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P460 Effect of fertility treatment on inflammatory bowel disease outcomes

M. Bejaoui*, C. Landman, J. Kirchgesner, A. Bourrier, I. Nion-Larmurier, H. Sokol, L. Beaugerie, J. Cosnes, P. Seksik

Saint Antoine Hospital, Gastroenterology & Nutrition, Paris, France

Background

Inflammatory bowel disease (IBD) has been shown to have a deleterious effect on women fertility. However, little is known about the effects of fertility treatment on IBD course in women of childbearing age. The aim of our study was to investigate the effect of fertility treatments on IBD outcomes.

Methods

From the MICISTA registry, a database from Saint-Antoine Hospital, we identified all the women with IBD who underwent ovarian stimulation or medically assisted procreation between 1996 and 2014 (Infertility Group). Women in which fertility treatment preceded IBD diagnosis and those lost to follow-up within 1 year were excluded. Specific data on fertility were collected through a questionnaire using phone call interviews. The control group was composed of women without fertility treatment and matched for sex, date of birth, calendar year of IBD diagnosis, and regularity of follow-up in a 3:1 ratio. Results were compared between these 2 groups and within the infertility group between 3 periods: the year of the fertility management and the previous and the following ones.

Results

In total, 35 cases were matched to 105 controls. There were no significant differences between the groups with respect to demographic data, family history of IBD, prior appendectomy, and smoker status. IBD clinical and therapeutic features such as duration of the disease, location and behaviour, perianal lesions in CD, extra-digestives symptoms, immunosuppressants intake, and surgery were also similar in both groups. Infertility was primary in 91.4 % of the cases. All women underwent hormone tests associated with either pelvic sonography, hysteroscopy, or exploratory laparoscopy. Ovarian dysfunction was involved in 20.0% of patients; uterine factor in 8.6%; and adnexal defect in 11.4%. Further, 7 women underwent exclusive ovarian stimulation, and 28 experienced in-vitro fertilisation (IVF) with a mean of 2.1 IVF attempts per patient (range 1–7). Live births rate was 40.0%. The proportion of IBD women with active disease in the year of infertility management was significantly higher in the ‘infertility’ group when compared with controls (71.4% vs 37.1% respectively, p = 0.001). However, there were no significant differences between the 2 groups regarding hospitalisation rate (17.1% vs 10.5%) and intestinal surgery (2.9% vs 2.9%) in the year of fertility treatment. In addition, there was no significant difference in IBD activity between the 2 groups when considering the year before and after fertility management.

Conclusion

Our work suggests that fertility management in IBD women is associated with worsening of digestive symptoms during the fertility management period. The effect of hormone stimulation on disease activity needs to be explored and risk of flare should be anticipated.