Women with inflammatory bowel disease (IBD) who are looking to become pregnant have similar—if not greater—success with assisted reproductive technologies (ART) when compared with their peers without IBD, according to results presented at the American College of Gastroenterology’s 2026 annual meeting.
Overall, 73% of women with IBD who underwent fertility treatments achieved clinical pregnancy, with a much higher rate among those treated with an embryo transfer (ET) with or without intrauterine insemination (IUI) than among those treated with IUI alone (85% vs 38%), reported Eugenia Shmidt, MD, co-director of the IBD program at the University of Minnesota in Minneapolis.
Of note, all women with a history of IBD-related pelvic surgery who were treated with ET became pregnant; the two treated with IUI alone did not achieve pregnancy.
“These findings suggest that clinicians should consider early referral to [in vitro fertilization] and embryo transfer rather than prolonged IUI trials in women with IBD, and particularly in those with prior pelvic surgery,” Shmidt said.
Previous studies have shown that women with IBD have reduced fertility compared with others, but “while overall ART effectiveness appears comparable between women with and without IBD and in vitro fertilization can bypass mechanical barriers from pelvic adhesions, significant knowledge gaps remain.”
To address some of those areas, Shmidt’s team turned to WIsDoM registry, which involved more than 30 North American sites and prospectively followed women ages 18 to 45 who had IBD and were planning to become pregnant in the next 15 months. Participants completed online questionnaires at baseline and then monthly thereafter.
The registry included 354 women who did not undergo any fertility treatment and 67 who received at least one fertility treatment. Women who did versus did not receive fertility treatment were slightly older (median age 34 vs 32 years), had a longer time attempting conception (median 11 vs 2 months), and were more likely to have a history of prior pelvic IBD surgery (16.4% vs 5.4%).
Embryo retrieval alone was not considered a pregnancy attempt, leaving 52 women and 148 total fertility treatment events for the analysis looking at pregnancy success. Nearly three-quarters of these women achieved clinical pregnancy, and of the 14 who were not successful, four later conceived naturally.
Shmidt noted that the rate of successful pregnancy observed in this cohort is higher than what has been seen in studies of the general population (45-50%). Women with IBD may derive a particular benefit from fertility treatments like ET because “the biggest driver of infertility in IBD is pelvic adhesions and tubal factor infertility,” she said, adding that her team plans to investigate that further.
In a treatment-level analysis, there were 97 pregnancy attempts, with 41% being successful. As in the patient-level analysis, that figure was higher after ET with or without IUI than after IUI alone (73% vs 10%). After multivariable adjustment, ET was associated with a much greater likelihood of pregnancy compared with IUI (odds ratio 44; 95% CI 9-221).
No other variables, including those related to IBD disease activity, IBD-related surgery, and duration of disease, were significantly related to pregnancy success, “suggesting that embryo transfer effectively overcomes disease- and surgery-related factors,” Shmidt said.
