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In a prospective study of women with inflammatory bowel disease (IBD), 73% of embryo transfer attempts resulted in pregnancy, compared with 10% of intrauterine insemination attempts. The findings come from a small observational cohort and do not prove that embryo transfer itself caused the difference, but researchers said the results support considering earlier referral for IVF, especially after pelvic surgery.
A prospective study of women with inflammatory bowel disease (IBD) found that 73% of embryo transfer attempts resulted in pregnancy, compared with 10% of intrauterine insemination (IUI) attempts. The observational findings, presented by Eugenia Shmidt, MD, at the American College of Gastroenterology annual meeting, suggest fertility-treatment approach may matter for patients with IBD, but do not establish that embryo transfer caused the higher rate.
The analysis included 52 women who underwent fertility treatment involving IUI and/or embryo transfer. Across 97 treatment attempts, 41% resulted in pregnancy. The reported pregnancy rate was 10% per IUI attempt and 73% per embryo transfer attempt. The unadjusted odds ratio comparing embryo transfer with IUI was 24.0, with a 95% confidence interval of 8.0 to 70.0.
After adjustment for potential confounders, the odds of pregnancy with embryo transfer were nearly doubled relative to IUI, with an adjusted odds ratio of 44.0 (95% CI 8.9-221.0). The researchers reported that prior assisted reproductive technology use, disease activity, IBD-related surgery and disease duration were not significantly associated with attempt failure once treatment modality was accounted for. The wide confidence interval indicates substantial uncertainty around the size of the association.
The study drew on the Women with Inflammatory Bowel Disease and Motherhood (WIsDoM) cohort, which enrolled women ages 18 to 45 at 30 centers in the United States and Canada. Of 421 participants attempting pregnancy, 67 received some type of fertility treatment. That group included 13 women who had IUI only, 39 who had embryo transfer with or without IUI, and 15 who had egg retrieval only. Egg retrieval was not counted as a pregnancy attempt in this analysis; attempts were defined as IUI cycles or embryo transfers.
Why Embryo Transfer Stands Out
The results matter because IBD can affect fertility for some patients, particularly during active disease or after pelvic surgery involving rectal dissection. Adhesions or scarring may interfere with the fallopian tubes, while IVF followed by embryo transfer can bypass some mechanical barriers. The study’s results raise the possibility that the treatment route could be relevant when patients and clinicians discuss fertility care.
Shmidt said the findings suggest clinicians consider early referral to IVF and embryo transfer rather than extended IUI trials, particularly for women with prior pelvic surgery. That is a clinical interpretation of observational data, not a treatment rule established by a trial. Decisions about fertility treatment still depend on an individual’s medical history, preferences and fertility assessment.
The results also offer a data point for patients who may worry that IBD itself makes assisted reproductive technology ineffective. In this cohort, pregnancies occurred after treatment, and embryo transfer attempts had a high observed rate. But the study does not show that all women with IBD will have similar outcomes, or that the reported rates apply across clinics and patient groups.
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How the WIsDoM Study Tracked Treatment
The WIsDoM study followed women with IBD who planned to become pregnant within 15 months. Monthly surveys recorded attempts to conceive and pregnancy outcomes. Participants receiving fertility treatment were older than those not receiving it, with median ages of 34 and 32, respectively, and had typically been trying to conceive longer: a median of 11 months versus two.
Women receiving treatment were also more likely to have had previous fertility treatment, prior pelvic IBD surgery and active disease. These differences matter when interpreting the results because treatment groups were not randomly assigned. Among women who had embryo transfer, 32 of 39 went directly to it without IUI; seven moved from IUI to embryo transfer after an average of three IUI attempts. Repeat treatment was common, with 42% needing multiple attempts.
Shmidt said fertility may be reduced for some women with IBD, especially with active disease or after certain pelvic operations. She also noted that IVF can bypass mechanical barriers caused by pelvic adhesions. The study was designed to provide prospective information about how fertility treatment is used in real-world practice and which clinical factors may be linked to pregnancy success.
“Modality selection is paramount.”
— Eugenia Shmidt, MD, of the University of Minnesota, speaking at the American College of Gastroenterology meeting
Limits of the Pregnancy-Rate Comparison
The analysis was observational, and the number of treated participants and attempts was limited. Patients were not assigned at random to IUI or embryo transfer, so differences between those choosing or reaching each treatment may have affected the results. The adjusted estimate was imprecise, as reflected by its wide confidence interval, and cannot by itself establish a causal benefit.
The report said that embryo transfer rates in the general population range from 45% to 50%, compared with the higher rate observed in this cohort. However, the study did not provide a direct, matched comparison with people without IBD, and differences in patient selection or clinical practice could influence rates. The small subgroup with prior IBD-related pelvic surgery also limits conclusions: seven of nine women in that group who underwent embryo transfer conceived, while neither of the two who had IUI alone did.
It is not clear from the available report how the findings vary by age, specific IBD diagnosis, medication, fertility diagnosis or clinic. Nor does the analysis establish whether the observed difference would persist in a larger study or under different treatment protocols.
What Further Research Could Show
The findings were presented at the American College of Gastroenterology’s annual meeting; the supplied report does not describe a randomized trial or a change to clinical guidelines. Further research with larger numbers of participants could test whether treatment modality remains associated with pregnancy outcomes after accounting for patient selection, age, disease status, surgery and other fertility factors.
For now, the results may inform discussions between patients with IBD, gastroenterologists and fertility specialists. Shmidt’s recommendation was to consider referral to IVF and embryo transfer earlier, particularly after pelvic surgery, rather than assuming that IUI should always come first. The study does not specify an individual treatment plan, and care decisions remain dependent on each patient’s circumstances.
Key Questions
What pregnancy rates did the study report?
Across 97 fertility-treatment attempts, 41% resulted in pregnancy. The reported rate was 73% per embryo transfer attempt and 10% per IUI attempt. These are findings from a small observational cohort, not a prediction for any one patient.
Does the study prove embryo transfer is better for every woman with IBD?
No. The study was observational, treatment was not randomly assigned, and the number of participants was limited. The results show an association between embryo transfer and higher pregnancy rates in this cohort, but cannot prove the treatment caused the difference or applies to everyone.
Why might IVF and embryo transfer be considered after pelvic surgery?
Shmidt said pelvic surgery can be associated with adhesions or scarring that may affect the fallopian tubes. IVF and embryo transfer can bypass some mechanical barriers. The study’s small surgical subgroup is not large enough to establish a separate success rate for all patients with prior surgery.
Were egg retrievals counted as pregnancy attempts?
No. Although egg retrieval is part of the IVF pathway, this study defined a pregnancy attempt as an IUI cycle or an embryo transfer. Fifteen women underwent egg retrieval only.
What should patients take away from the findings?
The study supports discussing fertility options with clinicians familiar with both IBD and reproductive medicine. Its presenter suggested considering earlier IVF referral, especially after pelvic surgery, but the findings are not a universal treatment recommendation.
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