Contraception, fertility and inflammatory bowel disease (IBD): a survey of the perspectives of patients, gastroenterologists and women's healthcare providers.

Abstract

Objective: Despite guidelines indicating no contraindications for contraceptives in women with inflammatory bowel disease (IBD), this population shows increased voluntary childlessness and lower contraceptive use. Knowledge gaps among healthcare providers on IBD's impact on fertility and contraception may drive these trends. This survey assessed knowledge discrepancies among IBD patients, gastroenterologists (GEs), and women's healthcare providers (WHPs) regarding fertility and contraception.

Methods: An anonymous survey was conducted between August and December 2023, targeting IBD patients of childbearing age, GEs and WHPs. The questionnaire was offered consecutively to all patients consulting or hospitalised in our department. Additionally, the survey link was shared with healthcare professionals during dedicated training sessions. It assessed awareness of IBD-related fertility and contraception impacts.

Results: Two hundred twenty-two participants fulfilled the survey (100 patients, 50 GEs and 72 WHPs). Among patients (63% with Crohn's disease), 95% were on biologic or immunosuppressant therapy. Nearly half (47%) of women had not discussed fertility or contraception with their GE, and only 22% had done so on request. A majority (80% of women, 54% of GEs) were unsure if IBD affects contraception efficacy, and 50% of WHPs believed oral contraceptives to be less effective for IBD patients. Key concerns influencing patients' fertility decisions included the impact of IBD medication on pregnancy (51%), risk of passing IBD to offspring (47%) and potential flare-ups during pregnancy (39%).

Conclusion: Significant knowledge gaps on fertility and contraception in IBD persist among patients, GEs and WHPs.