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Subfertility and Gastrointestinal Disease: ‘Unexplained’ Is Often Undiagnosed

Bradley, Ryan J.* and; Rosen, Mitchell P. MD

Obstetrical & Gynecological Survey: February 2004 - Volume 59 - Issue 2 - p 108-117
doi: 10.1097/01.OGX.0000109223.04391.9D
CME Program: Category 1 CME Review Articles 3, 4, 5, and 6: CME Review Article

Subfertility can be more reliably explained and effectively treated with an improved understanding of the contribution of chronic medical disease to reproductive dysfunction. This review addresses several common gastrointestinal disorders which are increasingly implicated in infertility and early pregnancy loss: celiac disease, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), and hemochromatosis. Appreciating the reproductive impact of these comorbidities and their treatments enables clinicians to accurately counsel patients and to modify medical and fertility treatments based on etiology. Because unexplained infertility can represent the initial presentation of undiagnosed medical disease, considering these often-subclinical gastrointestinal disorders in the differential diagnosis of subfertility provides an opportunity not only to increase the probability of conception and uncomplicated pregnancy, but also to improve overall maternal health.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to describe the impact of gastrointestinal disease on infertility and early pregnancy outcomes, and to outline the clinical presentations of celiac disease, ulcerative colitis, Crohn’s disease, and hemochromatosis.

*Medical Student, †Clinical Fellow, Department of Obstetrics, Gynecology & Reproductive Sciences

CHIEF EDITOR’S NOTE: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credit hours can be earned in 2004. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Reprint requests to: Mitchell P. Rosen, MD, Box 0556, HSE 1634, University of California, San Francisco, San Francisco, CA 94143-0556. E-mail:

The authors have disclosed no significant financial or other relationship with any commercial entity.

© 2004 Lippincott Williams & Wilkins, Inc.