⚠️ This post discusses fertility and family planning after IBD surgery. It’s a sensitive topic, but an important one — and being open and informed can make a big difference when facing surgery decisions.
When you’re preparing for surgery for ulcerative colitis or Crohn’s disease, it’s natural to think about more than just recovery. For many people, fertility is a big concern — especially if you don’t yet have children, or even if you’re not sure now but want to keep your options open for the future.
This was exactly the position I found myself in before my J-pouch surgery. Let’s talk honestly about what the research says, the risks involved, and the options available.
Fertility and Men After IBD Surgery
For men, surgery doesn’t usually affect sperm production. Fertility risk comes more from sexual function changes.
Some men may experience erectile dysfunction (impotence) after pelvic surgery. This can range from temporary difficulty to ongoing issues. In large studies, around 1 in 20 men report problems with sexual function after surgery.
This doesn’t mean fertility is gone — but it may mean getting support to address the physical side of intimacy is needed. The good news is that treatments, medications, and supports are available, often without prescription, though speaking to a healthcare professional is always recommended.
Fertility and Women After IBD Surgery
For women, the picture is a bit more complicated. Pelvic surgery, particularly open surgery, can create scarring around the fallopian tubes. This may make natural conception more difficult.
Studies suggest nearly half of women may experience some form of sexual dysfunction after J-pouch surgery, but importantly, many also report the same or improved function afterwards. When it comes to fertility, some women may face additional challenges, but many go on to have children either naturally or with medical support.
Close monitoring during pregnancy to ensure the health of mother and baby is important. Having a clear delivery plan documenting whether a natural delivery or planned C-Section can help. This will allow surgical teams from both a maternity point of view, and gastro point of view to be on standby, should they be needed.
Options to Consider
If you are concerned about fertility, there are steps you can take before and after surgery:
- Delay pouch formation – Some people choose to have an end ileostomy first, delay J-pouch formation, and pursue children before the pouch surgery.
- Egg or sperm freezing – Preserving fertility before surgery can leave choices open later.
- Surgical approach – Discuss laparoscopic (keyhole) surgery, which may reduce scarring compared to open surgery.
- Multidisciplinary planning – Surgeons, gastroenterologists, and gynecologists working together can create a tailored approach based on your priorities.
Thinking Ahead
One thing I’d encourage is to pause and think long-term. You may feel now that you don’t want children, but that feeling might change in five or ten years. Surgery decisions made today can affect future choices, so it’s worth at least considering the “what if” before you go under the knife.
My Personal Experience
From my own journey: I had my J-pouch surgery 15 years ago. Since then, I’ve gotten married and fathered three children. While the risks are real and shouldn’t be dismissed, positive outcomes and success stories are very possible too.
I’d recommend reading the blog artifice I write on intimacy and body image after surgery HERE as a supporting read to post.
It’s also worth remembering that doing nothing carries risks too. Living with uncontrolled inflammatory bowel disease can itself impact your health, quality of life, and even fertility. Surgery may bring risks, but so does delaying treatment when the disease is active. I took this view when contemplating surgery, even though I wasn’t in a relationship at the time. I didn’t want to have children and be too unwell to pick them up.
Want to dive deeper into what living with ulcerative colitis and J-Pouch really feels like?
My book Ulcerative Colitis: Generations Apart shares the journey across two generations — raw, honest, and full of hope.
Find out more HERE
FAQs on Fertility After IBD Surgery
Does J-pouch surgery make you infertile?
No. Fertility risks are real but not guaranteed. For men, fertility is usually maintained unless sexual function is affected. For women, scarring around the fallopian tubes can reduce chances of natural conception, but many women go on to have children naturally or with support.
Should I freeze eggs or sperm before surgery?
This can be a good option if fertility is a priority and you want to keep choices open. Discuss it with your healthcare team.
Is laparoscopic surgery better for fertility?
Research suggests laparoscopic (keyhole) surgery may reduce scarring compared to open surgery, which can be better for preserving fertility.
Can I still have children after J-pouch surgery?
Yes. Many people go on to have healthy children after J-pouch surgery — either naturally or with medical help.
If you would like to watch the video of me discussing fertility, along with intimate relationship, please watch the video below. There are various other videos covering similar IBD topics on my YouTube Chanel HERE