My niece has Crohn's disease. Will it cause infertility in women?

Question

Hello doctor,

My 26-year-old niece has Crohn's disease affecting her small intestine and colon, and she has been hospitalized three times this year. It was diagnosed four years ago, and she was doing fine on Infliximab infusions, but now her body is making antibodies against it.

Her last colonoscopy showed deep ulcerations and possible fistula formation. She is having severe abdominal pain, diarrhea 10 to 12 times daily, and blood in stool.

Her CRP is 89, and calprotectin is over 1000. She has lost 28 pounds and looks skeletal. Her gastroenterologist wants to switch to Vedolizumab, but insurance is fighting the approval.

She is also dealing with perianal disease from Crohn's disease, which is incredibly painful and embarrassing, and she had to stop college and move back home because she cannot manage on her own. We are worried about her fertility because she wants to have kids someday.

Can Crohn's disease cause infertility in women?

Also, we are concerned about malnutrition because her albumin is 2.9. She needs something that works fast before her intestines get permanent damage.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

What you describe is a very severe and frightening phase of Crohn’s disease, and it is heartbreaking to see someone so young become this unwell and lose independence.

The high inflammatory markers, deep ulcerations, weight loss, low albumin, and perianal disease all point to very active, aggressive disease, so it makes sense that her doctors are pushing for a change in therapy quickly to prevent further bowel injury.

Loss of response to Infliximab due to antibody formation is unfortunately something that happens in some patients, and switching to another biologic, such as Vedolizumab or sometimes Ustekinumab, is a standard next step.

While insurance delays are incredibly frustrating, many gastroenterology teams can request urgent or compassionate approval given the severity, and in the meantime, they often focus on nutritional support, pain control, treatment of perianal disease, and sometimes short-term steroids or antibiotics to calm things while waiting for the new medication to work.

Vedolizumab can be very effective, but it can take time to reach full effect, so close monitoring is essential.

Regarding fertility, Crohn’s disease itself usually does not cause infertility in women when the disease is well controlled, and many women with Crohn’s go on to have healthy pregnancies.

Active inflammation, severe malnutrition, and certain surgeries can temporarily affect fertility, which is why getting the disease under control and improving her nutritional status are so important right now.

The low albumin and weight loss are signs that her body is under major stress, and nutrition support, sometimes with high-calorie supplements or even short-term enteral nutrition, can help her regain strength and support healing.

Perianal Crohn’s disease is especially painful and isolating, but it is treatable, often with a combination of biologics, antibiotics, and sometimes surgical input from colorectal specialists.

This is a devastating chapter, but it does not define her future, and with aggressive coordinated care, there is still real hope for remission, recovery of strength, and the possibility of returning to school and planning a family when her disease is stable.

I hope this helps.

Thank you.