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IMPACT OF CROHN’S DISEASE AND REPEATED ABDOMINAL SURGERIES ON INFERTILITY: A CASE OF DIMINISHED OVARIAN RESERVE AND IVF FAILURE IN A 34-YEAR-OLD WOMAN
Rubela Ray
*1, Kristina Patel
2, Fnu Aakash
31Bankura Sammilani Medical College, Bankura, West Bengal, India; 2China Medical University, Shenyang, Liaoning, China; 3Florida State University, Tallahassee, FL
Abstract
A 34-year-old woman with Crohn’s disease and infertility, complicated by multiple abdominal surgeries and diminished ovarian reserve, is transitioning to donor oocyte IVF after five failed IVF cycles (AMH: 0.02 ng/mL). This case highlights the complex etiology of infertility in Crohn’s disease and emphasizes the importance of multidisciplinary, patient-centered care.
Introduction
Crohn’s disease, a chronic inflammatory condition, can significantly impact fertility through systemic inflammation, surgical complications, and medication effects. This report highlights the challenges of managing infertility in a woman with Crohn’s disease, extensive surgical history, and diminished ovarian reserve, exploring strategies to optimize reproductive outcomes.
Case Presentation
A 34-year-old woman with a 9-year history of Crohn’s disease presented with primary infertility after four years of trying to conceive. Diagnosed at 25, she experienced frequent flares requiring three major abdominal surgeries: small bowel resection, intestinal perforation repair, and adhesiolysis for obstruction.
She developed diminished ovarian reserve (AMH: 0.02 ng/mL, FSH: 16 mIU/mL) and irregular cycles after age 31. Transvaginal ultrasound showed <3 antral follicles per ovary. All five IVF attempts failed due to poor ovarian response and embryo quality. Mild intrauterine adhesions were corrected via hysteroscopy.
Her Crohn’s disease remains in remission on adalimumab and azathioprine. She experiences significant emotional distress due to infertility and chronic illness. She is transitioning to donor oocyte IVF with a multidisciplinary care plan.
Discussion
Infertility in Crohn’s disease arises from chronic inflammation, pelvic adhesions, and diminished ovarian reserve. Repeated surgeries exacerbate these issues, reducing fertility potential. In this case, IVF failures and a severely low AMH required transitioning to donor oocyte IVF.Hormonal therapy for uterine preparation must balance optimizing endometrial receptivity and avoiding Crohn’s exacerbation. Multidisciplinary care is crucial, integrating gastroenterology, reproductive endocrinology, and psychological support. Early fertility counseling and individualized care improve outcomes in such complex cases.
Conclusion
This case underscores the reproductive challenges faced by women with Crohn’s disease. Donor oocyte IVF provides a viable option for those with diminished ovarian reserve. Holistic, patient-centered care, including early fertility counseling and psychosocial support, is essential for achieving success.
Patient Consent
Patient consent was obtained for publication, with details anonymized to protect privacy.
References
Smith GD, et al. "Ovarian reserve and IVF outcomes in Crohn’s disease." Reproductive Medicine, 2020.
Abraham C, et al. "Multidisciplinary care in IBD." Clinical Gastroenterology, 2018.
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