Kurdistan Board GEH/GIT SurgeryKurdistan Board GEH/GIT SurgeryWeekly J ClubWeekly J ClubSupervised by:Supervised by:

Dr. Mohamed AlshekhaniDr. Mohamed Alshekhani

Introduction:Introduction: Incidence peaks during childbearing, as 50% diagnosed before 32 Incidence peaks during childbearing, as 50% diagnosed before 32

making family planning & IBD management coincide. making family planning & IBD management coincide. Most IBD patients have successful pregnancies, but IBD women Most IBD patients have successful pregnancies, but IBD women

have fewer children than the general pop from voluntary have fewer children than the general pop from voluntary childlessness due to pprehension/misperceptions about fertility, childlessness due to pprehension/misperceptions about fertility, medication safety&potential adverse pregnancy outcomes.medication safety&potential adverse pregnancy outcomes.

Fear of infertility is common &adversely impact family planning Fear of infertility is common &adversely impact family planning decisions,but women with quiescent IBD & no prior pelvic surgery decisions,but women with quiescent IBD & no prior pelvic surgery have similar infertility (5–14%) as the general population.have similar infertility (5–14%) as the general population.

Active disease does impair fertility, via pelvic inflammation, poor Active disease does impair fertility, via pelvic inflammation, poor nutrition, decreased libido, dyspareunia, depression,pelvic surgery nutrition, decreased libido, dyspareunia, depression,pelvic surgery due to scarring/adhesions, IPAA surgery in ulcerative colitis (Lap due to scarring/adhesions, IPAA surgery in ulcerative colitis (Lap total proctocolectomy with IPAA / colectomy with ileorectal total proctocolectomy with IPAA / colectomy with ileorectal anastomosismay preserve fertility anastomosismay preserve fertility

IPAA does not appear to impact success rates of in IVF.IPAA does not appear to impact success rates of in IVF.

Introduction:Introduction: In Infertile women occult disease activity, hypovitaminosis D, and In Infertile women occult disease activity, hypovitaminosis D, and

celiac disease should be sopught&If women remain as such after 6 celiac disease should be sopught&If women remain as such after 6 months, reproductive endocrinologidt consulted.months, reproductive endocrinologidt consulted.

Zinc deficiency in Crohn may impair sperm function.Zinc deficiency in Crohn may impair sperm function. Sulfasalazine causes reversible infertility due to dose-dependent Sulfasalazine causes reversible infertility due to dose-dependent

oligospermia,reduced sperm motility& altered sperm morphology. oligospermia,reduced sperm motility& altered sperm morphology. Methotrexate may reduce sperm quality, reversible when the drug Methotrexate may reduce sperm quality, reversible when the drug

is discontinued&men should stop methotrexate at least 3 months is discontinued&men should stop methotrexate at least 3 months before attempting conception. before attempting conception.

anti-TNF s accelerate germ cell apoptosis in the seminiferous anti-TNF s accelerate germ cell apoptosis in the seminiferous tubules,20 which might theoretically decrease sperm count.tubules,20 which might theoretically decrease sperm count.