Inflammatory bowel disease (IBD), consisting of ulcerative colitis and Crohn’s disease, primarily affects young people during their peak reproductive years. The impact of disease activity status and its treatment on fertility, pregnancy and delivery outcome as well as the clinical management strategies with pregnant women and IBD patients in their periconceptive period are therefore an important clinical interdisciplinary question. Overall, neither IBD nor the majority of drugs used in IBD affect the ability to conceive in humans. Treatment with sulphasalazine has been shown to reversibly decrease male fertility. The disease severity at time of conception and during pregnancy is associated with higher risk of adverse pregnancy-related outcomes and perinatal complications. The basic rule for IBD management is appropriate proactive treatment for maintenance of remission during gestation. Most drugs used in IBD are considered safe in pregnancy.