Trying to conceive and being pregnant is an emotional period for those involved. There are many uncertainties that arise, especially among those patients receiving maintenance treatment for inﬂ ammatory bowel disease (IBD) or with a newly diagnosed IBD or ﬂ are that needs intervention during pregnancy. As many IBD patients are diagnosed between 20-40 years of age, their reproductive plan should be part of the treatment strategy. However, management of a pregnant IBD patient presents an even bigger challenge for health care providers. The current US Food and Drug Administration (FDA) (Boothby and Doering 2001) classiﬁ cations do not fully address the fact that the beneﬁ ts of treatment of some chronic conditions might outweigh the risk of foetal drug exposure. In this chapter, the effect of IBD drugs on fertility and pregnancy outcomes will be discussed. However, as large studies are lacking in most situations, risks, even if small, must be discussed with the patients, preferably during preconception clinics as advocated by the European Crohn’s and Colitis (ECCO) consensus on reproduction in patients with inﬂ ammatory bowel disease (van der Woude et al. 2010) in order to focus on delivering a new healthy life.