My husband has had colitis for about two years. He is taking prednisone and Asacol to control his colitis. We are considering trying for a child. I am wondering if these medicines could pose any difficulties.

L.M.

The inflammatory bowel diseases, which include Crohn's disease and ulcerative colitis, are chronic inflammatory conditions of the intestinal tract. In ulcerative colitis, the colon is affected and patients typically complain of bloody diarrhea, abdominal pain and weight loss. Therapy for inflammatory bowel diseases centers on several types of anti-inflammatory medications that are very effective in controlling the disease process. These include steroids (such as prednisone), mesalamine compounds (Sulfasalazine, Asacol, Pentasa) and newer immunosuppressive medications such as 6-MP and Remicaide.

Patients with inflammatory bowel disease are typically in their 20s or 30s when the condition is first diagnosed, so fertility is often an important issue in chronic management of the disease. Generally, fertility is a bigger concern when the patient is a woman. The active inflammation can impair fertility either directly by causing infrequent ovulation or indirectly by causing malnutrition. If the disease flares during pregnancy, it may cause a miscarriage. Interestingly, the various medications used to treat inflammatory bowel diseases are considered safe in pregnancy.

Chances for successful pregnancy are greater if the man is the affected partner. However, a lower sperm count sometimes results from malnutrition associated with poorly controlled disease. Thus, getting the disease into remission before attempting pregnancy is prudent. Also, low sperm counts have been seen with the use of Sulfasalazine. This medication is similar to Asacol in that they both contain the active ingredient mesalamine, but sulfasalazine -- the older of the two drugs -- also contains a sulfa compound (sulfapyridine), which accounts for this possible side effect. Low sperm counts have not been seen with Asacol therapy. Also, infertility is not a recognized side effect of prednisone therapy.