37 weeks' gestation), and 1.2 for low birth weight. The risks of stillbirth and preterm birth were increased only in women treated for ulcerative colitis. Congenital malformations were especially increased in women prescribed both 5-ASA drugs and steroids. The risk of preterm birth remained increased when exposed women were compared with control women with inflammatory bowel disease (IBD) who had been prescribed 5-ASA drugs before or after, but not during, pregnancy. Compared with the same control subjects, the OR for stillbirth in women exposed while pregnant was 7.1. Women who take 5-ASA drugs for IBD while pregnant are at increased risk of adverse outcomes, including stillbirth and preterm birth. The respective effects of 5-ASA drugs and disease activity itself remain uncertain.