Gender differences in the male IBD patient - warning sexual references

Ileal pouch anal anastomosis may contribute to erectile dysfunction (ED) in a small percentage of men (3% in one study) but that, overall, any loss of function was significantly offset by the benefits of remission/reduction in symptoms.

Successful treatment of ED in this circumstance has been demonstrated in 79% of patients seeking treatment.

There is not enough data available for a similar analysis on other forms of IBD surgery like total colectomy with ileo-rectal anastomosis.

Depression:

Found to be associated with ED and was the most important predictor of poor sexual function in male IBD patients. Expert opinion recommends assessment for depression in the presence of poor sexual function.

Infertility:

Overall, surveys suggest that male IBD patients have somewhat lower fertility rates. It is unclear whether this is a result of direct disease activity or increased use of birth control by men.

Medications:

Sulfasalazine is known to cause oligospermia (low sperm count). Improvements in sperm counts, motility and morphology were seen when patients switched to mesalamine formulation. Effects of sulfasalazine are NOT dose dependent: in other words it doesn't matter how much you take. If they take it men are likely to have abnormalities in their sperm count/quality. This stops when patient switches to mesalamine or stops sulfasalazine.

Steroids: appear to have no effect but very little data is available

6-MP: same as for steroids

Methotrexate: Known to have teratogenic effects (birth defects not caused by genes)in women, animal studies suggest there will be significant effects on sperm but only one small study has attempted to examine this question. That study found no difference in sperm quality but did not follow pregnancies to check for teratogenic effects in children.

Expert recommendation for men is to stop Methotrexate at least 4 months prior to attempting conception.

Remicade: No expert recommendation to stop this or any other anti-TNF alpha meds prior to attempting conception. One study of 10 men did show reduction in sperm quality. But there is no data that suggests there has been any impact on rates of fertility. If there were dramatic effects we would know by now but since there is almost no data on this issue it's hard to say whether there are effects at a lower level.

Secondary causes of infertility: possible other causes include disease activity, smoking, alcohol use, and poor nutritional status. Zinc deficiency has been found in up to 70% of IBD patients and zinc is essential to sperm development so this may be a significant cause of infertility in male IBD patients.

Antibodies to sperm have been found in both male and female with IBD. So optimizing nutrional status and reducing disease activity along with use of alcohol and tobacco may be essential to all patients with IBD who wish to conceive.

Adverse Fetal Outcomes: For men with IBD who father children, there do not appear to be increased rates of adverse fetal outcomes such as low birth weight and pre-term deliveries. Sulfasalazine was the only medication which showed a signficant association with congenital malformations. (My input: There is scant data for many of the other medications in use at this time.)