Sphingosine-1-phosphate

Yes.

It's S1P for Mu cells.

Mm-hmm.

Sphingosine 1-phosphate.

OK, now there's some medications that once you stop them, they're so good at suppressing flares that once you stop it, it runs the risk of immediate relapse.

Those are like S1P modulators.

And for those, you should not abruptly discontinue that.

The thought is, hey, you can continue using this or bridge to something else, but keep using that medication, this S1P modulator regularly.

up until like 30 to 34 weeks, and then you can stop.

So it's not like everything has to be stopped straight off if you're considering pregnancy.

Some medications must be avoided in pregnancy.

For example, methotrexate, JAK inhibitors, and S1P modulators must be stopped three months before conception.

In other situations, the gastroenterology team will weigh up the risk of harm from relapse against any potential harms from the medication and will often opt to continue.

Preconception advice for men now, and there is little evidence about the effect of IBD on male fertility.

Active Crohn's disease and pelvic surgery may reduce fertility.

All women taking medication or with active disease should be referred to a specialist during pregnancy.

JAK inhibitors, S1P inhibitors, and methotrexate should be stopped three months prior to conception, but many other drugs in IBD are low risk.

Women using sulfasalazine or at risk of malabsorption need high-dose folic acid at a dose of five milligrams per day.