Inflammatory Bowel Disease: How it affects male fertility

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Inflammatory Bowel Disease: How it affects male fertility

Inflammatory bowel disease (IBD) is a chronic inflammation of all or part of the digestive tract.  IBD is a debilitating condition that includes ulcerative colitis and Crohn’s disease with symptoms that can range from severe diarrhea, pain, fatigue, and weight loss.

IBD’s effect on fertility is unclear but some studies have shown that men with IBD may have some reduction in fertility and particularly if the man has Crohn’s disease. In some instances it may be that a man has decided not to have children so as not to pass the disease on to his children. However, physical aspects of IBD can affect fertility that involve medications used to treat it, any surgeries, poor nutrition, psychological issues and a man’s overall health status. 

Fertility and IBD

Just because a man has IBD does not necessarily mean it reduces his chance of being a parent.  But there are some men taking medications for Crohn’s disease who may find themselves less fertile.  In most of these cases, there are things that can help.

Most of the medications available for ID are safe to take when trying to conceive but it is important to consult with your doctor before stopping or changing any medications to prevent a flare up of IBD, since fertility is reduced by the active phase of the disease.

IBD medications effect on fertility

There are certain IBD drugs not to take when trying to conceive.  These include the immunosuppressive drugs of methotrexate and mycophenolate mofetil that should not be taken when trying to conceive as there is a risk of birth defects.  Couples should avoid pregnancy if methotrexate or mycophenolate mofetil has been taken by either partner within the last three to twelve months.

Infliximab (Remicade) and Adalimumab (Hurmira) also used in severe cases of Crohn’s disease should be avoided if trying to conceive. 

Sulphasalazine (Salazopyrin) is a common medication used for IBD which has shown to reduce fertility in men but this is usually temporary and is reversible within two to three months after stopping the medication.  Good alternatives to use in place of sulphasalazine are mesalazine, olsalazine, or balsalazide, which have the same effect on the colon but do not affect fertility.

Other problems with fertility in men with IBD

Men with Crohn’s disease may produce fewer sperm when the disease is very severe and the sperm that is produced may be damaged or may function less well than normal.  If a man is underweight or undernourished, this can also affect fertility. Again, these problems are believed to be temporary - receiving treatment for Crohn’s should restore a man’s fertility back to normal.

In very rare cases, men with IBD who have had their colon removed, including the rectum may be unable to achieve an erection.  This is usually temporary and with sophisticated surgical technique that are less likely to damage nerve, there is less likelihood of it occurring.

Studies on male infertility and IBD have recommended for some male patients wanting to become a parent, to bank their sperm as an option for fertility. If a man with IBD requires extensive surgical intervention such as a rectal incision that could affect sexual performance or initiation of a potentially gonadotoxic medication, a discussion of preservation of sperm fertility should be encouraged by his gastroenterologist or surgeon.      

Tips for improving fertility

Men can do several things to increase their chance of producing healthy sperm and being able to father a child:

·      Do not smoke

·      If drinking alcohol, do so only in moderation

·      Exercise but not obsessively

·      Reduce stress by getting sufficient relaxation

·      Eat a balanced diet

 A couple of nutrients important for boosting male fertility are zinc and vitamin B6.  There is some evidence that a zinc deficiency may lower fertility and men with Crohn’s disease have been shown to have low zinc levels – men require 11 milligrams of zinc each day.  Good food sources of zinc include oysters, red meat, poultry, beans, buts, crab, lobster, whole grains, fortified breakfast cereals and dairy products.

 

Good food sources of vitamin B6 include fish, beef liver, sweet potatoes, chicken breast, and spinach – 1.3 milligrams of vitamin B6 is required of men each day.

 

Other things a man needs to remember is that the testicles need to be cooler than the rest of the body to allow sperm to develop normally.  They can help themselves achieve this by wearing boxer shorts and looser trousers rather than tight underpants and trousers that fit snugly which keep the genitals warm.