Crohn's Disease & Fertility Treatment Medications
Recently I wrote an article on the impact of hormones on my Crohn’s disease, and talked specifically about increased symptoms right before my menstrual cycle, anxiety and stress around my period and IBD symptoms, and how I try to manage Crohn’s disease symptoms before and during my period.
While I feel like this applies to nearly every female with IBD, there is a second part of the conversation that is also really important in our community - the impact of fertility treatments and fertility medications on IBD symptoms.
Struggling with unexplained infertility and IBD
Let me start by saying that not every female with IBD will have trouble conceiving or struggle to get pregnant naturally. In fact, IBD alone should not directly “cause” infertility. However, because many of us have other health conditions, related or unrelated to our IBD, or by chance discover that we struggle with unexplained infertility, I wanted to bring up this discussion.
When I began trying to conceive, I had received a nod of approval from my GI, PCP, and OB/GYN. When I failed to get pregnant and began working with a Reproductive Endocrinologist, I didn’t know how much there was to learn about infertility.
I experienced 4 failed IUI’s and a failed round of IVF before being successful with IVF in the fall of 2018. As I prepared to welcome my daughter, I wrote in-depth about the parallels to IBD I experienced with regard to the stigma, emotions, hopes, and fears surrounding fertility challenges.
In that season, I was so grateful for the opportunity to be able to get pregnant that I pushed aside many of the tangentially related things associated with fertility treatments. They were uncomfortable and exhausting, frustrating, and challenging, but I was never not going to shoulder through them. I wanted to carry a baby. I wasn’t able to get pregnant naturally. This was my story.
Side effects of medications and IBD symptoms
My daughter is now 16 months old, and I just recently started fertility medications again with the hopes of having a second child through IVF. The testing, labs, ultrasounds, and other logistical aspects of infertility - they are just facts to me this time around. Nothing feels surprising. However, the medications, the hormones that I have to take to prepare my body for an embryo transfer - they are overwhelmingly challenging for me at this moment.
Estrogen & progesterone are the main medications used for my protocol. Both are hormones my body produces naturally, but not in the dose necessary before pregnancy. Both are hormones needed to support pregnancy, but my body needs help with turning on and increasing those processes.
Both medications have side effects on their own. Both medications, for me, also impact my IBD. What does that look and feel like? Well, it’s very similar to the increase in Crohn’s symptoms I have experienced around the time of my period. Similar hormones, similar impact.
Increased bowel movements, urgency, nausea, and vomiting
But it’s a lot longer and more drawn out than my normal IBD menstrual symptoms. I’m currently six weeks into my fertility treatment cycle, and that means that yes, for six weeks I’ve experienced an increase in bowel movements per day, in urgency before bowel movements, in nausea, and in vomiting.
When this happened for the first time two years ago before my pregnancy with my daughter, pushing through the challenges felt easier. I was so focused on the excitement and nerves around beginning IVF, everything else felt just like part of the package.
Today, it feels like a major struggle. I’m a veteran, meaning none of the IVF process is new. I’m also chasing a toddler all day, and balancing work and life and my IBD care in the midst of a global pandemic.
How am I getting through these tough times?
Holding out hope for a repeat pattern. When I did have IVF success in the past, after early pregnancy (& high levels of hormones) most of my IBD symptoms evened out. In fact, my IBD was well controlled during my pregnancy, and I generally felt pretty well (outside of daily vomiting, but that’s another story!)
My biggest hope is that this round (or you know, the next round, or the round after that) of IVF will be successful, and once I am hopefully again pregnant, my symptoms will calm down. In the interim, I will try anything to support my mental health during this process, including an arbitrary countdown clock to when treatment is over.
If you’ve gone through fertility treatment, have you noticed an impact on your IBD symptoms? If you’re preparing for fertility treatment, I share this just as a loose warning - it's good to talk to your GI and RE about your disease status and what tools (medications, diet, etc) can support any symptom flare ups you have during treatment.
Have you completed the IBD in America survey? Answer poll for survey link.