Development of a Patient-Centered Educational Resource on Fertility, Conception, Pregnancy, and Postpartum Outcomes After Surgery for Ulcerative Colitis  - Screening Form

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Study: Development of a Patient-Centered Educational Resource on Fertility, Conception, Pregnancy, and Postpartum Outcomes After Surgery for Ulcerative Colitis 
REB #2025-1588-3693 

Version Date: 15-Dec-2025

*1. What is your IBD Diagnosis  ?

Ulcerative Colitis 
Crohn’s Disease 
IBD-Unclassified

*2. What is your reproductive status  ?

Preconception (contemplating pregnancy or trying to conceive) 
Currently pregnant  
Have been pregnant in the past 
I am not contemplating pregnancy, and I have never been pregnant before

* 3. Have you ever undergone an IBD Surgery?

Yes I have undergone a colectomy surgery 
Yes, I have undergone a J pouch procedure surgery 
Not yet, but I am contemplating/ need to have surgery for my Ulcerative colitis in the future  
No, I have not and I am not contemplating a surgery in the future

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