How do I manage my Crohn’s disease despite medicines at 31?

Question

Hi doctor,

I am 31 years old, and my Crohn’s disease is currently out of control despite trying multiple medications. It is also affecting my fertility plans with my husband. I was diagnosed eight years ago with terminal ileum involvement, but the disease has since progressed to involve the jejunum and the colon as well.

I have been on Adalimumab for three years, which worked well initially, but it recently stopped being effective after I developed antibodies. Infliximab also failed to control my disease. I am now experiencing severe abdominal pain, significant weight loss, and diarrhea up to 12 times daily.

A recent CT scan showed strictures and possible abscess formation near the ileocecal valve. My CRP is 67, and fecal calprotectin is over 1,000, indicating severe inflammation.

My fertility specialist has advised that active Crohn’s disease and certain medications may be contributing to difficulty conceiving, despite trying for 18 months. I had to stop Methotrexate, which may have been helping, because it is teratogenic. Vedolizumab was tried but was ineffective, and Ustekinumab is now being considered.

Surgery may be required to remove diseased bowel, but I am concerned about how this could affect my fertility. What Crohn’s disease treatments are safe while trying to conceive, and would surgery improve my chances of becoming pregnant?

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Your Crohn’s disease is severely active, based on the following findings:

CRP (C-reactive protein): 67
Fecal calprotectin: >1,000
CT (computed tomography) scan showing strictures and a possible abscess.

You are also experiencing diarrhea up to 12 times per day and significant weight loss.

You have failed anti-TNF (tumor necrotizing factor) therapy due to antibody formation, have not responded to Vedolizumab, and Methotrexate has been discontinued which is correct, as it is absolutely contraindicated when trying to conceive.

When Crohn’s disease is this active, fertility drops sharply not because of medications, but because ongoing inflammation itself reduces ovarian function, implantation success, and egg quality, and can disrupt the menstrual cycle. Therefore, the number one priority is to get you into remission quickly using a therapy that is safe for pregnancy.

You cannot safely conceive while inflammation is this severe.

Ustekinumab medication is considered safe. It is increasingly used in patients who have failed Adalimumab, Infliximab, and Vedolizumab. It is effective for both small bowel and colonic disease, with no evidence of increased birth defects. It can dramatically stabilize disease before conception and is an excellent next step for you, especially given your pattern of biologic failure.

Even if antibodies have developed, some patients respond to a different anti-TNF agent or to restarting therapy with a combination immunomodulator (if fertility-safe). Safe options include:

Certolizumab pegol: The best anti-TNF option during pregnancy due to minimal placental transfer
Adalimumab: Safe, but you have already lost response
Infliximab: Safe, but previously ineffective

Certolizumab may be an option if your doctor is considering an anti-TNF recapture strategy.

Despite common concerns, these medications are considered safe during pregnancy when required to maintain remission. You must remain off Methotrexate, but Azathioprine does not reduce fertility or increase pregnancy risk. It is often added to prevent antibody formation when restarting an anti-TNF agent.

Prednisone or Budesonide is safe for short-term disease control. However, they are not long-term solutions and are typically used as a bridge while waiting for a biologic to take effect.

Metronidazole and Amoxicillin–Clavulanate are considered safe during pregnancy. Ciprofloxacin is generally avoided during pregnancy but may be used before conception if absolutely necessary, particularly for abscess control.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.