Assisted Reproductive Technology Live Birth Rates Decrease Following Panproctocolectomy in Crohn's Disease: A Case...

Women with Crohn's disease (CD) are often affected during their reproductive years. Live birth rates following assisted reproductive technology (ART) in medically managed CD are comparable to those in the general population. However, ART outcomes decline significantly after CD-related surgery, a pattern not observed in ulcerative colitis (UC). We report the case of a 33-year-old woman with longstanding perianal and vulvovaginal CD who underwent a panproctocolectomy with end ileostomy at age 28. Postoperatively, she developed an enterovaginal fistula and recurrent bacterial vaginosis. Despite being in remission, she achieved only one biochemical pregnancy across five ART cycles. Investigations revealed group B Streptococcus vaginal colonisation and chronic endometritis (CE). This case highlights multiple factors that may impair fertility following surgical management of CD, including pelvic adhesions, CE, microbial dysbiosis, immune dysfunction, and micronutrient deficiencies such as vitamin B12. Unlike UC, surgery is not curative in CD and relapse is common. Where possible, major abdominal surgery in CD should be delayed until after childbearing to preserve fertility. A multidisciplinary approach is essential, and preoperative fertility counselling is strongly recommended. Further research and clear clinical guidelines are needed to optimise reproductive outcomes in women undergoing surgery for CD.