Fertility Treatment in IBD: Insights From the WIsDoM Cohort

Nearly three-quarters of women with inflammatory bowel disease (IBD) who underwent intrauterine insemination (IUI) or embryo transfer (ET) achieved pregnancy, according to prospective data from the WIsDoM cohort presented at the American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting in Nashville, Tennessee. Success varied sharply by treatment modality.¹

Co-first authors Eugenia Shmidt, MD, of the University of Minnesota, and Zoë Gottlieb, MD, of the Icahn School of Medicine at Mount Sinai, discussed the findings in an interview with HCPLive.

Why IBD Fertility Data Have Been Limited

IBD frequently affects women during their reproductive years, and both active disease and prior pelvic surgery have been linked to reduced fertility.2 In a meta-analysis, ileal pouch-anal anastomosis in women with ulcerative colitis was associated with a roughly threefold increase in infertility risk, from 15% to 48%.³ The 2025 Global Consensus Statement on pregnancy in IBD suggests that assisted reproductive technology (ART) appears similarly effective in women with and without IBD, but prospective data have been scarce.^1,2

Gottlieb explained that most existing evidence comes from retrospective questionnaires subject to recall bias, or from large databases that miss nuances in individual care. WIsDoM was designed to follow women in real time through their attempts to conceive. The registry enrolls women aged 18 to 45 years who plan pregnancy within 15 months, at more than 30 US and Canadian sites, and collects monthly surveys that are adjudicated against medical records.¹

Who Used Fertility Treatment and How Often It Worked

In the dataset presented at ACG, of 421 participants, 67 underwent fertility treatment. Compared with women who did not, they were older (median age, 34 vs 32 years; P <.001) and had attempted conception longer (median, 11 vs 2 months; P <.001). They were also more likely to have had prior pelvic IBD surgery (16.4% vs 5.4%; P = .01). Active disease was numerically more common in the fertility treatment group (56.7% vs 43.5%; P = .06).¹

Among 52 women who attempted pregnancy with IUI, ET, or both, 38 (73%) conceived. Across 97 individual attempts, 73% of ET attempts resulted in pregnancy, compared with 10% of IUI attempts (adjusted OR, 44; 95% CI, 8.9-221; P <.001). Disease activity and prior IBD surgery were not significantly associated with success. All 7 women with prior pelvic surgery who underwent ET conceived, while neither of the 2 who tried IUI alone did.¹

Shmidt noted that this subgroup is too small for statistical conclusions. Even so, she said the results suggest women with prior pelvic surgery may benefit from going directly to ET rather than delaying with unsuccessful IUI cycles. Gottlieb said the gap between ET and IUI was considerably wider than in the general population. She added that cost and insurance barriers to ET deserve attention, because repeated failed IUI cycles take both a financial and an emotional toll.

Fertility Counseling and Referral Timing in IBD

Shmidt encouraged gastroenterologists to raise family planning early. She cited consensus guidance recommending referral to a fertility specialist after 6 months of attempted conception.² She said women older than 40 years should be referred after 3 months, and she suggested a similarly early referral after rectal dissection.

Voluntary childlessness has been reported in 18% of women with Crohn disease and 14% of those with ulcerative colitis, compared with 6.2% in the general population.⁴ Gottlieb said this is one reason counseling matters, and she noted that WIsDoM is still enrolling to broaden the diversity of its cohort.

Editors’ note: Shmidt reports relevant disclosures with Celgene and Takeda. Gottlieb reports no relevant disclosures.

References

1. Shmidt E, Gottlieb ZS, Evans M, et al. Assisted reproductive technology outcomes in women with inflammatory bowel disease: prospective data from the WIsDoM cohort. Presented at: American College of Gastroenterology 2026 Annual Scientific Meeting; October 9-14, 2026; Nashville, TN.

2. Mahadevan U, Seow CH, Barnes EL, et al. Global consensus statement on the management of pregnancy in inflammatory bowel disease. J Crohns Colitis. 2025;19(8). doi:10.1093/ecco-jcc/jjaf129

3. Waljee A, Waljee J, Morris AM, Higgins PDR. Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut. 2006;55(11):1575-1580. doi:10.1136/gut.2005.090316

4. Marri SR, Ahn C, Buchman AL. Voluntary childlessness is increased in women with inflammatory bowel disease. Inflamm Bowel Dis. 2007;13(5):591-599. doi:10.1002/ibd.20082